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
"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
"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.