How a drug that is taken before intercourse with a HIV patient helped one family

A decade ago, Missy* and her husband Seth* sat across from me at the clinic and asked me a question that was quite difficult to answer at the time.

They had met at a local polytechnic as students. Then, each of them was seeing other people.

But in the course of the three years they were studying together, they gravitated towards each other as their previous relationships fizzled out.

By the time they were graduating, Seth had introduced Missy to his parents and fast-tracked the traditional rites of marriage, claiming Missy as his wife. 

Soon after, they both moved to Nairobi. As they worked hard to find their footing, the gleeful mothers-in-law began to pester them for grandkids. But Missy was not feeling too good.

She was losing unexplained weight, had crazy night sweats and a weird swelling on the right side of her neck that seemed to be growing slowly but surely, though it was not painful.

She started covering it up with a neckerchief. One evening, she was feeling so exhausted at the end of the day that she requested Seth to come pick her up from work.

Seth was surprised that he hadn’t noticed just how badly his wife had deteriorated. Instead of going home, he took her to the nearby health centre where a team stabilised her and sent her to us at the referral hospital.

TB adenitis is the diagnosis we slapped her with! Missy was in shock at the speed at which things were going. She moved from discovering that tuberculosis, a disease she thought only affected the lungs, was eating up the lymph nodes in her neck.

She also learnt that she was HIV-positive. The roller-coaster she was riding was hurtling full-speed ahead, and she had no idea how to stop it.

She fell into the pits of despair, knowing she had to break the disheartening news of her status to her husband and prepare for the worst rejection of her life. Instead, Seth embraced his wife and took her home, where he nursed her back to health.

He made sure she ate well, took her medication and attended all her clinics on time. He fully provided for her even as she was laid off from work due to her prolonged ill-health.

He braced himself and went for the HIV test too, fully knowing that he also needed to start care as soon as possible. He was quite confused when he tested negative. He had been together with his wife for over two years, and here he was, not understanding how he wasn’t infected.

The two sailed through the south side of being a discordant couple by keeping their status to themselves, keeping their heads down, and following their doctors’ instructions to the letter. Condoms became a permanent fixture in their lives.

Missy finished her TB treatment as prescribed, regained her weight and went on to get another job. She also enrolled in a business diploma program, where she took evening classes.

By the time I met the two, they had been together for six years and were the model discordant couple. The only thing missing was the thing they craved most—a baby.  When they raised this conversation at their HIV care clinic, they were referred to our reproductive health unit for advice.

The couple had done their homework. They knew that the recommended approach to conception back then was through assisted reproductive technologies.

Missy and Seth would have to rely on artificial insemination to conceive safely without putting Seth at risk of contracting HIV. This was a cost they could not afford at the time. But their inability to afford the treatment did nothing to quench their thirst to be parents.

Seth timidly raised the option of attempting conception via the natural pathway while taking anti-retroviral drugs for the duration. He had read in a news clip that this was possible and was being tried elsewhere. With strict guidelines leaving no room for negotiations, this was way above my head, and off I went to seek the wise counsel of my teacher.

Let’s just say I walked out of the room dejected on behalf of Seth. There was no loophole. They would have to find the money for the procedure.

Seth was grateful for my assistance. He asked for my number and left. I didn’t expect to hear from him again, but Seth was a stubborn man. He weighed his options and decided to take his chances and swim across the crocodile-infested waters. 

After all, he reasoned that he regularly did the same before he learnt of the crocodiles and he had survived unscathed. You can imagine my surprise when Seth called me out of the blue a year later and told me they were at the outpatient unit, starting their antenatal journey.

Seth was way ahead of us. By the time he was bringing the matter up with me, Truvada, the Pre-Exposure Prophylaxis (PrEP) drug, had already shown remarkable success in preventing HIV acquisition for men who have sex with men and was being considered for other scopes of treatment. It just hadn’t been licensed formally.

Today, with regard to statistics, the significant winner in the use of PrEP is the woman with high-risk sexual encounters, most especially because women are less likely to have the power to negotiate for safer sex options.

However, PrEP continues to face difficulty in acceptance from the social perspective because it has been regarded as a key to opening the door to even more casual sexual behaviour, just because there is an option for avoiding HIV infection.

At a more personal level, PrEP is a prayer answered to a significant number of families where discordance exists. It opened the door for affordable and safe options for child-bearing. It levelled the playing field even further, ensuring that economic background was no longer a barrier to fulfilled families as they live positively. I am glad that science caught up with Seth!

Dr Bosire is an obstetrician/ gynaecologist