Of course Africa is ready for PrEP!
From the Incidence 0 Archives
📢 First published: 12-APR-2011
☑️ Reviewed: 07-SEP-2024
Stella Nyanzi
(Following in the streps of Bisi Alimi)
Whether or not Africa is ready for PrEP interests me because of several underlying assumptions in some of the answers about how we define Africa.
Africa's MSM, Africa's people who engage in anal sex and Africa's public health prevention campaigns have been desperately in need of new HIV prevention options for a very long time. Issues of affordability can be strategically handled through diverse modalities. However, there is no doubt in my mind that access and availability remains burning questions at the heart of providing interventions to those who need it. Because there are many people in Africa who need HIV prevention, I say "Africa is ready for PrEP!"
It is important to recognise that there are many faces to Africa. There is the Africa which is poor, under-resourced, without cash reserves and unable to meet the costs of its survival. That's the Africa in need of greatly subsidised if not entirely free interventions - be it lubes, gels, condoms or even PrEP.
But there are also many African MSM who can afford PrEP. There are many MSM communities that can innovatively strategise through their local and international networks to find the resources to meet the costs of the drugs used for PrEP. There are many ways in which activism and negotiation with the powerful public organisations and actors can win unanticipated victories for providing access to PrEP to MSM who need it.
I have witnessed how innovative local LGBTI support groups and networks can be to access essential sexual health commodities in Kampala. I have observed “wealthier” MSM dispatching materials such as condoms, lubes and education pamphlets to those who cannot afford them or don't have access to HIV prevention information. I have attended lobbying campaigns where small but significant successes were made to put MSM health onto the health and human rights agendas, particularly through arguing that it contribute to the fight against HIV/AIDS.
At the risk of sounding like a neoliberal capitalist who is blind to the needs of the less financially empowered in Africa, I think that current market trends in Kampala indicate that putting a product on the market, where there is both demand and need, results into the product being bought and used. And again, there is a need for PrEP in Africa.
The bigger question for me is, “Are the manufacturers of the ARVs used for PrEP (whether they are generics or the patented version) ready to meet the terms of the African clientele?” What are the possibility and the margins for negotiating the price of PrEP drugs? We could always argue that there is a sizeable market for PrEP in Africa because of relatively higher prevalence and incidence rates of HIV among those who engage in anal sex (whether MSM, MSW, WSM …). Therefore there is economic sense in reducing the price of drugs in order to capture the African market. If the current price of drugs cannot be negotiated, is it possible to find innovative ways to ensure that Africa can meet the cost of providing PrEP to those who need it? Philanthropists, funding organisations, multi-lateral organisations, and the giants like the Global Fund for AIDS, Malaria and Tuberculosis can be engaged to consider making PrEP available to those who need it but cannot afford it.
Many of our public health systems in Africa are inadequately providing the essential services needed by the Poor in our communities and there are gaps in public health provisioning of mosquito nets, condoms, ARVs and many other essential health saving drugs and interventions. However this is no ground or rationale for claiming that Africa is not ready for another critically essential HIV prevention product.
It is important that we conduct meaningful acceptability trials of rectal microbicides and oral PrEP that have already shown sign of success in previous clinical trials, so that a wide range of people in Africa who practice anal sex can try and test them out. The feedback from these acceptability trials should be the basis upon which decisions about what form(s) of PrEP Africa is ready for are made.
At the micro level of individuals, people, lovers, sex partners, bodies who desire and consummate our passions anally, Africa is ready for PrEP. The macro issues of cost and affordability, acceptability, supply chains, rolling out and scaling up of PrEP interventions, can all be negotiated and strategically resolved.
Africa was ready for PrEP the day that Africa got HIV and AIDS. No question about it.
The World Trade Organisation's patent rules, known as Trade-Related Aspect of Intellectual Property Rights (TRIPS), recognise the right of countries to protect public health. They were introduced "in an attempt to narrow the gaps in the way [intellectual property] rights are protected around the world, and to bring them under common international rules". The 2001 Doha declaration allowed flexibility in the application of TRIPS to ensure that medicines are available and affordable and that generic drugs can be produced and drugs imported at a lower cost than brand versions. Thailand and Brazil have both shown the way on how to use TRIPS to save life. Recently, the World Health Organization, the UN Development Programme, and UNAIDS agencies have encouraged the use of TRIPS to lower the cost of medicines
- Stella Nyanzi is a Ugandan human rights advocate, poet, medical anthropologist, and scholar specializing in sexuality, family planning, and public health. Known for her outspoken feminism and support for queer rights. She was arrested in 2017 for criticizing the Ugandan president. In January 2022, she relocated to Germany with her three children, as part of PEN Germany's writers-in-exile program.
- A number of African country rolled out PrEP long before it was available in higher income country, demonstrating that when there is political will it is possible to implement state of the art prevention.
- In February 2024 Zambia became the first African country to roll out long-acting, injectable HIV prevention drug
- According to an AVAC report, as of September 2023, the world surpassed 5.6 million cumulative PrEP initiations. Early-adopting African countries continue to lead in rapid PrEP uptake. South Africa has surpassed 1 million cumulative initiations, while Nigeria, Uganda, and Zambia have each exceeded 500,000. Kenya has reached over 400,000 initiations, and Zimbabwe has crossed the 200,000 mark. Malawi and Brazil saw increases of around 20,000 initiations this quarter, while Lesotho had a more modest rise of 10,000. Many other countries continue to expand their programs. Notably, El Salvador, Honduras, and South Sudan each surpassed 1,000 cumulative initiations. Cyprus and Malta recorded their first oral PrEP initiations, with 29 and 579, respectively.
- Africa has clearly demonstrated its readiness for PrEP, surpassing even some high-income countries in roll out and uptake. Remarkably, many African nations were better prepared than the countries where the original PrEP trials took place. This highlights a critical issue: the need to ensure that products are made accessible to the people and countries that contributed to their development.
- Will Lenacapavir, a 6-monthly injectable make it to Africa? And at what cost? Th efuture will tell but some advocacy will be needed.
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