Windhoek-While cleaning the shack that she shares with her partner and their children in Okahandja Park, 24-year old *Wilhelmina could not believe her eyes when she found a container of antiretroviral (ARVs) pills in one of his pockets.

“I was afraid because I had already slept with him and I was expecting his child,” related Wilhelmina of her dilemma.

Wilhelmina and her partner never tested together for HIV but he always assured her that he was ‘clean’, she told New Era in a recent interview.

She waited for her partner, who is the breadwinner, to get home and asked him about the medicine. “He wanted to deny it but he eventually admitted that it was his pills and that he was HIV positive,” she said.
Wilhelmina continued to have unprotected sex with her partner after being exposed to the virus. “I continued because I thought he already infected me so there is no point to use condoms,” she explained.
However, she later visited the Namibia Planned Parenthood Association (NAPPA) clinic for antenatal care and a HIV test. To her surprise, the results were negative.

The health professionals at the youth-friendly clinic put her on pre-exposure prophylaxis (PrEP) after explaining the benefits. PrEP is for people who are HIV negative but are at substantial risk of contracting the virus – they take one pill every day.

The pill, Truvada, contains two medicines, tenofovir and emtricitabine that are used in combination with other medicines for HIV positive patients. When taken consistently, PrEP can reduce the risk of HIV infection in people who are at high risk by up to 92 percent, according to studies. However, it is less effective if it is not taken consistently.

Wilhelmina has been taking PrEP since last year when she sought medical attention for antenatal care and has been taking the pill religiously ever since.
Registered nurse Fungai Bhera at the NAPPA clinic in Okuryangava has been attending to Wilhelmina since last year in August.

“She is still HIV negative and she is breastfeeding,” Bhera said yesterday (Sunday).
The NAPPA clinic started serving clients with PrEP at the end of July last year.

People at high risk of contracting HIV such as those in sero-discordant relationships, where one partner is
negative and the other is positive, key populations, including men who have sex with men and those who are sexually active but do not stick to one partner, are eligible for PrEP at the clinic at no cost.
Statistics availed by NAPPA show that by February, 67 percent of registered NAPPA clients were taking their medicines. By that time, 33 percent stopped either as their own preference or because of reduced risk.
“Of those who are currently taking their medicines, 34 percent are below the age of 30 years, both men and women,” said Bhera.

“The idea is that in the bloodstream there is an anti-viral. If the virus comes in and wants to attach itself to the CD4, it will eventually die without finding a host,” Bhera explained.

CD4 cells are white blood cells that play an important role in the immune system. The CD4 cell count gives an indication of the health of an individual and the body’s natural defence system against infections and illnesses.
Meanwhile, Eric Atkins, the public affairs officer at the embassy of the United States in Namibia, said “several hundreds of people” are taking PrEP, which is offered by the Ministry of Health and Social Services in different regions.

“PrEP is safe to take and it is highly effective in preventing new infections, which has been extensively demonstrated by 12 studies,” said Atkins.

The 12 studies, he explained, tested the effectiveness of PrEP and were conducted among different high-risk population groups. The result, he added, demonstrated that PrEP can significantly reduce the chances of acquiring HIV after an exposure by almost 92 percent.

“It is against this background that the Ministry of Health and Social Services has recommended PrEP for any person who is at substantial risk of acquiring HIV infection,” said Atkins.
He also urged people who feel that they are at risk of contracting HIV infection to seek medical attention concerning PrEP.

Among individuals who are taking PrEP in Namibia, no major side effects have been reported to health workers, Atkins said.
“A few individuals have experienced minor side effects like nausea and abdominal discomfort in the first week of taking PrEP but these symptoms have mostly disappeared by the second or third week of taking the medicine,” said Atkins.

PrEP works when users adhere to the medicine and get the timing right, emphasised Atkins. He further explained that it takes at least seven days to reach high levels of protection against HIV for someone who is starting PrEP.
“Individuals should continue using PrEP for four weeks after the last significant exposure when stopping PrEP,” said Atkins. Meanwhile, Wilhelmina said she would remain on PrEP for as long as she is in that relationship.
“I am looking for ways to move out because he does not treat me well and I am not working and I depend on him. The mother of his other children constantly bothers me that I stole her man but when we met he did not tell me that he has a partner. I am in this situation because I have no means of survival and life here in Windhoek is expensive,” said Wilhelmina who is unemployed.

PrEP is just one of the interventions by the Ministry of Health and Social Services to prevent HIV. The health ministry has in its arsenal a broad range of tools for HIV prevention. These include condoms and voluntary medical male circumcision (VMMC).

PrEP is not used in isolation and has not replaced the already existing interventions for HIV prevention and it is not a cure for HIV, Atkins highlighted.

“PrEP does not protect against other sexually transmitted illnesses or pregnancy. PrEP is always provided together with other HIV prevention options such as risk reduction education, condoms and VMMC,” Atkins explained.
The U.S Government has been supporting Namibia in its fight against HIV/AIDS.

*Wilhelmina is not her real name. She spoke on condition that we withhold her name.

Author: Alvine Kapitako