EPISODE 9 - ARVs and Prevention

Antiretroviral (ARV) Treatment or ART can play a big role in preventing HIV infection, maybe bigger than we imagine. Rape survivors can take a combination of three drugs, Combivir (3TC and d4T) and AZT for 28 days to prevent HIV infection. Doctors and nurses have been doing the same thing if they accidently prick themselves with a needle that’s been used on a patient who is HIV positive. In both of these situations it’s been shown that ART is effective. Finding out your HIV status after a sexual assault may prove to be a traumatic experience, but it is essential that rape survivors do test so that counselling and treatment can begin as soon as possible. Based on evidence from mother to child transmission studies PEP could be up to 99% effective at preventing infection.

Busisiwe Nama and Bonisile Makeleni live near Queenstown. They are both HIV positive and both on ART. When Busisiwe fell pregnant “by mistake” as Bonisile says, Dr Nopasika Pinzi of Queenstown hospital explained to her she didn’t need to take anything additional to protect her baby from HIV. The three drugs she was already on – 3TC, d4T and Nevirapine, which are suppressing the virus in her body - would also help prevent her baby from infection. This is PMTCT or Prevention of Mother To Child Transmission. Less than 1% of babies are infected during birth when the mother is on a three drug combination of ARVs. Still, Busisiwe was worried because both she and Bonisele are HIV positive. She wondered how it was possible for them to have a negative baby whilst they were both positive? HIV is only in the seminal fluid of the man and vaginal fluid of the women – not in the sperm or the egg – so it is perfectly possible for positive partners to have a healthy negative child. In fact only 30 out of 100 births to women living with HIV will be positive, the other 70 will be negative – even without treatment. But a 30% risk is still very high, so mothers must make sure they are tested when pregnant and access ARVs to prevent infecting their babies. After the birth of her child Busisiwe was still nervous and postponed going to the clinic to have the child tested at six weeks when it is supposed to be done. Two weeks later she did it and her baby tested HIV negative. The ARVs that Busisiwe is taking also make it safe for her to breast feed her child- because the ARVs reduce the HIV in the breast-milk which otherwise might infect the baby.

Sister Pinky Mongwe at Sebokeng clinic provides post exposure prophylaxis (PEP) for rape survivors and people who have suffered accidental needle pricks. The course is 28 days of ARVs. The big difficulty is the rape survivor may already be HIV positive – in which case you should not take ARVs because they will not prevent HIV infection and could cause complications resulting in a resistance to the medication. It’s traumatic to have to test for HIV after surviving rape, but it is essential to know your status and whether you can take PEP. ART for HIV negative rape survivors is widely available at primary healthcare centers and a nurse can start a rape survivor on treatment. More controversially, you can use PEP in cases where a condom breaks when you are having sex with someone you know is HIV positive. At the moment our health system doesn’t allow for this, but it’s possible.

We know ART after exposure can stop HIV infection, but can taking just one pill a day before you play help prevent infection as well? This is known as PrEP or pre-exposure prophylaxis. That’s the question Dr Linda-Gail Bekker and her team at the Desmond Tutu AIDS Foundation are trying to answer. Zolani and Bongani of Woodstock in Cape Town are two young men on the trial. They are both taking a single pill every day for two years to see if they stay HIV negative. Bongani was recruited to the study while hanging out in Mzoli’s tavern. Zolani and Bongani are pleased that they tested negative and want to stay that way but alcohol and sex is a risky combination. They reckoned anything that can help them stay negative is good and enrolled on the study. Zolani says this study specifically targets high risk people like “men who have sex with men”. Everyone on the study is counselled that they must continue to use condoms every time they have sex – because we don’t know if this pill a day before you play works and even if it does make a difference it won’t be 100%. So condoms are a must together with the daily ARVs, because both the participants and the researchers don’t know who has the ARVs and who has the placebo. At the end of the trial they will be able to see if there was a lower rate of new infections amongst the participants getting the ARVs compared to another group who got nothing. Zolani explains: “you can’t sleep around without a condom because the study results are not even in and we don’t know if it works”.