If this works, of course it is a good idea to give teenagers who are sexually active a medical way to prevent getting HIV, taking into account the reality of what they are doing. My question is if it isn't bound to fail, in the long run. I also wonder if depending on it avoids working on other parts of the problem, which if unaddressed may lead to other and, possibly, worse problems.
Every night at 8 p.m., 18-year-old Catherine Msimango takes a pill.
It's the same pill that people with HIV take to fight the virus. Only she doesn't have HIV.
Msimango says the pill gives her power against the virus. She can take it even without her boyfriend knowing.
"It's all about my safety because I don't know what he does when I'm not around," she says. "If he doesn't want to use protection [a condom], I know that I'm safe from the pill."
Msimango lives in the sprawling South African township of Soweto in the heart of the HIV epidemic. South Africa has nearly 7 million people living with HIV, more than any other country in the world. And nearly 1 in 5 adults is infected. HIV rates are lower for adolescents but increase rapidly as teens move into their 20s.
Some AIDS experts now believe that one way to keep rates down is with a daily pill...
... The novel prevention technique has proven highly effective in blocking the transmission of HIV in gay men and sex workers. Now it's being tried among sexually active teens.
Studies have shown that taking daily doses of the drugs offers an extremely high level of protection against HIV. If taken correctly and consistently the pill is nearly 100 percent effective in blocking transmission of the virus. Researchers call the technique pre-exposure prophylaxis, or PrEP.
Those earlier studies were primarily with gay men. The study Msimango is in was launched last year with 150 sexually active teens between the ages of 15 and 19. Linda-Gail Bekker is the deputy director of the Desmond Tutu HIV Centre at the University of Cape Town and one of the lead investigators on this pilot study.
"I think having [a form of HIV prevention] that a young woman can use discreetly and is in her absolute control is something we've been missing throughout this epidemic," Bekker says.
Being realistic about how people are having sex is essential in trying to prevent the spread of sexually transmitted diseases and there is no question that the fact is that even the existence of horrifically damaging diseases being contracted has not in the past or today kept people from engaging in sexual practices that spread them.
My question is if the virus won't, perhaps even more rapidly with increased promiscuity, evolve strains that are resistant to the drugs being used, now. If that is what happens, this is, at best, a temporary fix. Fixing the economic conditions described in the story, especially the commodification of people for sex, is still necessary and this kind of program shouldn't be used as an excuse to not work on that, though I fear it will be.
Sabelo Sekhukhuni, one of the counselors helping to run the PrEP program in Soweto, says the pressure on teenage girls in impoverished parts of South Africa to have sex is huge.
"When you look at an informal settlement where there isn't electricity, sex is a sport. Sex is an activity to keep themselves busy," he says.
Sex also at times is used as currency. Girls who have no money can be offered cell phones or new clothes by older men who want to sleep with them.
Just behind the hospital where the PrEP study is being conducted, says Sekhukhuni, there's a settlement of shacks where the people don't have electricity.
"So there's this one guy who owns a tavern and he has a generator and he makes people pay 5 rand to charge their cellphones," he says.
But he offers to charge girls' phones for free in exchange for sex. And some of the girls accept his offer.
In these types of relationships the tavern owner holds a lot of power in the community. He's got the generator. The man may be HIV positive and Sekhukhuni says he may refuse to use condoms.
"The same girls that sleep with this guy they'll go back and sleep with their peers of their same age group," he says. "Meaning [HIV] is still going to spread some more."
But Sekhukhuni says this is the beauty of PrEP. In these complex, messy, real-world sexual networks, PrEP may be able to protect these teenagers from the lifelong burden of HIV.
I don't, not for a second, believe this program should be stopped if it is keeping people, especially young people, from becoming infected but it is certainly not enough. It should certainly be closely monitored.
But this doesn't touch the bigger problem that controlling the epidemic spread of HIV requires. The media has certainly encouraged the idea that people are rightly seen as a commodity both in terms of labor and sex, especially young women and girls. The media could encourage respect for other people and drive home the reality that using other people as if they are object isn't just entirely immoral, it is also dangerous to both the used and the user.
I have mentioned that one of the justified fears of general sexual promiscuity is that other, as or more deadly viruses and other organisms can evolve and arise just as HIV did four decades ago. Even if they can use this regimen to put a significant dent in the pandemic of HIV invections, now, there is nothing to keep another sexually transmitted disease from arising. The biological fact is that any act of sex which includes contact with semen, blood and other biological material carries a high potential of infection. The story says that just encouraging the use of condoms has not been universally successful, though it is another means of preventing some infections. The biggest problem is that men and boys often won't use them and they are often in a position to either force other men and women and, certainly, children into letting them have sex without condoms. If men and boys didn't feel entitled to be selfish, irresponsible jerks, it would, as well, be another partially successful way to prevent the spread of STDs. Today, entertainment media, especially when the topic is sex, tells them the exact opposite. The role of the media in encouraging selfish, irresponsible behavior among men is among the biggest problems that anyone trying to fight the pandemic of HIV is up against. It goes way beyond encouraging condom use, though that is certainly part of it.
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