How ‘medicines first’ US HIV policy is changing sex in Kenya


By Gatonye Gathura

The World Aids Day observed on Friday is also about the fifth year since the US adopted a ‘medicines first’ HIV policy for Kenya and other donor recipient countries.

Called Dollars to Results the policy has led to what doctors are calling the over medicalization of sex through HIV.

The policy overseen by USaid since 2013 had prioritized HIV funding into core, near core and none core in that order.

Through this model, pharmaceutical commodities represent the top priority followed by treatment in which category falls health workers and medical infrastructure.

At the bottom are behavior change HIV prevention activities which were then anchored on abstention and faithfulness.

The policy has partly been instrumental in doubling the number of Kenyans on antiretrovirals to more than one million in the last five years.

According to the American NGO called AVAC today about 9,000 Kenyans are on the daily HIV prevention pill initiative called Pre-Exposure Prophylaxis or PrEP.

The US President’s Emergency Plan for AIDS Relief (PEPFAR) plans to bring another 5,000 Kenyans into the programme next year.

By 2022, the Ministry of Health targets at having 500,000 Kenyans on PrEP at a cost of Sh 32 billion.

The US driven PrEP was launched in May by the Ministry of Health alongside a home HIV testing kit.

“Our work has never been as complicated as it is now,” says Ms Karen, 43, a sex workers and a peer educator with the Sex Workers Outreach Programme (SWOP) in Nairobi.

SWOP is a project of the National Aids and STI Control Programme  (NASCOP) and the University of Manitoba Canada attending to more than 27,000 male and female prostitutes in Nairobi.

“Unlike in the past where a condom was the much you need to report to work, today you prepare as you are going for war,” Karen told this writer at her operational base, a bar along Luthuli Avenue in Nairobi.

Karen explains that despite many regrettable but necessary on the job risks, she is HIV free but on PrEP to be on the safe side.

Every day she has to swallow a pill for protection against HIV infection. “Most times you do not know where this job will take you next or when you will go back home,” says Karen.

Consequently she has to carry her stock of PrEP. “We are strongly counseled that together with PrEP to also use condoms.”

“This is my pack for the weekend,” she discreetly shows a pack of about 50 freely supplied condoms.

Accompanying these are about a dozen GoK-Not-For-Sale Sure Lube lubricants manufactured in France by Sasmar.

“We encourage clients to use lubricates to reduce the risk of condom burst,” explains the mother of six most who are grownups.

She digs deeper into her arsenal and this time she comes out with several project issue HIV test kits.

Through an experimentation project a sex worker is given about five HIV test kits to offer to willing clients before they engage in sex.

In Kenya the project was first tried in Kisumu with researchers reporting good uptake by clients of the sex workers.

In his report published last year lead investigator Prof Harsha Thirumurthy of University of North Carolina, US said despite a few cases of violence against the women, almost all the prostitutes managed to distribute a kit to their steady sexual partners.

Karen who also has with her some family planning pills has a steady boyfriend who is HIV positive and on antiretroviral. “You meet us at his place you think it is a commercial pharmacy,” says Karen.

“This is what medicalization of HIV has done to the simple natural act of human sex,” explains Prof Alain Giami of the French National Institute of Health and Medical Research.

In a recent paper on the medicalization of sex through HIV Prof Giami says what is been seen now is the replacement of behavior modification with medicalization of sex especially in developing countries.

“Chemoprevention and treatment, as well as the surgical technique of male circumcision are replacing the sensible act of responsible sex,” says Prof Giami in his study published in the Journal for Sex Research.

“We are very worried about the persisting high rates of new HIV infections, despite our big spend in treatment and medicines,” says Dr Nduku Kilonzo, head of the National Aids Control Council.

At a recent Lancet Commission event in Nairobi, Dr Kilonzo said they are aware of the possible benefits on promoting responsible sex behaviour. “We have now skewed our budget to reflect our thinking.”

An earlier study led by Dr Sara Gitome, of Kenya Medical Research Institute defends the medicalization of HIV in Kenya for what they say are extensive benefits.

However they oppose the casual medicalization of sex such as the current crave for sex performance and organ enlargement drugs and devices

Next week from Monday (4th – 9th) the Aids community is congregating in Abidjan, Ivory Coast for the 19th International Conference on Aids and STIs in Africa (ICASA).

Among the main discussion in this conference is how to make science deliver better and easier medicines for HIV control.

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