Scaling access to innovations for HIV prevention

When the global HIV epidemic began more than 40 years ago, HIV was a terminal illness. It’s now a preventable and chronic disease for people who are able to access treatment. However, access to prevention and treatment services is not equitable, and new innovations are not always reaching people in need.

It has been more than a decade since the first evidence of the efficacy of daily oral pre-exposure prophylaxis (PrEP) was published. PrEP is a daily pill you can take that helps prevent HIV. In 2021, more than 1.6 million people worldwide were receiving oral pre- exposure prophylaxis (PrEP), which remains well short of the 2025 target of 10 million people.

Partnerships for increasing access to PrEP

Until recently, PrEP was concentrated in high-income countries. The last two years have seen a pronounced uptake of PrEP in eastern and southern Africa.

“I first heard about pre-exposure prophylaxis (PrEP) in 2018 when I started coming here to the Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) for treatment. The clinic treats sex workers. The aunties, our nurses who work here would tell us about why PrEP, and why it is good. That’s how I knew about it,” says Nashly, 26, from Mutare, Zimbabwe.

Nashly shares her story of being raped on her way home from work in 2020 resulting in pregnancy. She underwent a psychological trauma with the possible thought of the baby and herself contracting AIDS. “I saw the goodness of PrEP when I gave birth. My baby doesn’t have HIV and I did not contract it either,” she says.

“The services we get at CeSHHAAR are important to us. If these services are no longer available, we would suffer and we would all fall sick.”

UNDP is supporting countries to increase access to PrEP for the most vulnerable communities, as part of its larger efforts to improve and expand coverage of HIV prevention for key populations (gay men and other men having sex with men, sex workers, transgender people, people who use drugs and prisoners) and their sexual partners who now account for 70 percent of new HIV infections worldwide.

In 2021, in Zimbabwe, UNDP in partnership with the Global Fund, the Ministry of Health and NGOs reached 3,300 female sex workers with PrEP. This was done through a combination of fixed sites providing prevention services, and outreach conducted by NGO partners such as the Centre for Sexual Health and HIV/AIDS Research Zimbabwe (CeSHHAR).

In Pakistan, UNDP with support from the Global Fund and in partnership with local community-based organizations, the Government, UNAIDS and WHO launched a new PrEP initiative in June 2022. The initiative is also working closely with key population communities to provide PrEP through networks of peer outreach workers and drop-in centres. In addition, government health care workers stationed at existing antiretroviral (ART) treatment centres are being trained on delivering safe and effective PrEP services.

“When I found out about PrEP, I wanted to use it myself,” shares Kiran Danesh from the Gender Interactive Alliance, Karachi, Pakistan. “When I asked my doctor to give me PrEP, he warned me that this is not a good thing, and I should not use it. I later realized that the doctor was wrong and that he probably did not have the correct information.”

“I would like to use PrEP myself,” says Mobin Ahmed from the Saathi Foundation, Faisalabad. “I am working as a leader in my community and I want to set an example for the people in the community that this is a very beneficial medicine. I will use it as soon as it becomes available.”

Using digital platforms to scale up PrEP

Digital solutions can play an important role in increasing access to services for vulnerable and marginalized populations, as well as increase retention. In Colombia, the prep-Colombia.org platform is used for initial screening, setting up medical appointments, keeping records of follow-up appointments and sharing the results of laboratory tests. It also allows doctors to generate different metrics such as level of acceptance, initial continuation, prevalence of toxicity and HIV status. All this is combined with training on combination prevention strategies reaching more than 20,300 people. This innovative approach has made it possible to guarantee the continuous provision of services, obtain good adherence to treatment, and support individuals despite the challenges posed by the COVID-19 pandemic.

“Thanks to the prep-Colombia, today I know how to take care of myself and how to take care of the people I love and those around me. Staying negative fills me with peace of mind and makes me want to live life, obviously responsibly”, says Joan Alfaro, 22, Colombian social leader.

The need to scale up

With the potential for PrEP and other innovative tools such as long-acting ARVs for PrEP and vaginal ring for women to transform HIV prevention, we simply cannot afford to repeat the mistakes from the past.

Only by addressing inequalities and increasing the capacity of people living with HIV, key populations and other excluded groups to access HIV and health services can we regain lost ground on HIV.

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