How Do you Like Your PrEP

Just to add to Bk’s post…. In each site for HPTN 062   qualitative research in the form of in depth interviews were carried out with some participants. Rivet Amico found that in Africa, women’s adherence very much had to do with their trust/mistrust of the study drug. When they were suspicious they had low adherence. When they had confidence the drug worked, when  they felt they had ownership  of the study they had good adherence. Stigma played an important role in adherence in Bangkok and Harlem. Participants were viewed as either being HIV infected or sexually promiscuous if seen taking the drug. On the other hand for some participants it greatly relieved the anxiety of HIV acquisition and gave them a sense of freedom. One participant who had come of age during the AIDS epidemic commented that this was the first time in his sexual life he had ever felt truly free. This freedom from anxiety has been something which many of the participants on the Prelude Study that I have met have commented on also.

In addition to the PK data BK presented there were interesting differences in the PK data between rectal and vaginal mucosa. Concentrations of TDF-DP were 10-100 times greater in the rectal tissue compared with vaginal tissue after a similar dosing period. Time to reach peak concentration was also slower in the cervix compared with rectum. The reason for lack of protection in the studies such as FEM-PREP was explained by lack of adherence but perhaps this also has something to do with it.

Francois Venter from South Africa gave a great plenary yesterday about Biomedical Interventions : Contrasting Implementation Changes. He called for less moralising from politicians in his country and more accountability when it comes to the issue of young women in his country being infected by older men. Stop talking about the morality of it and act by keeping the girls at school- an intervention which has shown makes  a difference.