Doctor says HIV prevention drug only works somewhat

ST JOHN’S, Antigua – Following a landmark Food and Drug Administration (FDA) advisory panel recommendation last week to fast-track the HIV prevention treatment drug, Truvada, an infectious disease specialist on island said it might not be the cure for Antigua & Barbuda’s HIV/AIDS woes – at least not for now.

In an interview with OBSERVER Media, HIV/AIDS Co-ordinator for Antigua & Barbuda, Dr Amina Fernandez, said the lack of sufficient financial resources and the culture in Antigua & Barbuda might preclude a Pre-Exposure Prophylaxis treatment option – one that prescribes antiretroviral medications to HIV negative people who are at high risk for infection – such as Truvada – from becoming widely used on island.

“With our limited resources we have to restrict the medicine to the people who need it the most. So if we are not able to prescribe antiretroviral medication to all persons who are HIV infected, there is definitely no way that we’re going to prescribe them to people who are not HIV infected,” said the board certified internist.

According to Fernandez, the Organisation of the Eastern Caribbean States’ (OECS) Pharmaceutical Procurement Service (PPS), funded by the Global Fund, supplies certain HIV positive persons on island with free medication, but the entity does not presently authorise medications to HIV negative persons.

“In Antigua and the OECS, our medicines are provided by the Global Fund and we are governed by them in terms of to whom we can provide the medicine. As it is, we are not giving medication to all HIV infected persons. It depends on their stage,” Fernandez said.

Although the doctor says drugs like Truvada can cause a “significant reduction” in incidences of infection, culturally the people of Antigua & Barbuda may not be ready for this preventative step.

“Culturally I think that people here don’t like to take pills in general. I think it will be the same with this, they won’t take it properly. I don’t see it happening anytime soon, ” Fernandez said.

The HIV/AIDS specialist is warning the population although the drug professes to reduce the risk of infection, by 44 per cent, people must be cognizant of the continued risk of infection.

“Even with taking Truvada and engaging in high risk activity from time to time, you do not have a zero risk of acquiring the virus.

In people who were more than 90 per cent adherent (to the medication schedule), the risk reduction was 70 per cent. It was not 100 per cent so they are still going to have a risk of acquiring HIV.”

Fernandez staunchly believes that the prevention plan for Antigua & Barbuda should be continued education and traditional prevention.

“Here we should continue to push for condom use and the reduction of sexual partners as opposed to medication.”

The OECS PPS programme does not currently offer Truvada for HIV treatment on island or in OECS territories.

Fernandez noted that Antigua & Barbuda does offer comparable HIV medicines, including Tenofovir Lamivudine and Emtricitabine, which are currently used as an antiretroviral drug and can be used as a Pre-Exposure Prophylaxis treatment drug.

(More in today’s Daily OBSERVER)