The South African MSM (male-to-male sex) community has been radically transformed by the introduction of PrEP (Pre-Exposure Prohylaxis) -- a highly effective HIV-prevention medication that, for the first time, is now widely available –– and free –– at certain clinics.
Since the medication was rolled out in September 2015, almost 600 men have begun using the medication, which international studies indicate provides 92%-99% reduction in HIV risk for HIV-negative individuals who take the pills every day as directed.
In South Africa, where it is estimated that 32 to 38 percent of gay men are infected with HIV, the treatment could be a real game-changer.
Johan Meyer, health manager at Out LGBT Wellbeing, explained to HuffPost that so far, the Out clinic in Pretoria -- where PrEP is available for free -- has seen a positive "adherence ratio" of patients who use the medication and stay on it.
"With regards to the MSM group, our experience is that up to end of October, we initiated 157 PrEP patients –– and of that 157, 107 patients still remained on PrEP. So in terms of adherence, that's quite a high number on a global level," he said.
But adherence is not necessarily the most important factor in judging the success rate of PrEP, Meyer explains.
"The idea of PrEP is that they can start when they enter a high-risk period, and after that they could go off of PrEP, and then go on again when they have a high-risk period again. They call it 'cycle on and cycle off'. But there's a couple things you need to know, especially in terms of MSM.
"Where people have anal sex, they need to use the medication for at least seven days prior to exposure –– and for vaginal sex, it needs 21 days to reach its optimum protection benefits. That means that someone cannot decide tonight that they are going to a sex club, then take it on the same day."
The initial success of the programme comes after trials early last year with sex workers, considered one of the most high-risk groups in the country. But the study showed a very poor rate of adherence, partly due to stigma surrounding the use of antiretrovirals, and partly because the erratic nature of sex work makes it difficult to maintain regular use of the drug.
Nevertheless, the trial encouraged the introduction of PrEP to the MSM community, who are the second-highest risk group according to Meyer. It led to the landmark decision in April this year to make PrEP available to men who have sex with men (MSM) at three clinics around the country -- one of which is OUT, the other two being the Health4Men clinics in Cape Town and Johannesburg.
All participants in the South African PrEP Demonstration Project, Anova Health's Kevin Rede explained, will now have the opportunity to continue PrEP on the National Department of Heath's MSM PrEP programme.
"It's still early days," he said. "It's only been eight months into the period, and now government is making inroads into seeing whether other clinics could make it available to MSM as well."
After the success of the project, government is also looking at expanding PrEP access to other at-risk groups. Early indications are that the next key population might be young women and adolescent girls, for whom lack of education and the threat of sexual assault combine to make them high-risk individuals.
But Anova Health warned that this should not detract from the work that needs to be done with men.
"For too long, we have persisted on focusing all our HIV efforts on girls and women, hoping in vain that men would somehow follow," Anova CEO and HIV/Aids clinician Kevin McIntyre said. "The reality is that men won't or can't use health services as we would expect them to, and the general health gap for men widens the HIV prevention and care gap."
McIntyre stressed that it's a "trap" to think that increasing the focus on men somehow will detract from efforts to protect women. "It is only when HIV services take up their responsibility to look after men, that men will be able to take up their responsibility to protect women," he said.