PrEPs uptake, contraceptives scaled down HIV infection in Migori
Mr Samson Odhiambo and his wife Jackline Akinyi Odhiambo at their home in Udonga village, Siaya County.
Mildred Atieno and her neighbour Josephine* bask in the sun outside their two-room house in Oruba estate, about one kilometre from Migori town
The two are engrossed in a deep conversation on oral pre-exposure prophylaxis drugs that are helping them avoid HIV infection when the Nation catches up with them.
As commercial sex workers, they have been on contraceptives for the past five years and freely share their experiences on the use of PrEP, a drug taken to lower the risk of HIV infection among high-risk individuals.
In 2015, the World Health Organization recommended that people at high risk of HIV infection, like the two, get the drug.
Both Mildred and Josephine were in the same secondary school but could not continue their education after Form Four because their parents did not have money.
As fate would have it, they both got entangled in the murky world of sex work to make ends meet.
“Initially, I did not know about the uptake of PrEP and only survived on female condoms whenever I went out with a client. I also ensured that my client was protected,” recounts Mildred, who has plied the trade since 2018.
The decision to take PrEP, she said, came when she accidentally engaged in unprotected sex with a client who promised to pay her more than what she usually charges.
“He promised to pay me Sh15,000 and insisted that he never wanted to use any form of protection. I was a little bit hesitant but gave in owing to the huge figure,” she said.
Fearing an imminent infection, she decided to try PrEP and to her surprise, the results were encouraging.
“I went for a test and I was negative. That’s how I chose to stick to the drug and I have never defaulted,” she said.
For Josephine, despite the nature of her job, the decision to use PrEP started when she noticed that her husband, who works at a gold mine in Siaya, was sleeping with other women.
“Despite sleeping with many sexual partners, he refused to undergo an HIV test and coupled with the nature of my work, I took an early precaution,” recalled the mother of two.
“A community mobiliser came here and tested us for HIV. I was shocked when I learnt I was negative. I called my neighbour and fortunately she also tested negative. It was a miracle to me because my husband and I are both sexually active with other partners,” she noted.
The women continue to use PrEPs alongside other preventive measures.
Ms Diana Rose, a director at the Faraja Women Initiative, a community-based group that deals with sex workers in the county, noted that the PrEPs uptake among the key population had shot up by a huge margin from previous years.
“We are sensitising them on the benefits of taking the drugs and the results have been positive. A majority have adhered to PrEPs, which I find laudable,” she said.
But Ms Rose raised concerns about stigma caused by the packaging of the product, which she said deterred some women from getting the product.
"We had more clients at the beginning of the project. The number has, however, gone down due to fear, because PrEPs are packaged in bottles resembling ARVs. It takes a lot of counselling to make them accept it,” she said.
"As they use PrEP and other ways of preventing HIV infection, their time off PrEP reduces despite short use durations."
She noted that unlike the antiretrovirals, which are taken daily, one takes PrEP when they need it.
"When clients are not engaging in risky sexual behaviour, they do not need to take the pill. We also encourage dual protection such as use of condoms to avoid STIs and unintended pregnancies " she said.
She noted that her group had mapped hotspot areas, such as bars and lodgings, salons, massage parlours and chang’aa dens.
“We do our hotspot listing owing to the clientele of the sex workers who may be at risk and take necessary protective measures. This has further led to a sharp decline in STI and other venereal infections,” she said.
Migori County Aids and STIs coordinator Daniel Oneya said the county has recorded a decline in infection among sex workers over the past five years due to increased access to PrEPs.
More facilities giving PrePs
The number of health facilities offering PrEP has also risen from 46 when the programme was rolled out in 2017 to the current 108.
"The county health department is counting on PrEP to reduce the number of HIV infections, which will eventually bring down the overall statistics of infected persons nationally," she said.
The National Aids Control Council (NACC) estimates that 13.3 per cent of the population in Migori is HIV-positive.
But NACC data indicates that the county has stepped up its efforts to address infections and, as a result, has registered a 32 percent drop in the total number of new infections over the past two years.
The county has for a long time conducted public health interventions such as pushing the use of condoms and antiretrovirals and abstinence for those already infected.
In 2017, Migori was among nine devolved units, including Kisii and Kisumu, that rolled out the use of PrEPs in partnership with Jhpiego under the Jilinde research programme in efforts to widen protection from HIV/Aids.
A study in 2016 revealed that PrEP prevented infections among women who were at high risk of infection in Kenya, South Africa and Tanzania.
The project sought to reduce HIV infections among adolescent girls and young women (AGYW) and to help develop and document an acceptable approach to launching and scaling up the use of pills.
In Migori, the drugs were made available in safe places for AGYW, female sex workers and gay men during outreach to hotspots.
By the end of the five-year project, Migori had recorded 86 per cent PrEP awareness, with gay men leading at 98.8 per cent while female sex workers followed closely at 94.4 per cent.
"We rolled out community outreach programmes on the use of the drug, leading to its acceptance and use. The uptake of PrEP has been positive, especially for those who know they are at a high risk,” Mr Oneya said.
“The drugs have been offered in all 55 public health facilities in the county and other drop-off points by our strategic partners.”
Illustrating the effectiveness of PrEP among sex workers, he said the positivity rate stood at 6.3 per cent in 2018 but after intake, it dropped to 2.1 per cent in December 2020.
Mr Oneya said the main challenge is often the high dropout rate of enrollees.
He attributed this to the stigma associated with PrEP, which is likened to antiretroviral drugs given to people who are already HIV-positive.
“We realised taking PrEP and ARVs in the same area saw most potential clients skip them because of stigma. We moved over to mobile places and used community mobilisers to provide drugs to increase the uptake,” he said.
