Preventing HIV in KenyaA new, injectable antiretroviral drug, cabotegravir (CAB LA), may have significant potential for preventing HIV among sub-Saharan African women. In November 2020, the World Health Organization (WHO) reported trial results of the HIV Prevention Trials Network Study (HPTN 084), testing the use and effectiveness of CAB LA in preventing HIV among more than 3,200 HIV-negative, sexually active women across east and southern Africa. This drug could significantly lower prevalence rates and help in preventing HIV in Kenya, which has one of the largest HIV/AIDS epidemics in the world.

Cabotegravir or CAB LA

CAB LA, a long-acting pre-exposure prophylaxis (PrEP) regimen, requires an injection only every eight weeks and has been shown to be 89% more effective in preventing HIV than taking a daily oral antiretroviral PrEP, a generic pill currently marketed as Truvada.

Kenya’s HIV Epidemic

The first case of HIV in Kenya appeared in 1984. By 1990, HIV was one of the leading causes of illness in the country. At its highest point, more than three million Kenyans lived with AIDS. Since then, the government of Kenya decreased the prevalence of HIV from its 10.5% peak in 1996 to 5.6% in 2012. By 2019, the prevalence rate was 4.5% in adults aged 15-49. However, certain vulnerable populations within Kenya are more at risk of getting HIV, such as women. Males have an estimated prevalence rate of 4.5% while the rate for females is 5.2%. Among youth aged between 15 and 24 years old, boys have a prevalence rate of 1.34% compared to girls at 2.61%.

The only option for preventing HIV in Kenya is a daily PrEP pill called Truvada. The government of Kenya first approved oral PrEP for country-wide distribution in 2015, and since 2017, has scaled up the distribution throughout Kenya. However, of the 1.5 million Kenyans living with HIV, only 26,098 (1.7%) are currently on PrEP.

Though 72% of the population had been tested for HIV, only 70% had been tested more than once. Frequent testing, at least once a year if sexually active or at least every six months if part of a particularly vulnerable population, is vital to giving care and treatment for at-risk groups.

The Potential of CAB LA for Preventing HIV in Kenya

  1. The HPTN study reported that CAB LA is nine times more effective in preventing HIV in Kenya than the Truvada pill, the current form of PrEP. The PrEP pill is only effective if taken daily and is not a standalone prevention method for other STIs or unplanned pregnancies. The new drug also does not require other forms of protection, such as condoms.
  2. This drug gives vulnerable populations more HIV options for preventing HIV in Kenya. Vulnerable populations include sex workers, men who have sex with men, people who inject drugs, youth and women. These vulnerable populations face stigma, which affects their ability to access PrEP pills. Because the injection is needed only once every two months, the increased discretion and ease of the infrequent injection may increase its use and thus increase the protection of those who need it.
  3. Discretion in use of the drug may be able to reach more women specifically. In combination with the stigma attached to HIV, women in Kenya face discrimination in terms of access to education, employment and healthcare. As a result, men often dominate sexual relationships, with women not always able to practice safer sex, even when they know they should. For example, in 2014, 35% of adult women (aged 15-49) who were or had been married had experienced spousal violence and 14% had experienced sexual violence. Women in Kenya find it especially difficult to take a daily pill, which significantly reduces the effectiveness of the medicine. Only 68% of Kenyan women have access to antiretroviral pills.

Though not yet approved by the U.S. Food and Drug Administration (FDA), the developer of the drug, ViiV Healthcare, expects cabotegravir to be ready for the market by early 2021.

– Charlotte Ehlers
Photo: Flickr

Climate Resiliency
Amid the hottest year on record, pacific island states are preparing for the consequences of climate change.

Climate change bears a consequential effect on the entire international community, but the first countries to contend with its baleful side effects are the Pacific Island states.

According to a report from the World Bank, pacific island states are highly susceptible to acts of “extreme weather and climate,” because of their reduced population, geographic location and restricted economies.

In 2012, the Pacific Island Regional Climate Assessment (PIRCA) conducted an assessment of climate change in the pacific region and discovered that the effects of climate change cannot always be observed by human senses. For instance, the balance of Pacific Island habitats is eroding – Hawaiian native forest birds are dying as a result of mosquito-borne disease, which stems from increasing global temperatures.

Papua New Guinea, Samoa and Tonga, however, have demonstrated their commitment to climate resiliency through programs to mollify the aftermath of natural disasters and climate change consequences.

Utilizing $75 million of U.S. federal grants, the aforementioned pacific states have financed the Pilot Program for Climate Resilience (PPCR), which provides local, national and sectoral agencies with added capital to “mainstream climate change adaptation and disaster risk reduction.”

Other pacific region climate resiliency plans include the 2016 Pacific Resiliency Program (PREP), which was the culmination of a three-day workshop where pacific region diplomats collaborated to abate the effect of climate change.

International institutions play an integral role in climate resiliency, which is demonstrated by their generous grants and credits for preventative programs. For instance, the International Development Association (IDA), the Global Environment Facility Special Climate Change Fund to Tonga, the Global Facility for Disaster Reduction and Recovery to Tonga contributed $43.66 million to the PREP program.

The 2012 PIRCA also noted the potential for a climate change-induced human rights catastrophe. Pacific Island states are likely to have reduced freshwater supplies, increased coastal flooding and erosion, coastal economic decline, and human migration if climate change continues at its current pace.

In the coming years, the international community will be tested by the effects of climate change. It is incumbent for citizens across the world to ensure their political leaders are held to the principles of climate resiliency, as it is likely to be the most consequential threat of the 21st century.

Adam George

Photo: Flickr