New Prevention Technologies (NPTs) also technically referred as biomedical tools for HIV prevention are advancements in the fight against AIDS. NPTs have yet to receive adequate traction in Africa, especially among young people. The potential for impact, results registered in trials so far and the benefits we stand to gain in our HIV Prevention efforts across the continent merits that we make deliberate efforts to educate young people in particular.
While HIV prevalence has gone down by 25% in Sub Saharan Africa, the risk for new infection is still high among young people. What has changed about this rhetoric on HIV vulnerabilities among young people, especially in Sub Saharan Africa? – The current demographic status in Africa.
Africa’s population has the most pronounced youth population than any region in the world; of the 1.2 billion people, more than 60% are young people below 35 years of age with lack of access to adequate information and services, and skills to make appropriate health choices. The need to enhance access to preventive measures against new infections is at the core of why young people must have access to new prevention technologies.
What are these biomedical tools for HIV prevention?
With new prevention technologies, we are looking at a variety of prevention tools that can significantly reduce the chance for infection; and with time can also include discussion of a viable vaccine and/or cure for AIDS. These include Microbicides, Pre-Exposure Prophylaxis, Post Exposure Prophylaxis etc.
Male and Female condoms have existed and have been a critical part of our prevention regime. They provide dual protection – both against unintended pregnancies and HIV infection. While access to condoms has increased significantly over time, there has not been corresponding usage. Challenges, especially among young people – of correct and consistent use; and the power to negotiate use for girls and women – continue to inhibit progress in prevention.
Microbicides continue to evolve, with a number of trials currently ongoing in different regions of the world. These prevention technologies are applied vaginally or rectally to prevent the sexual transmission of HIV. These come in the form of a gel, foam, cream or film. They can also be contained in a vaginal ring that releases the active ingredient gradually, or in a rectal enema or douche.
Pre and Post Exposure Prophylaxis – PrEP and PEP – are by and large marginally used as an approach to mitigate exposure to HIV infection. PrEP is an approach that has HIV negative persons taking antiretroviral drugs to reduce the risk of infection. PEP involves taking anti-HIV medications as soon as possible after possible exposure to HIV to try to reduce the chance of becoming HIV positive. The use of PEP is recommended in particular for victims of sexual assault or health care workers. These medications keep HIV from making copies of itself and spreading throughout the body.
Treatment as Prevention can also work on a large scale as a behavioural change driver. The premise here is that with large scale testing, people would know their status, those positive would get on treatment.
Most preventive vaccines to fight virus infections on the market today work by fooling the body into thinking it is infected. It triggers the body’s immune system to produce antibodies to recognize the virus as foreign and ‘remember’ the encounter, so that the immune system can more easily recognize and eliminate the live virus in the future, thereby preventing an infection. What is important to note is that vaccines are given to people who are not infected with HIV to prevent infection or slow disease progression, which is different from a cure, which is targeted at HIV positive people to stop them developing AIDS without treatment or possibly eliminating HIV from the body.
Why would they be important for young people?
Access to these technologies when finalised and available, with respective advances registered in Microbicide development; in the prevention offered by PrEP and PEP; and in ongoing Vaccine trials are critical for populations at risk, particularly young people. NPTs not only expand options for prevention, but for women and indeed young girls, provide for increased array of choices for HIV prevention – choices that are within their sphere of influence on use.
Microbicides in particular are already in different stages of trials and development. According to the WHO, there are 23 Microbicide products that are on various stages of trials in African countries including Botswana, Malawi, South Africa, Tanzania and Zimbabwe. They work in different ways; some provide a barrier that stops HIV and other pathogens. Others enhance natural vaginal defence mechanisms. Another group prevents the virus from replication after it enters the cell.
As other technologies are being developed (vaccine and cure), microbicides will compliment condoms in primary HIV prevention. What is important to emphasize is that microbicides are a potential preventive option that women can easily control and do not require the cooperation, consent or even knowledge of the partner.
Post Exposure Prophylaxis are also a very important prevention option that must be made available to young people. But regulation and practice continue to confound access for young people. In cases of sexual violence and rape, where possibilities of HIV infection are high, access to Post Exposure Prophylaxis must be ensured. Rape cases often go unreported due to discrimination young girls and women face. While efforts to address these inequalities continue, making sure that PEP is available (without discrimination of any kind) is critical in expanding options for prevention, especially for young people.
The push for access to information, education and services for young people needs to marry the need for access to new prevention technologies as well.
Finally, because introduction of these prevention technologies is largely a regulatory issue; governments must make provisions for their introduction. Governments must also honour their commitments to set aside 2% of the health budget towards Research and Development, which would facilitate for testing and rolling out of Microbicide and Vaccine trials.
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