Will PrEP win the war against HIV?

Crocodiles are dangerous animals. Unlike most animals, which kill almost exclusively for food and self-preservation, crocodiles like playing around; they often kill just for the fun of it. And they are very efficient at doing it. They’ll firmly grab their prey in their teeth and roll fast in the water to disorient and drown the victim. When a croc has you, death has you. Once done, they’ll go and stash your mangled remains among some reeds for your family to collect and bury.

Imagine now that you are in a group of 100 people standing on the edge of a pond with crocodiles in it. A crocodile expert comes along and announces that if all of you jump into the pond and attempt to swim across, only four of you will be killed by the reptiles. Save for the thrill of surviving the exhilarating experience, no prize is offered to those who make it across. However, though he doesn’t mention it, you lose nothing if you decide not to jump in.

Would you take the plunge?

I don’t want to anticipate your answer. But here is the true story that inspires the analogy; last week, the Kenyan government launched a program to provide pre-exposure prophylaxis (PrEP) medication to people who are at a higher risk of contracting HIV. Think discordant couples (couples in which one partner is HIV-positive); prostitutes (calling them ‘sex workers’ does nothing to dignify their profession, sorry); promiscuous youth (Team Mafisi, Sponsored Chics, et al); spouses who have long lost respect for their significant others and the sacredness of their union (Team Mpango ya Kando); and everyone else who is otherwise unable either to resist the temptation to have the carnal knowledge of multiple partners, or to protect themselves from the temptations of others.

PrEP essentially involves the taking of ART drugs by people who are HIV-negative to reduce their chances of contracting the virus should they be exposed to it. ARTs are those drugs which are normally taken by HIV-positive people to control the virus. Apparently, tests have confirmed that PrEP reduces one’s chances of contracting the virus by 96%… if used in concert with all the other methods. Looked at another way, one only has a 4% chance of contracting the virus if one uses it properly and has sex with a HIV-positive person… four in a hundred chance of being grabbed by a croc.

Anyway, the launch of PrEP was presented as a big step in the long-running fight against HIV in Kenya. And why not? After all, isn’t this country among the worst hit by HIV? So bad is the epidemic, in fact, that if you go to the Wikipedia entry for Kenya, and scroll all the way down the info-box on the right – the one that has a neat summary of the country’s statistics – you will find this little disclaimer at the bottom: “According to the CIA, estimates for this country explicitly take into account the effects of mortality because of AIDS… blah, blah, blah.”

What it is telling the world, in short, is that this country is so messed up by the virus, any mention of their screw-ups has to be looked at with HIV/AIDs in mind. Post-Election violence? HIV is partly to blame. Corruption? HIV is pulling some of the strings. Bad leaders? Their virtue was taken away by HIV. High cost of living, expensive maize flour? Damn virus has a hand in that too. Kick out HIV by any means and the country will bounce right into the first world like a compressed spring. It’s a concern for everyone. Every conscientious citizen should put his weight behind every effort to eliminate HIV.

It is for this reason that you will be really surprised by my next statement. I refuse to buy into this latest ‘great leap forward in the fight against HIV.’ Who am I to, you may ask. What do I know about the virus anyway to think I can talk about it? Let me explain. It’s because I am tired of the same old lies being peddled by these people while HIV keeps taking more Kenyan lives. Because I come from that part of the country which is responsible for a large chunk of those disheartening HIV statistics I just talked about.

I grew up in Kisumu, in Nyanza. Yes, that place where one in five people has HIV. I was born there just as the virus was starting its campaign of decimation in the area, when people still thought it was chira. I grew up as it strengthened its death-grip on my people, heard Princess Jully sing Dunia Mbaya on the radio. If anybody has seen children orphaned, lives destroyed and entire homesteads mowed clean by the virus, it’s me. And it has struck closer than I dare write here. That ought to count for something, right? So, spare me the “you know nothing” talk. I’ve been there. I feel the pain. I want to end HIV more than you know.

You heard me scoff the other day when they attempted to blame this epidemic on insufficient sex education. Who in Nyanza doesn’t know that HIV is a sexually-transmitted infection? Who in Nyanza doesn’t know about condoms and how to use them? From my earliest days, they came to our classes (mixed classes packed full with wide-eyed little boys and girls) and propped up rubber replicas  of human genitals on the teacher’s table and told us how to dress them in those transparent latex bags. They showed us how to roll out the bags and stash them down pit latrines. I knew how to use a condom long before I had my first wet dream. I, alongside countless other kids, did not lose my innocence to sex; I lost it to sex education.

Not once did they talk about love. Not once did they say that sex is not the only way to show someone you love them. Not once did they tell us that sex is not a one-act affair, that sex leaves emotional residues that never go away. Not once did they tell us that sex is only good for married people and dangerous for all the rest. Not once did they mention that restraint is a mark of virtue. Heck, they never once talked about virtue. They must have assumed we were animals, because I know virtue is only for human beings.

Every now and then, they dragged us to those seminars where some know-it-all community educator drones on and on about the effectiveness of this method and that method. If you don’t believe me, ask any Luo kid who went to school in Nyanza from the late 90s till today if they don’t have sex education in their schools. OK, you may say, but they didn’t say there isn’t sex education; they said there isn’t enough. To which I will respond with the question: when will it be enough, when they bring hardcore pornography to class? The demonstrations they gave us were more than we needed; more than enough.

When they blame it on stigma against people who use condoms, I laugh. If someone is ashamed to use a condom, shouldn’t that say a lot about what they think about promiscuity? They know promiscuity is wrong, but they want to be promiscuous without being known to be promiscuous. No thief wants to be known as a thief. Because there is shame in that, and shame counts for something because a person gets shame from within himself, not from society. And even with all that, who really faces stigma in the current society, those who use condoms or those who don’t?

These people will always have excuses for all the failures of their methods; because these methods have all failed to achieve the end of HIV we were promised. And what was their response to that? They went to some shiny hotel and toasted with imported drinks to a model of a tablet made in some foreign factory which is to be the newest addition to the impressively impotent anti-HIV arsenal. And after they downed their drinks and posted their photos on Twitter, they said the drug will cost 280 shillings a pop.

Yes, you got that right; 280 bob for a dose of sexual licence at a time when a 2-kilogramme bag of sugar costs 400 bob; at a time when the definition of poverty is living on less than 150 bob daily; at a time when over 40% of Kenyans are living in poverty; at a time when these same poor people are the worst-hit by the virus among us. You may point out that they said it would be free for some of these people. But have you realised that they will use your taxpayer shillings to fund the sexual licence of a few people?

Somehow, amidst all the talk and glitz of the launch, they all managed to ignore the rather large elephant in the room: that people spread sexually transmitted infections, HIV included, not just by having sex, but by having sex with people they are not supposed to have sex with; that if people only had sex with the people they are supposed to have sex with and no other, there would be no justification for unnecessary multibillion-dollar programmes to tame the virus. They didn’t talk about faithfulness. They didn’t talk about abstinence. When they bothered mention other methods to be used in concert with the pill, they mentioned condoms.

Every now and then, sounding like a broken record, one of these people will stand in a public pulpit and proclaim that abstinence is impossible, that people won’t listen if you urge them to abstain. So fervently convinced are these people of their notions that they always entirely miss the obvious implication of their proclamations, a contradiction so stark it doesn’t take formal education to notice: if people can’t abstain when you tell them to, why would they use condoms (leave alone use them properly) or PrEP when you tell them to either? If you have already dismissed people’s ability to keep their sexual urges in check, do you seriously think any amount of drugs or latex bags you provide them with will make them any more responsible with their bodies?

Now, let this not be (mis)construed as an offhand dismissal of the drug itself. Sure, there are cases where it could prove quite helpful. One easily thinks here of discordant couples, doctors who are constantly at risk of being infected, and women in warzones where the use of rape as a weapon of war is common, among others. But these are not cases where one has any other practical choice. In cases like these, people don’t go seeking the virus; it comes to them unbidden. Making the PrEP available to them would be an act, not of indulgence, but of prudence

The vast majority of people, however, have a choice whether to have sex with someone who is not their spouse or not. These people are under no pressure except from their unrestrained lust and the urging of the self-appointed guardians of society’s sexual pleasure. For them, this drug is little more than a licence to indulge in laissez-faire sex. Problem is, sex is never laissez faire. It will eventually saddle them with other sexually-transmitted infections, unwanted pregnancies, broken hearts, destroyed families and many other such ills that were not mentioned at the launch of the drug. All without complete assurance that HIV will be kept at bay.

I am sorry of I sound like I’m out of character today. But that’s because I’m growing increasingly exasperated by the anti-HIV lobby. I don’t want to second-guess their real motives, but I am increasingly convinced that they are in this for something else, not the elimination of HIV. There is no other way to explain this show of tail-chasing that they so expertly mount before us every day.

I don’t think they will convince me of their goodwill if they continue ignoring the only fool-proof method for stopping the virus in its tracks. And that method is good old sexual discipline, the preserve of men and women who know they are more human than beast; abstinence before marriage, and faithfulness in marriage. Anything else is little more than hot air. Let’s not lie to ourselves.

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  1. Truely every bit of our increasing rate of our economy as Kenyans is tied up to the fact that HIV is still roaming around in our lives like a hungry lioness and that the ministry of health and government at large hasn’t seen.
    This is an eye opener to most Kenyan’s and it surely rings an alarm not even a bell something has to be done and facts should not be ignored…abstainace is cheaper than PrEP.
    Kudos to you MathewAbeiro.

  2. This should sound an alarm not even a bell in our brains.Truely out of the 100%
    we can’t dare sacrifice even the 4%of our lives to this hungry lioness that’s roaming about in our nation.Life is precious and no risk should be taken for it.Abstainace is cheaper than PrEP…but it’s too expensive in the mouths of our economy’s “gold diggers” so to say who want to reap of our lives with a mere experimental drug that puts our lives at risk.
    Kudos Mathew

  3. You have hit the nail on the head! The PreP roll-out is partly beneficial although it looks like a perfect mockery of virtue. In fact, I am still wondering why the implementation primarily targets young women and adolescents from my roots.
    The drugs are not even a “sure bet” since they entirely depend on whether they are taken correctly and consistently. In addition, they have major side effects like creatinine elevation and loss of bone mineral density.

    1. Thanks for your comment Felix. Everyone knows taking medicine should always be a last resort. I don’t know why they would put this drug front and centre in the struggle against HIV… not to mention that abstinence has never been proven to have any side-effects.

    1. Thanks Jorges… If I don’t get involved in those politics, then only the people with ideas I don’t agree with will. And they will go on misleading people without facing opposition… I think it is my obligation, as a conscientious citizen, to stand up and contribute to that debate.

  4. This is more than a great read. It’s an eye opener and it’s something that has not only affected Kenya but Africa as a whole. HIV has got a grip on our continent and meddles with everything, something you have a shown light to me. Thank you for this and for doing your part in fighting the good fight in terms on this battle against the disease. It’s a challenge to me and for everyone that reads it. Well done Mathew..

    1. Thanks a million Simon. What a pleasant surprise it is to find you here in the comments section! I totally agree with you.

  5. Nice article bro. Am happy that we have brilliant minds around who can question things rather than acting like tabularasa. Keep it up

  6. Great read. These people should benchmark with our immediate neighbours Uganda. They didn’t succeed to reverse the spread of HIV by leaving out the message of abstinence and faithfulness especially to the youth. Their lack of consideration for this fact leaves a lot of unanswered questions about their motives

    1. Very true, Marty. I have seen the Ugandan abstinence campaign first-hand in my two visits to the country. I was actually tempted to drop the story into my article, but I figured I should reserve it for another day… if they have the temerity to ask whether abstinence has worked anywhere.

      1. Nice strategy Mathew. I can’t wait for them to ask (if they would dare to). I hope they could also extrapolate to us some of their not-so-obvious motives for their leaving out the abstinence and faithfulness message in their campaign

  7. Wait! Attitudes about sex and abstinence have changed. More young people are engaging in sexual experiences even in groups. Their world view about sex is farfetched from the traditional abstinence stance. In fact, the word does not exist in their dictionary. Additionally, aside from a religious based argument of premarital sex as immoral, what other argument would you present? Not many people think of sex in that way. Personally, I love the idea of abstinence and faithfulness, however, I do not impose on others my beliefs claiming that others are wrong or immoral or engaging in dangerous affairs because in their world, such attitudes do not exist. And BTW, how does having sex make you lustful or perverted? Most unmarried people have sex once in a blue moon, how are they lustful? Furthermore, the present technological progression
    makes the showcasing of sexual acts constantly conscious, how can you use that to assist in abstinence because it’s not going to stop. In fact, people are starting to embrace sexual scenes. Look at how social media socializes children contemporarily. Clearly, there’s nothing like abstinence in it. The most interesting part is years ago, when condoms and contraceptives where introduced, same arguments were propagated in vain. Try consider a holistic and historical argument, maybe that can help advance your worldview.

    1. Hey Fiyoz. Thanks a lot for your comment. You rightly raise a lot of issues. But I think there are some things I should clarify.

      First, I haven’t claimed that views about sex have NOT changed. Of course they have changed. My point is that the new views are not necessarily the right ones just because they are different from old attitudes. To paraphrase a great writer, a fallacy does not stop being a fallacy just because it becomes fashion. So, of course, you are right when you say views of sex have changed. The problem is that this is not the point. The point is, what to do about it?

      Second, I will ask you to comb through the article again and try to pinpoint any reference to religion; just because I say sex is only good for married people does not mean my argument is made from a religious standpoint. Although a religious basis would give the argument more strength, I base my argument here entirely on natural law. If you are interested in how such a conclusion can be arrived at without opening a page of the Bible, please let me know.

      Third, the fact that sex is now portrayed in the media so flippantly does not make abstinence impossible; it makes it hard, but not impossible. And human beings have done hard things since the dawn of civilisation.

      Fourth, if you truly love the idea of abstinence, you cannot escape from the responsibility of encouraging it by claiming you do not wish to impose it on others. Advocating good values is not equivalent to imposing them on people. In fact, I am tempted to think, you don’t love the idea of abstinence ENOUGH. For if you truly love something, the natural impulse is to share it.

      I hope I have addressed your concerns. Again, thanks for dropping by.

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