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In Kenya 1.5 million people are living
with HIV, and there are about 100,000
new infections every year. Despite this,
some sex workers are having unprotected
sex – and taking antiretroviral drugs
afterwards to cut the infection risk. How
reckless is this?
“Let me tell you the truth about why
many of us don’t use condoms,” says
Sheila who has been a prostitute in
Nairobi’s Korogocho slum for six years.
“We don’t have money, and when you
meet a client who offers to give you more
money than you usually get, you have sex
without protection even when you don’t
know his HIV status.”
Sheila says she and other prostitutes can
go to a clinic the next morning to get
emergency antiretrovirals – drugs which
suppress the virus, if taken within 72
hours of infection, and in many cases stop
its progression.
“We use this medicine like condoms,” she
says.
The type of antiretroviral in question is
known as post-exposure prophylaxis, or
PEP.
It is intended to be used in emergencies.
For example, it is given to victims of rape
if their attacker is thought to be HIV-
positive, or to medics who have been
pricked by a potentially infected needle.
There are no definitive figures to show
how well PEP works. It’s far better,
experts say, to prevent exposure the
virus in the first place, by using condoms.
Some clinics will only give clients one
course of PEP a year. They worry that if
they hand the drugs out too freely,
prostitutes will stop using condoms
altogether.
This hasn’t stopped 24-year-old sex
worker Pamela using PEP four times in
the past year.
“I had unprotected sex when I was very
drunk one night and the following
morning I didn’t go to the same clinic
where I got the first PEP tablets… I went
to a different clinic where they don’t have
my records, and lied that I was forced
into unprotected sex,” she says.
She didn’t finish the full course because
of the side-effects. “You feel bad, like
vomiting, dizziness, and generally you just
feel sick,” she says. “So I stopped taking
them.”
Peter Godfrey-Faussett, senior science
adviser with UNAIDS, says there is a place
for antiretrovirals among sex workers, but
only when used in the right way.
“We know that despite fairly high rates of
condom use in many sex-work
communities, we still have very high rates
of HIV so we need additional tools as well
as what’s already happening,” he says.
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