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| Sex workers using anti-HIV drugs instead of condoms | Sex workers using anti-HIV drugs instead of condoms |
| (about 9 hours later) | |
| In Kenya 1.5 million people are living with HIV, and there are about 100,000 new infections every year. Despite this, some sex workers are having unprotected sex - and taking antiretroviral drugs afterwards to cut the infection risk. How reckless is this? | In Kenya 1.5 million people are living with HIV, and there are about 100,000 new infections every year. Despite this, some sex workers are having unprotected sex - and taking antiretroviral drugs afterwards to cut the infection risk. How reckless is this? |
| "Let me tell you the truth about why many of us don't use condoms," says Sheila who has been a prostitute in Nairobi's Korogocho slum for six years. | "Let me tell you the truth about why many of us don't use condoms," says Sheila who has been a prostitute in Nairobi's Korogocho slum for six years. |
| "We don't have money, and when you meet a client who offers to give you more money than you usually get, you have sex without protection even when you don't know his HIV status." | "We don't have money, and when you meet a client who offers to give you more money than you usually get, you have sex without protection even when you don't know his HIV status." |
| Sheila says she and other prostitutes can go to a clinic the next morning to get emergency antiretrovirals - drugs which suppress the virus, if taken within 72 hours of infection, and in many cases stop its progression. | Sheila says she and other prostitutes can go to a clinic the next morning to get emergency antiretrovirals - drugs which suppress the virus, if taken within 72 hours of infection, and in many cases stop its progression. |
| "We use this medicine like condoms," she says. | "We use this medicine like condoms," she says. |
| The type of antiretroviral in question is known as post-exposure prophylaxis, or PEP. | The type of antiretroviral in question is known as post-exposure prophylaxis, or PEP. |
| It is intended to be used in emergencies. For example, it is given to victims of rape if their attacker is thought to be HIV-positive, or to medics who have been pricked by a potentially infected needle. | It is intended to be used in emergencies. For example, it is given to victims of rape if their attacker is thought to be HIV-positive, or to medics who have been pricked by a potentially infected needle. |
| There are no definitive figures to show how well PEP works. It's far better, experts say, to prevent exposure the virus in the first place, by using condoms. | There are no definitive figures to show how well PEP works. It's far better, experts say, to prevent exposure the virus in the first place, by using condoms. |
| Some clinics will only give clients one course of PEP a year. They worry that if they hand the drugs out too freely, prostitutes will stop using condoms altogether. | Some clinics will only give clients one course of PEP a year. They worry that if they hand the drugs out too freely, prostitutes will stop using condoms altogether. |
| This hasn't stopped 24-year-old sex worker Pamela using PEP four times in the past year. | This hasn't stopped 24-year-old sex worker Pamela using PEP four times in the past year. |
| "I had unprotected sex when I was very drunk one night and the following morning I didn't go to the same clinic where I got the first PEP tablets... I went to a different clinic where they don't have my records, and lied that I was forced into unprotected sex," she says. | "I had unprotected sex when I was very drunk one night and the following morning I didn't go to the same clinic where I got the first PEP tablets... I went to a different clinic where they don't have my records, and lied that I was forced into unprotected sex," she says. |
| She didn't finish the full course because of the side-effects. "You feel bad, like vomiting, dizziness, and generally you just feel sick," she says. "So I stopped taking them." | She didn't finish the full course because of the side-effects. "You feel bad, like vomiting, dizziness, and generally you just feel sick," she says. "So I stopped taking them." |
| Peter Godfrey-Faussett, senior science adviser with UNAIDS, says there is a place for antiretrovirals among sex workers, but only when used in the right way. | Peter Godfrey-Faussett, senior science adviser with UNAIDS, says there is a place for antiretrovirals among sex workers, but only when used in the right way. |
| "We know that despite fairly high rates of condom use in many sex-work communities, we still have very high rates of HIV so we need additional tools as well as what's already happening," he says. | "We know that despite fairly high rates of condom use in many sex-work communities, we still have very high rates of HIV so we need additional tools as well as what's already happening," he says. |
| However, emergency use of PEP is not the best way to go about it, he says. Instead it would be better for prostitutes to take a type of antiretroviral designed to be taken before exposure to HIV - known as Pre-exposure prophylaxis (PrEP). | |
| These are taken daily, and contain fewer drugs than PEP, so there are fewer side effects. But Godfrey-Faussett stresses that they must be used as part of a wider package, including regular HIV testing to make sure that the patient is on the correct medication. | These are taken daily, and contain fewer drugs than PEP, so there are fewer side effects. But Godfrey-Faussett stresses that they must be used as part of a wider package, including regular HIV testing to make sure that the patient is on the correct medication. |
| There are plans to run a pilot programme with sex workers in Kenya to see if it could be practical for them to use PrEP as an extra layer of defence. | There are plans to run a pilot programme with sex workers in Kenya to see if it could be practical for them to use PrEP as an extra layer of defence. |
| The drugs are not cheap, though. | The drugs are not cheap, though. |
| In the US, PrEP costs around $14,000 (£8,700) a year at the full price, although people on low incomes can get it much cheaper, or even free. | In the US, PrEP costs around $14,000 (£8,700) a year at the full price, although people on low incomes can get it much cheaper, or even free. |
| In developing countries, where generic copies of the drugs are used, the cost may be about $150 (£93) a year. | In developing countries, where generic copies of the drugs are used, the cost may be about $150 (£93) a year. |
| Godfrey-Faussett stresses that the cheapest line of defence is, in this case, the strongest. | Godfrey-Faussett stresses that the cheapest line of defence is, in this case, the strongest. |
| "Condoms are the single most effective way of preventing HIV, sexually transmitted infections and pregnancy," he says. "PrEP is not a silver bullet that will suddenly take away all those other issues." | "Condoms are the single most effective way of preventing HIV, sexually transmitted infections and pregnancy," he says. "PrEP is not a silver bullet that will suddenly take away all those other issues." |
| Additional reporting by Alison Gee in London. | Additional reporting by Alison Gee in London. |
| Zainab Deen's report was featured on Newsday on the BBC World Service. | Zainab Deen's report was featured on Newsday on the BBC World Service. |
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