Preparing for PrEP: a new weapon in the fight against HIV

Vu, 24, grew up in the countryside outside Ho Chi Minh City. Rural southern Viet Nam was not an easy place to be gay. At the age of 12, Vu told some friends he liked boys. “My friends were supportive, but the guy I liked told everyone I was disgusting,” he recalls. After that, Vu kept his sexual orientation secret from his friends and family. When Vu finally came out to his parents, they didn’t take it very well. “My mum said I would die of HIV because I’m gay,” he says. “We stopped communicating for several years after that.”

Vu was no stranger to HIV. When he was growing up, one of his relatives contracted the disease. “My family did not handle her situation very well,” he remembers. “They hid her away in the mountains while her condition was getting worse. When she died, her body was quickly cremated without having a funeral”

When he was 16, Vu, like most teenagers, started to explore sex. Unsurprisingly, he thought about HIV a lot and became fatalistic about it. “Because of all the stories of gay men dying of HIV I was exposed to, getting it eventually seemed inevitable to me, he says. “I learned that people living with HIV could still lead a healthy life, but I was worried about discrimination.”

Vu was lucky to attend a school where sex education was taught as an extra-curricular activity, and he viewed condoms as a normal part of sex. Then one day he had sex without a condom. “It was a sudden encounter,” he says. “I knew something wasn’t right and I needed to get an HIV test, but I didn’t do it until much later. I didn’t want to see a positive result, so I put it off.” When Vu eventually got tested the result was negative. “I was so relieved,” he says.

A few years later, things started to change. Using condom during every sexual encounter became unmanageable for Vu. “I had to compromise between safety and pleasure,” he says. “At one point I was so worried about getting HIV that I was having a test every week. Then I heard that PrEP was available for just $1 USD a day. So I asked my doctor about it.”

What is PrEP?

Niluka Perera
© UNICEF EAPRO/2016/Andy BrownNiluka Perera from Youth Voices Count holds a promotional PrEP bottle

Pre-exposure prophylaxis, or PrEP, is a new way to prevent HIV. It’s a combination of two existing drugs for treating HIV, which can also help prevent the disease. Taken daily, PrEP can lower the risk of getting HIV from sex by more than 90 percent. However it is much less effective if not taken regularly. PrEP users are also required to have regular HIV tests to confirm that they are free from the virus.

The World Health Organisation recommends that people at high risk of HIV should be offered PrEP, including gay and bisexual men, transgender people, sex workers and people who inject drugs. “We see this as an additional HIV prevention choice,” UNICEF HIV/AIDS Specialist Shirley Mark Prabhu says. “It should be part of a comprehensive package of services including use of condoms and lubricants, HIV testing and counselling, and antiretroviral therapy for partners living with HIV.”

Niluka Perera, 27, works for Youth Voices Count, a network of young gay men and transgender women in Asia-Pacific. Following a consultation last year, Youth Voices Count decided to embrace PrEP for HIV prevention. Niluka says their members found PrEP to be an “agent of empowerment”. It gave them the means and motivation to take charge of their own health and prevent HIV.

“We’ve been promoting condoms for some time but it hasn’t really worked,” Niluka explains. “All of us are human. We have feelings, and they can overpower our informed choices. Maybe you have an opportunity to have sex but the other person doesn’t want to use a condom. With PrEP you can make the decision to be safe in advance.”

Youth Voices Count is working with UNICEF to reach young people across Asia-Pacific and increase understanding of PrEP. The aim is to raise awareness of PrEP, counter the myths, and create demand from young people. “To do this we need to reach, not just young gay men, but also their parents and teachers,” Niluka says. “There are cultural barriers in many Asian countries, but sex education can help normalise this.”

UNICEF is also leading a five-year pilot project on PrEP for adolescents in three countries: Brazil, South Africa and Thailand. Working with partners, this will provide PrEP free of charge to adolescents who are in the high-risk category and eligible for it.

Kawee’s story

Kawee
© UNICEF EAPRO/2016/Andy BrownKawee, 18, sits on a bench in Lumpini Park, central Bangkok

While Thailand has made great progress in reducing HIV infection rates and improving treatment in the past few years, the challenge now is prevention among those most at risk. With the pilot project in Thailand, UNICEF and partners want to demonstrate that PrEP can be effectively implemented as part of a comprehensive package of HIV prevention services that will empower adolescents to make informed sexual choices and stay safe from HIV.

For some young people, unfortunately, PrEP has come too late. In Bangkok, 18-year-old Kawee* lives in a single rented room with his mother, a supermarket cashier. His father abandoned them both when he was very young. When he was around 15, he found out he had HIV after several years of unprotected sex with older men.

“I always knew I was different to other boys,” Kawee says. “I had my first boyfriend when I was 12. He was 34. After that I had many different boyfriends. I never used a condom.”

It wasn’t until he was 14 that Kawee found out about HIV, through sex education at school. “My teacher taught us about HIV, showed us images of AIDS patients, which was scary,” he says. “But I carried on having sex without condoms. I was having fun and enjoying sex, and I didn’t think HIV would affect me.”

Within a year, Kawee started developing AIDS symptoms, including loss of appetite and diarrhoea. He searched online and found a clinic that did anonymous HIV tests. His result was positive. “I was shocked and confused,” he recalls. “I didn’t know what to do. My mother couldn’t accept what had happened but I told my teacher and she helped me through it. She said ‘I will always be at your side to support you’.”

These days, Kawee is healthy. He takes his antiretroviral (ARV) medicine regularly and practices safe sex. He also attends counselling sessions at SEARCH Thailand, where he is training to be a peer educator. But he still struggles with stigma and discrimination.

Blue Ribbon Boys

Vu
© UNAIDS/2015/Aries ValerianoVu at an Asia-Pacific HIV/AIDS meeting

Vu now works for the gay mobile dating app Hornet. With apps becoming an increasingly common way for gay men meet each other, he is working to reach users with messages about taking responsibility for their own sexual health. Vu runs a campaign called Blue Ribbon Boys, which encourages app users in Asia to add a blue ribbon to their profile picture, to indicate that they’re committed to sexual health. Importantly, they can do this regardless of their HIV status.

“It’s a symbol of the user’s commitment to protect health,” Vu explains. “There are different ways to achieve this: they could be HIV-negative and using PrEP, or positive but taking ARV medication and using condoms.”

Vu says that PrEP is right for him at this time in his life. “I won’t be on PrEP forever,” he says. “But right now it works for me. It gives me peace of mind that I don’t have to worry about getting HIV or passing it on to other people.”

His determination to take charge of his own health even helped Vu with his family. “I recently got back in touch with my mother,” he says. “She’s starting to come to terms with me being gay. I told her about PrEP and she did some research on it. She’d still prefer it if I wasn’t having sex with men, but she’s relieved that I’m protecting myself from HIV.”

The author
Andy Brown is Regional Communication Specialist for UNICEF East Asia and Pacific

* Some names have been changed to protect identities.

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