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Keza (not real name), a 20-year-old sex worker in Nyagatare District, says that despite the risks and dangers linked to her profession, such as the possibility of contracting HIV, she feels she has no alternative means to provide for herself and her daughter.

She mentioned that the main challenge in her work is that many clients refuse to use protection. As a result, she has chosen to use pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP) medication to prevent HIV infection.

“Most men who come to me are not willing to use protection; however, I cannot afford to turn them away as I need the money to survive. I know the risks I am taking, but I have no other choice. I decided to use PrEP medicine as a form of protection. I make sure to get tested regularly. I hope that one day I will be able to find a more sustainable and safer way to earn a living.”

PrEP and PEP are medicines used to prevent HIV. PrEP, or pre-exposure prophylaxis, is medicine people at risk of HIV take to prevent getting HIV from sex or injection use.

PrEP can stop HIV from taking hold and spreading throughout your body.

PEP is the use of antiretroviral drugs after a single high-risk event to stop HIV seroconversion. PEP must be started as soon as possible to be effective—and always within 72 hours of a possible exposure.

Adolescent girls and young women (AGYW) like Keza are among the most affected populations and at risk of acquiring HIV.

The Rwanda Biomedical Centre (RBC) considers them as a high risk population, including female sex workers (FSWs), men who have sex with men (MSM), HIV serodiscordant couples (SDCs), sexual partners of index clients, and adolescent girls and young women (AGYW) facing significant risk of HIV infection.

The Rwanda Biomedical Center (RBC) has implemented targeted prevention campaigns and initiatives to provide education, testing, and support to these high-risk populations in an effort to reduce the spread of HIV.

In a 10-day campaign launched on May 8, RBC aims to increase awareness about HIV prevention, educational initiatives, the distribution of condoms, and the importance of access to pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) for high risk categories, reaching Rwamagana, Kayonza, Gatsibo, Nyagatare, and Kigali City, which have the highest HIV yield positivity rates.

According to RBC’s 2022–2023 HIV annual report, adolescent girls and young women currently on PrEP increased from 1,695 in January 2023 to 2,936 in June of the same year.

The figures highlight that AGYW registered outstanding turnouts in 2023, as well as the number of female sex workers and men who have sex with men receiving PrEP gradually increased from 10,078 in July 2022 to 10,789 in June 2023.

Dr Basile Ikuzo, Director of the HIV Prevention Unit at RBC, said improving services in health facilities for AGYW, Men who have sex with Men, and sex workers by empowering providers and implementers has been crucial in increasing access to PrEP and other HIV prevention methods.

He said: “Over 300 trained health facilities are offering PrEP to targeted groups in need.

With those exposed, for example, in times of accidents, we recommend they visit the nearest health facility and receive PEP medication within 72 hours to prevent new infections.”

Ikuzo reminds Rwandans that the use of PrEP is not the only way to prevent HIV, and encourages individuals also to use condoms consistently because PrEP doesn’t prevent unwanted pregnancies as well as other sexually transmitted diseases and get tested regularly for HIV.

He emphasised the importance of a comprehensive approach to HIV prevention, including education, testing, and treatment.

ALSO READ: RBC relies on youth centres, campaigns to curb HIV in Eastern Province

Improving services in health facilities for AGYW by empowering providers and implementers, and the national HIV programme designed as a comprehensive package of services specific to these groups—which includes other services like formal education, life skills, and TVET support—as well as economic strengthening support to build their economic resilience, have contributed to a more comprehensive and inclusive approach to HIV prevention and care for key populations.

To curb new HIV infections in Nyagatare, Juliet Murekatete, Nyagatare District Vice Mayor in charge of Social Affairs, said the district has put more emphasis on the most vulnerable groups among them, including sex workers, adolescents, and young women (AGYW) by working with partners to bring them together for a more sophisticated approach aimed at reducing new infections.

The district’s partners engage sex workers and adolescent girls and young women (AGYW) in discussions about preventing new infections. Also, some focal persons attend household sensitisation.

“Through this approach, we have registered several sex workers who have excluded themselves from the act, formed development cooperatives, and have embraced the importance of using PEP and PrEP medicine in their social networks if protection fails, which we believe will keep helping us to reduce the number of registered new infections.”

Countrywide, 330 out of 584 trained health facilities are offering PrEP, 2,936 AGYW have been enrolled and retained on PrEP for HIV prevention, 8,550 female sex workers and 2,239 MSM were on PrEP by the end of June 2023.

About PrEP and PEP medicines

PrEP stands for pre-exposure prophylaxis. It is for people who don’t already have HIV but are at risk of getting it.

PrEP is a medicine that can reduce this risk. It can either be a pill that one takes every day or an injection given every two months. With PrEP, if one gets exposed to HIV, the medicine can stop HIV from taking hold and spreading throughout the body.

PEP stands for post-exposure prophylaxis, PEP is for people who have possibly been exposed to HIV. It is only for emergencies. PEP must be started within 72 hours after a possible exposure to HIV, according to doctors.

PrEP does not protect against other STDs, so latex condoms should be used every time one has sex. One must have an HIV test every three months while taking PrEP and will have regular follow-up visits.

To start PEP, one must begin within 72 hours (three days) after possible exposure to HIV. One needs to take the PEP medicine every day for 28 days. PEP is only for emergencies and is not the right choice for people who may be exposed to HIV frequently.

Those in need are recommended to contact healthcare providers about whether PrEP (pre-exposure prophylaxis) or PEP would be right for them before a prescription.

Emmanuel Nkangura, The New Times
Populations & Programmes
PEP, antiretroviral therapy, antiretroviral-based prevention, pre-exposure prophylaxis, PrEP, post-exposure prophylaxis, PEP, co-trimoxazole prophylaxis