PEP and PrEP for HIV: Dispelling the Myth of HIV/AIDS as a Death Sentence

POST-EXPOSURE PROPHYLAXIS & PRE-EXPOSURE PROPHYLAXIS or PEP and PrEP, are medical formulations that can be taken preemptively or after exposure to sources of specific viruses (like Tetanus, Hepatitis A, B, C or HIV). For HIV prevention, PEP and PrEP drugs can be taken orally (with topical and injectable forms still pending approval).

Both PEP and PrEp involve a full course of medication, and are not just one-time emergency pills. So how come we haven't heard more about both classes of medicines in India? You'd think a treatment method that reduces the risk of HIV transmission by over 90% would be a bigger deal, right?

Even WHO recommends:

"PrEP is offered as a choice, free of coercion, and with access to other prevention strategies... The decision to use PrEP should always be made by the individual concerned."

But how are we supposed to choose a solution we rarely hear about in the first place?

One possible theory (that we are currently looking further into and is difficult to document in populations as large and diverse as India's) is the dangers of antiviral resistance.

If an entire population is given antiviral medication at uncontrolled or unregulated frequency, the virus itself may become resistant to the drug and people who do find themselves exposed to HIV would then need higher and higher doses of PEP and PrEP to control the spread of the virus. This could potentially have adverse effects on our health as individuals, communities and whole populations, and is therefore not advised.

Surely that's why India still restricts the distribution of PEP and PrEP drugs, right?

This isn't still about India's unwillingness to accept sexual autonomy, especially among young, unmarried and/or LGBTQ+ individuals... right?

“PEP is primarily meant for people who are occupationally exposed to HIV," says a NACO representative, who requested not to be named. "By and large, it is for hospital staff who might be at risk of getting HIV after an exposure, either because of a spill, or if they have (accidentally) pricked themselves with the same needle they used on (an infected) patient while taking a blood sample. It is not meant for a person who has had casual sex, suspects that he may be HIV positive and wants PEP. If you are having sex, then please use a condom- this is our stance."

– Excerpt from Do The Pep Talk , published on 13th November 2018.

The above comment was made by a representative from India's National AIDS Control Organisation. Sounds like this particular individual is under the impression that medical support and preventative measures do not necessarily belong to someone engaging in 'casual sex'. 2018 is not all that long ago and it’s tedious to continue envisioning a country where a government needs exact labels for all our relationships and encounters in order to consider our medical needs.

India is currently home to the world’s third largest population of persons living with HIV as of 2023 with an estimate of 2.3 million individuals. For generations, HIV/AIDS has been referred to as a disease of the gay men and sex workers– people we often like to refer to as minorities in the country, and yet that ‘disease of the minorities’ ranks us third in the world.

Stigmas and misinformation aside, here's what we do know about PEP and PrEP:

PEP and PrEP have reduced the risk of acquiring HIV by over 90% in clinical trials.

It has significantly reduced the risk of transmission through needles, contact with mucous membranes and other percutaneous wounds.

It has also reduced the risk of transmission between pregnant parents and their foetuses.

Considering the information at hand, could it be possible that PEP and PrEP, when administered correctly to more people in India (without solely targeting gay and bisexual men and sex workers), might provide people with an added barrier of protection from HIV? Without prying into their sexual orientation or the nature of their relationships?

While we are yet to speak to experts from the field to better understand the factors affecting PEP & PrEP distribution, one thing is certain-- we cannot tackle a virus by continuing to associate it with specific identities alone.

The only way to responsibly strategise solutions for HIV is by first accepting that it could happen to anyone and that medical treatments and good health belong to us all.