Who’s to blame for misuse of HIV drugs in Kenya?

Reports of sex workers misusing HIV drugs have left activists wondering if the government invested enough in HIV education before purchasing medicine, worth 4 billion Kenyan shilling.

Reports of Kenyan sex workers misusing HIV prevention drugs have left HIV activists wondering if the government invested enough in HIV prevention and education before purchasing medicine, worth four billion Kenyan shillings.

The government’s intention was to distribute the pre-exposure prophylactic medication to sex workers and their clients to reduce new HIV infections. However there are fears that the intended precaution may cause more harm than good.

Pre-exposure prophylaxis is a special course of HIV antiretroviral treatment that aims to prevent people from becoming infected with HIV and is intended for people at-risk of exposure.

The pill is taken every day and contains two medicines (tenofovir and emtricitabine) that are used in combination with other HIV medicines. The government also provides post-exposure prophylaxis medication as an emergency measure to people who have been exposed to HIV. These drugs can cause severe side-effects and resistance to other HIV medication and must be prescribed by a doctor.

Stockpiling antitretrovirals

Some sex workers are reportedly taking more drugs than they need from different facilities and then selling them to colleagues who do not have the confidence to go and get them. In a story carried by the Daily Nation, the head of National Aids and STI Control Programme (Nascop), Dr Martin Sirengo, was quoted as decrying the alarming rise in the number of people misusing the drugs. “We cannot deny them the drug because it is available,” he was quoted as saying.

Many sex workers say clients prefer to have unprotected sex and will pay more money for it. This being a business, the women often choose to have unprotected sex, then rush to a public hospital for post-exposure prophylaxis medication, claiming they have been raped or had a burst condom. Some sex workers have also expressed uncertainties about the sustainability of the project, so they go to different hospitals and stockpile the medication, just in case it is no longer available in public hospitals.

*Joyce, a 22-year-old sex worker, said she had enough antiretrovirals in her house to last her several months. “I wouldn’t be worried if the government said that there was no more funding for the project, since I have enough medicine to keep me going,” she said, adding that antiretroviral shortages were common in Kenya.

She also said that some sex workers sell the drugs. “If, for example, a person is too shy to go to hospital for pre or post-exposure prophylaxis, I can supply them with it for a fee,” she said.

Education is vital

Dr Hellen Barsulai, a Mombasa-based sexual reproductive health researcher, said she regrets that medical experts shout loudest when antiretrovirals are misused, when it is their responsibility to ensure service providers give comprehensive education to people who use them.

“I wouldn’t blame the sex workers because they are acting out of complete ignorance,” said Dr Barsulai. She said the government may have invested a lot in HIV prevention and risk reduction education, but suspected poor implementation among the service providers. “I doubt anyone with proper information would abuse antiretrovirals,” she said, adding that the misuse of any medicine can be detrimental to human health.

Dr Barsulai called upon medical practitioners and service providers to take it upon themselves to educate clients on the dangers of misusing antiretrovirals. “Clients ought to be taught that if they have no virus in their bodies, they shouldn’t continuously take the medication,” she said. Dr Barsulai believes that a comprehensive prevention package would solve the problem of medicine abuse, not only to sex workers but to all other patients.

Stigmatising sex workers

She added that sex work is a means of earning a living, so denying sex workers or their clients the right to such vital information amounts to stigma. She pointed out that it is a pity that such stigmatizing words as ‘prostitutes’ are still rife on Kenyan media.

“Though sex work is illegal in Kenya, medical practitioners should embrace the health aspect and treat sex workers with the respect and dignity accorded to any other person,” Dr Barsulai said.

She also added that sex workers should be fully equipped with knowledge of how to negotiate for safe sex during their first visit for the pre-exposure prophylaxis drugs. This, she notes, will help them understand that pre and post-exposure prophylaxis drugs should only be used as directed by a physician.

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