Let’S Talk About Prep!

Local doctor explains the ins and outs of drug that reduces the risk of getting HIV


Dr Nikkiah Forbes heads the National HIV/AIDS Programme.


Tribune Features Writer


WITH 151 new cases of HIV reported in 2017 and about 5,287 people living with the disease in the Bahamas, the National HIV/AIDS Programme headed by Dr Nikkiah Forbes is continuing with its vigorous efforts to teach Bahamians about the epidemic, how it is contracted, how to get tested, what treatment is available locally and preventative options.

As education is major component in getting the HIV numbers down, the thrust of the programme has always been making people aware of how the disease is contracted and what measures they must take to prevent becoming infected.

As the guest speaker at the recent Doctors Hospital Distinguished Lecture Series, Dr Forbes gave a comprehensive presentation detailing the ins and out of HIV/AIDS, as well as the global, regional and local statistics, while also sharing about the work the programme does here in the Bahamas.

One main highlight of Dr Forbes’ presentation was the pre-exposure prophylaxis (PrEP) prevention pill that can stop new HIV infections and is recommended for high-risk HIV negative individuals. It does nothing to treat an existing HIV infection.

“Oral PrEP is an HIV prevention strategy in which a high-risk HIV negative individual takes antiretroviral medication regularly to prevent HIV infection. So the high-risk HIV negative person takes this pill daily. It has been around from 2012,” Dr Forbes explained.

The drug has been gaining exposure locally in recent times, and Dr Forbes said some people now believe the pill to be a “magic bullet”. She stressed that this is not the case.

“I want to say that off the top because it is not. One of my dedicated nurses said people are hearing about the drug and are thinking you take it like a morning-after pill, but it does not work like that. PrEP is a commitment,” she said.

“You cannot use it as a standalone strategy. It should be used in combination with other things like knowing your partner’s status, condoms and lubricants, frequent testing.”

The drug also requires daily adherence in order to work to its fullest potential.

“It has to be taken every day,” she said. “PrEP can fail if it is not taken regularly. And with unprotected sex a new infection can arise. There have been reports of new HIV infections even in people who have been taking the drug all the time or (have been) so-called adherent to it.

“There has been a case study report of someone who got HIV even though they were on PrEP and it was proven that they were adherent. They had bio-chemical tests that showed they were on the medication. But they had high-risk behaviour. They had multiple partners, engaged in unprotected sex, so they had a lot of exposure.”

Adult heterosexual men and women with “substantial risk” can benefit from PrEP.

“So that is if you had a recent sexual transmitted infection like a genital ulcer, syphilis, genital herpes, chlamydia, gonorrhea, which is transferred in the same way, PrEP could be used to prevent HIV transmission,” noted Dr Forbes.

Those at a substantial risk of HIV infection also include HIV negative individuals with a sexual partner who his HIV positive who are not virally suppressed or sexually active in a high HIV incidence/HIV prevalence population.

Those engaging in vaginal or anal sexual intercourse without condoms with more than one partner, or a sexual partner with one or more HIV risk factors, a history of a sexually transmitted infections (STI) by lab testing or self-report or syndromic STI treatment, use of post-exposure prophylaxis (PEP) for sexual exposure are all recommended for PrEP.

“If you have a high-risk partner or your partner has other partners, or you have multiple partners you should be on PrEP,” she said. “If you are not sure about what your partner is doing or you should be on PrEP...sexually active partners who have inconsistent condom use should use PrEP.”

PrEP is a free drug and is available at the Infectious Diseases Clinic. However, it must be prescribed by a doctor.

“You have to see your doctor in order to get this pill. There has to be some tests done beforehand because some medications can have side effects. We have to screen persons to make sure they don’t have diseases before we prescribe this medication. Risk reduction behaviour is something that we need to do,” she said.


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