From Georgina Pope
It is indeed a shame that the potentially lifesaving pre-exposure prophylaxis (PrEP) for HIV will certainly be heavily criticised by those who are against “carefree sex” (22 November 2008, p 41 and p 5). Detractors will no doubt include those who are also against vaccinating girls against cervical cancer, just because in order to get it you have to have had sex at some point.
Those who criticise the use of the PrEP pill on such grounds, and those in favour of abstinence-until-marriage campaigns, should consider the fact that in Africa and other parts of the world huge numbers of married women are contracting HIV. This is in large part due to their low social and economic status, allowing them little power to insist that their husband wears a condom even if they know or suspect he is HIV-positive, and even if they know he visits local prostitutes. Unmarried women also often face violence and force if they ask for condom use or refuse sex.
This pill, if provided cheaply, could be a lifeline to millions of women, their children, and men. It is an opportunity that must be embraced.
From Marsha Rosengarten, Department of Sociology, Goldsmiths, University of London
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Though you covered many of the key issues raised with the promise of HIV pre-exposure prophylaxis (PrEP), enthusiasm for the possibility of reducing new infections appears to have glossed over the complexities of this intervention.
The most appealing feature of PrEP is that it offers women who are unable to institute the use of condoms a form of possible protection. But on the basis of experience with the contraceptive pill, we can anticipate that PrEP will affect gender relations: while it will enhance some women’s capacity to protect themselves, it may place more onus for HIV prevention on them.
Implementation of PrEP could merely replace some of the risk of HIV infection in otherwise healthy women with the risk of side effects from the drug – including risk in pregnancy.
PrEP presents us with a quandary, one that will require advanced techniques for managing the coming together of a complex mix of biomedical and social factors.
London, UK
London, UK
