PrEP can help control the HIV epidemic in India: Experts

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India stands 3rd globally for highest number of HIV cases with 2.3 million patients living with HIV. Despite the high prevalence, the general population's understanding of drugs that help prevent HIV infection is extremely low.

Over these years, significant efforts have been made by multiple stakeholders to spread awareness around Human Immunodeficiency Viruses (HIV) and Acquired Immuno-Deficiency Syndrome (AIDS). Many people are unaware that the disease is no longer life-threatening and has evolved into a chronic manageable infection with a near normal life expectancy. Among these attempts to tackle HIV, one such paradigm shift has been to scale up pre-exposure prophylaxis (PrEP)- a practice to reduce the transmission of HIV. Infectious diseases specialist, Dr Atul Patel believes that efforts need to be strengthened to scale up PrEP and create awareness about the PrEP regimen among high-risk target groups.

PrEP is a prevention strategy that involves the administration of antiretroviral medications, that prevents HIV infection. The medications are quite effective for high risk populations who are exposed to HIV virus through injection drug abuse and sexual exposure. In 2015, the World Health Organization (WHO) recommended oral PrEP (tenofovir disoproxil fumarate-based oral regimen) as an additional prevention choice for individuals who are at substantial risk of HIV infection. In spite of WHO recommendations, the acceptance of PrEP has been limited due to a lack of awareness among the target groups.

Commenting on the awareness levels, Patel said, "Studies have found that the majority of the individuals from high-risk groups were not aware and had never heard about PrEP. Low level of awareness was observed in men who have sex with men (MSM) and transgender community. However, despite low awareness among high risk groups, once informed about the medications, a substantial percentage of individuals expressed their willingness to use oral PrEP." He further added that advocacy efforts and a multi-disciplinary approach through key population-targeted education campaigns needs to be at the maximum to ensure better tailored awareness programs for the community. The acceptance to adopt PrEP is quite positive, provided they have been engaged with right communication and information about PrEP.

Talking about the efficacy of PrEP, Dr Patel said, "Several studies have found strong efficacy of PrEP in preventing HIV infection." Patel further emphasised that adherence is an imperative aspect that plays a pivotal role. Barriers to PrEP includes PrEP-related stigma, pill burden, doubting PrEP efficacy, the complexities of the timing, and schedule of taking PrEP and PrEP characteristics. "PrEP is critical to bridge the prevention gap of HIV and hence efforts need to be strengthened to monitor PrEP adherence," added Patel.

Novel prevention strategies like PrEP can help control the HIV epidemic in India. The barriers and challenges for adherence needs to be studied and strategies need to be adopted to ensure PrEP acceptability and optimization.