Uganda Rejects HIV Prevention Tool On Moral Grounds

Kampala — Activists in Uganda, where some 400 people are infected with HIV every day, have called on the government to rethink its dismissal of an emerging prevention protocol demonstrated to be effective in a trial conducted partly in Uganda, and which has been approved by the US Food and Drug Administration.
The protocol in question is a form of pre-exposure prophylaxis (PrEP) involving a daily dose of two antiretroviral drugs - marketed as Truvada - taken by an uninfected person who is in a sexual relationship with an HIV-positive partner.
According to PrEPWatch, a website run by AVAC (Global Advocacy for HIV Prevention), Truvada "has been proven effective at reducing the risk of HIV via sexual exposure in heterosexual men and women, gay men and other men who have sex with men, and transgender women". One study among serodiscordant couples in Kenya and Uganda, found Truvada reduced HIV transmission by 73 percent, when compared against a placebo.
The World Health Organization guidelines issued in 2012 called for a cautious and gradual rollout.
Uganda has no such plans, according to Alex Ario, programme manager in the Ministry of Health's AIDS Control Programme, who said public misunderstanding of the protocol could encourage "reckless sex".
"In our discussions, the technical committee has not recommended the use of PrEP among HIV-negative people. It's morally unfit, not right and incorrect to put people who are HIV-negative on treatment, when we have not been able to enrol those who are HIV-positive on it," he told told IRIN.
"People will engage in reckless sex behaviour and rush to health facilities, saying 'I had sex but the condom burst'," he added. "It will be naïve for the ministry to adopt such guidelines and policy."
Ario said Uganda would continue to focus on its long-standing ABC - Abstinence, Be faithful, and Correct and Consistent Condom use - as the foundation of its HIV prevention strategy.
Experts say, however, that there is no evidence from PrEP trials to date to indicate that its use increases risky sexual behaviour.
"In fact, risk behaviours went down, not up," said AVAC Executive Director Mitchell Warren. "These were clinical trials, of course, and we don't know what might happen outside of trials, so it is an important consideration in designing PrEP programmes that might translate clinical trial efficacy into public health impact."
Ugandan activists have called on the government to rethink its decision, especially in light of the fact that the country's HIV prevalence has risen from 6.4 percent to 7.3 percent over the past five years.
Missed opportunity?
"It would be a great missed opportunity if PreP is one of the prevention tools that the country fails to adopts," Milly Katana, a long-time HIV activist and one of the inaugural board members of the Global Fund to Fight HIV, Tuberculosis and Malaria, told IRIN.
"With the rate of new infections in Uganda, a reasonable prevention programme must be hungry - indeed very hungry - to add to its arsenal of tools any of the scientifically proven technologies ... This is more so for settings like Uganda, where ... there is a very high presence of discordance among couples."
The Uganda AIDS Commission describes HIV discordance as one of the risk factors responsible for HIV transmission, along with, among others, multiple partners, inconsistent condom use and infection with sexually transmitted infections.


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