Why Healthy Teens Are Taking A Daily Anti-AIDS Pill | KERA News

Why Healthy Teens Are Taking A Daily Anti-AIDS Pill

Jul 21, 2016
Originally published on July 21, 2016 8:03 am

Every night at 8 p.m., 18-year-old Catherine Msimango takes a pill.

It's the same pill that people with HIV take to fight the virus. Only she doesn't have HIV.

Msimango says the pill gives her power against the virus. She can take it even without her boyfriend knowing.

"It's all about my safety because I don't know what he does when I'm not around," she says. "If he doesn't want to use protection [a condom], I know that I'm safe from the pill."

Msimango lives in the sprawling South African township of Soweto in the heart of the HIV epidemic. South Africa has nearly 7 million people living with HIV, more than any other country in the world. And nearly 1 in 5 adults is infected. HIV rates are lower for adolescents but increase rapidly as teens move into their 20s.

Some AIDS experts now believe that one way to keep rates down is with a daily pill.

The novel prevention technique has proven highly effective in blocking the transmission of HIV in gay men and sex workers. Now it's being tried among sexually active teens.

"I know the experience of HIV," says Msimango, who has lost several close relatives to AIDS. "I don't want to get there."

She says that's why she joined this pilot program last year to offer anti-retroviral drugs to teenagers in Soweto and Cape Town, South Africa.

Studies have shown that taking daily doses of the drugs offers an extremely high level of protection against HIV. If taken correctly and consistently, the pill is nearly 100 percent effective in blocking transmission of the virus. Researchers call the technique pre-exposure prophylaxis, or PrEP.

Those earlier studies were primarily with gay men. The study Msimango is in was launched last year with 150 sexually active teens between the ages of 15 and 19. Linda-Gail Bekker is the deputy director of the Desmond Tutu HIV Centre at the University of Cape Town and one of the lead investigators on this pilot study.

"I think having [a form of HIV prevention] that a young woman can use discreetly and is in her absolute control is something we've been missing throughout this epidemic," Bekker says.

"And I think now for the first time we are able to offer something to young women that is not required at the time of sexual coitus." Expecting teenagers to negotiate the use of condoms in the heat of sexual passion hasn't always been successful, she notes.

Bekker is optimistic about PrEP as a new HIV prevention method. She says it could be revolutionary if it's introduced on a large scale. The study wraps up next year; it's hard to say if the ministry of health will make PrEP available to teens after that.

She and her colleagues are monitoring the teens to make sure there are no ill effects from the drugs. These anti-retroviral drugs have improved dramatically over the past decade; they're far less toxic than they used to be. Doctors, however, continue to be concerned about possible kidney damage from long-term use of these drugs. So far they haven't seen problems.

Indeed, the safety of PrEP isn't the issue. That's now widely accepted. The main purpose of this pilot program is to see how well teens adhere to the daily treatment, says Bekker.

PrEP is about adding more tools to the HIV prevention toolbox, she says. And they're needed. The reality is, she says, prevention messages based primarily on trying to get people to use condoms haven't stopped the spread of HIV.

"Thirty years into this epidemic, it's clear that condoms are not the solution for everyone," she says.

Bekker calls the PrEP pills a "chemical condom."

Globally, new HIV infections continue at an alarmingly high rate. A new study from The Lancet says HIV infections worldwide peaked in 2005 at nearly 5 million and now are reported to have plateaued at 2.5 million a year.

Sabelo Sekhukhuni, one of the counselors helping to run the PrEP program in Soweto, says the pressure on teenage girls in impoverished parts of South Africa to have sex is huge.

"When you look at an informal settlement where there isn't electricity, sex is a sport. Sex is an activity to keep themselves busy," he says.

Sex also at times is used as currency. Girls who have no money can be offered cellphones or new clothes by older men who want to sleep with them.

Just behind the hospital where the PrEP study is being conducted, says Sekhukhuni, there's a settlement of shacks where the people don't have electricity.

"So there's this one guy who owns a tavern and he has a generator, and he makes people pay 5 rand to charge their cellphones," he says.

But he offers to charge girls' phones for free in exchange for sex. And some of the girls accept his offer.

In these types of relationships, the tavern owner holds a lot of power in the community. He's got the generator. The man may be HIV positive, and Sekhukhuni says he may refuse to use condoms.

"The same girls that sleep with this guy, they'll go back and sleep with their peers of their same age group," he says. "Meaning [HIV] is still going to spread some more."

But Sekhukhuni says this is the beauty of PrEP. In these complex, messy, real-world sexual networks, PrEP may be able to protect these teenagers from the lifelong burden of HIV.

Copyright 2018 NPR. To see more, visit http://www.npr.org/.

RENEE MONTAGNE, HOST:

And in South Africa, a technique used to block the transmission of HIV in gay men and sex workers is now being tried on sexually active teens. Healthy teens not infected with the virus are going on daily regimens of anti-AIDS drugs. NPR's Jason Beaubien reports from Johannesburg.

JASON BEAUBIEN, BYLINE: Eighteen-year-old Catherine Msimango lives in the sprawling township of Soweto on the western side of Johannesburg. She's in the 11th grade in high school. Her family, as she puts it, is not rich. Her father is self-employed. He fixes cars to make money. Msimango is afraid of HIV.

CATHERINE MSIMANGO: Some of my sisters have passed away from HIV - yeah, some of my brothers. So yeah, I know the experience of HIV. I don't want to get there, yeah.

BEAUBIEN: Having seen her siblings die from the disease, she wants to make sure she never gets it, so she's joined a pilot program in which HIV-negative teens like her take anti-retroviral drugs, just like someone who's HIV-positive would take.

MSIMANGO: Its a pack of pills - 30 pills inside. So you take one each and every day. You choose your time. I chose 8 p.m., so I take it every day at 8 p.m., yeah.

BEAUBIEN: Msimango lives in the heart of the HIV epidemic. South Africa has nearly 7 million people living with HIV, which is more than any other country in the world. And nearly 20 percent of all adults here are infected with the virus. The HIV rates are lower for adolescents, but increase rapidly as teens move into their 20s. Msimango says the pills give her power against HIV.

MSIMANGO: If they take the pill when my boyfriend doesn't know, it's all in my safety because I don't know what he does when I'm not around him. So, like, I'm doing it for my own safety. So if I take the pill and use protection - if he doesn't want us to use protection, then I know that I'm safe from the pill.

BEAUBIEN: Earlier studies have shown that taking daily doses of anti-retroviral drugs do offer an extremely high level of protection against HIV. If taken correctly and consistently, it's nearly 100 percent effective in blocking transmission of the virus. Researchers call the technique pre-exposure prophylaxis, or PrEP. Those earlier studies were primarily with gay men. Msimango is part of an ongoing pilot program in Soweto and Cape Town to see how well PrEP works with 150 teenagers.

LINDA-GAIL BEKKER: We did find that adolescents needed - well, certainly not all - but a number of them needed a little bit of hand-holding through that initial phase.

BEAUBIEN: Linda-Gail Bekker is the deputy director of the Desmond Tutu HIV Centre at the University of Cape Town. Bekker says they have counselors available at any time to answer the teens' questions or concerns about taking the drugs. They also set up a system of daily alerts, sent by text message, to remind the teenagers to take their pills. Bekker is extremely optimistic about PrEP as a new HIV prevention tool. And the reality is, she adds, prevention messages based primarily on trying to get people to use condoms haven't stopped the spread of HIV.

BEKKER: Thirty years into this epidemic, it's clear that condoms are not the solution for everyone.

BEAUBIEN: Globally, new HIV infections have essentially plateaued over the last five years. The number of additional people getting HIV is stuck at roughly 2 million each year. Bekker says PrEP is something a young woman can use discretely to try to keep herself from joining those statistics. Sabelo Sekhukhuni is one of the counselors helping to run the PrEP program in Soweto. He says the pressure on teenage girls in impoverished parts of South Africa to have sex is huge.

SABELO SEKHUKHUNI: When you look at an informal settlement where there isn't electricity, sex is a sport. Sex is an activity to keep themselves busy.

BEAUBIEN: And he says sex is also used as currency. Girls who have no money can be offered cell phones or new clothes by older men who want to sleep with them. Sekhukhuni says, even just behind the hospital where the PrEP study is being conducted, there's a settlement of shacks where the people don't have electricity.

SEKHUKHUNI: So there's this one guy who owns a tavern. He has a generator. And he makes people pay five rand to charge their cell phones, mobile phones.

BEAUBIEN: But the tavern owner offers to charge the girls' phones for free in exchange for sex, and some of the girls accept his offer. In these types of relationships, the tavern owner holds a lot of power in the community. He's got the generator. The man may be HIV-positive, and Sekhukhuni says he may insist the girls have sex with him without condoms.

SEKHUKHUNI: The same girls that sleep with this guy, they'll go back to their peers and sleep with the boys of the same age group, meaning it's still going to spread some more.

BEAUBIEN: But Sekhukhuni says this is the beauty of PrEP. In these complex, messy, real-world sexual networks, PrEP may be able to protect these teenagers from the lifelong burden of HIV. Jason Beaubien, NPR News, Johannesburg. Transcript provided by NPR, Copyright NPR.