So the other day, I was seeing a serodiscordant couple when the issue of PrEP came up. Before I continue, allow me to clarify what PrEP and a serodiscordant couple are.

A serodiscordant couple is one where one person is HIV positive and the other is HIV negative. It’s sometimes referred to as mixed serostatus. In the case I was attending to, the husband is positive and the wife is negative.

PrEP (Pre-Exposure Prophylaxis) is a combination of two anti-HIV medications taken on a daily basis by HIV negative folks to prevent them from getting HIV.

Now back to my story: After the preliminary gist and counseling and all that jazz, I sent the couple off to the lab to run some basic routine tests, and 5 minutes later, the woman returned alone saying she was worried about my advice that they will need to use a condom each time they have sex so as to keep her from getting infected. The thing is her husband doesn’t like using condoms ever, and she had to get an implant because of this, in order to ward off any unwanted pregnancy. Apparently she had heard about PrEP and she was hoping I would start her on it. Thus we went into a discussion on PrEP.

Fifteen minutes later, we arrived at the conclusion that she had to get her husband to start using condoms whenever they have sex by fire by force, as he is a notorious womanizer without any signs of repenting. She was lucky to have dodged the HIV bullet, and common sense demanded that she protect herself from other STDs as well.

PrEP hasn’t been widely adopted across the world, and in Nigeria, it is still in testing with demonstration projects allegedly going on in Abuja, Lagos, Edo, Cross River and Plateau state.

To anyone who has access to PrEP and plans on taking it, do please note the following important points:

1. PrEP is not Vitamin C. You need to be 100% sure you need it, as it comes with its fair share of side effects, like kidney and bone issues amongst others. You need to be 100% dedicated to it as you run the risk of getting infected with HIV while on it and subsequently developing drug resistance.

2. PrEP is not a license to engage in bareback sex of any kind. You still need to use a condom to protect yourself from other STDs such as Hepatitis B & C, gonorrhea, chlamydia, syphilis, herpes, and HPV.

3. Truth be told, bareback sex can be AMAZING and some would have it no other way, thus the only exception to the second point above is if you’re in a monogamous relationship, built on a ton of trust and understanding. If your partner is not paranoid about health issues, slap on a condom biko.

4. PrEP does not work like Postinor (Morning After Pill), which can be taken up to 72 hours after unprotected sex to prevent unwanted pregnancies. PrEP is said to become effective from Day 8 of regularly taking it, and for it to stay super effective, you have to adhere to it religiously every day.

5. You can only stop PrEP 28 days after your last possible exposure to HIV. Stopping earlier than this exposes you to being infected.

6. Prior to starting PrEP, you need to do a HIV RNA test to ensure you’re HIV negative. And such a test isn’t widely available in Nigeria; an alternative for sexually active folks could be to abstain from sex for 6 months, during which time you would run a regular HIV test at least twice. If you haven’t been sexually active in the past six months and you haven’t been exposed to HIV, just one regular HIV test is okay before commencing PrEP. Failure to test for and rule out HIV properly before commencing PrEP could lead to drug resistance.

7. Still on testing, while on PrEP, you need to run at least one regular HIV test every 3 months to ensure you’re still negative, as shit can still happen (PrEP is only 99% effective if taken regularly 7 days a week). Also kidney checkups are required every 3 – 6 months as well to detect and manage any kidney issues that may develop before they become permanent.

NOTE: By Regular HIV Test, I mean the normal HIV antibody test readily available nationwide for free or a token fee.

PrEP is not just for people in relationships. It can also be used by single individuals who are sexually active as an added protection against HIV. Please ensure you’re properly educated on the pros and cons before jumping on it.

IT IS NOT a quick fix.

Questions and comments, if any, are welcome as always.

Written by Francis