WHen Lesedi Growing up in a very poor family in Johannesburg, South Africa’s commercial capital, she used a cloth filled with sand as makeshift hygiene kit. That changed when she was 14 (below the legal age of consent) and she began having sex with a man almost 15 years her senior who drove her to school and bought her toiletries. The boyfriends she courted in her teens and early twenties were increasingly generous. “If I’m going to date you, you have to make sure you’re working,” said Lesedi (whose name we’ve changed). “Love alone couldn’t feed me.” A married man paid for her apartment and clothes and gave her money to support his family. Lesedi says she got everything she wanted until she found out she was infected HIV.
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Relationships between adolescent girls or young women and older men are new HIV global infection.Eastern and Southern Africa has about one-tenth of the world’s population, but accounts for nearly half of the world’s 1.5 million additional population HIV Number of cases in 2021. Young women (aged 15-24) are disproportionately affected, with infection rates more than three times those of their male counterparts (see Figure 1). Like Lesedi, many of these girls and women became infected while dating a series of older men. After a few years, many people pass it on when they meet someone their age with whom they wish to settle down. “This is when HIV passed on to the young man, who then becomes the older man,” said Linda-Gail Bekker of Desmond Tutu HIV University of Cape Town Centre. “So you are malicious HIV cycle. “
Breaking this cycle is one of the greatest challenges facing public health. Efforts to change the behavior of younger women and older men are rarely successful. Instead, the solution may be pharmacological, in the form of pre-exposure prophylaxis (PrEP) medicines taken by healthy people to avoid infection HIV. Innovative and efficient PrEP Treatment options for women are on the market or in late-stage development.If they are widely used by girls and women who have sex with older men, African HIV The epidemic will take a turn for the worse.
explain the age gap
A relationship with a sugar daddy (what nerds prefer to call a “transactional relationship”) is different than sex work. Some women spoke of dating older men and receiving emotional support from them that they might not have received from men their own age. Girls in South Africa typically start having sex at 14 or 15, and they are more mature than males of the same age in terms of puberty, Dr Bekker said. Some start relationships with slightly older men as part of discovering their sexuality and are flattered that they are so attractive to them. The South African study found the man was usually five to eight years his senior, although there have been cases like Lesedi’s where a man was a generation older than him.
Attitudes towards men in this relationship are reflected in what many young Africans call their older male partner: “the well-wisher.” Some women brag about their talents on social media (using #blessed). Having a well-wisher can provide social status, as well as trendy clothes, smartphones and other goodies that parents couldn’t afford, says Joyce Wamoyi of the National Institute of Medical Research in Tanzania. This gift is very common among college students. In poorer rural areas, by contrast, men pay for necessities such as food and clothing.
Younger men struggle to get the attention of younger women because they tend to make less money than older men.However, their male elders were more likely HIVsimply because they are having sex for longer periods of time and with more partners in societies with high rates of sexual activity HIV. Men in their 20s—often the first partners of adolescent girls—were less likely to know they were infected and thus less likely to take antiretroviral drugs (antiretroviral drugss), which would make them less likely to transmit the virus sexually. A 2016 study in KwaZulu-Natal, South Africa HIV, found that women under the age of 25 had sex partners who were, on average, 8.7 years older. Women aged 25-40 have partners who are only one year older.Clusters of relevant infections identified by HIV Genotyping led the researchers to conclude that younger women are infected by older men. Then, as they get older, they infect their peers.
Various plans to change this situation have mostly failed. Charities have tried to provide poor teenage girls with small amounts of cash to meet their basic needs. But once they have food because of this handout, they crave more, such as better clothes; once they have these, they want more expensive things, such as a smartphone, Dr Wamoyi said. The cash transfer program might give them the equivalent of $10 or $20 every three months. “An older man can give you $20 on the spot,” she said.
A more promising idea is to prevent girls and young women from becoming infected, preferably using methods that don’t require them to persuade men to wear condoms (which is difficult).There are three of them PrEP Methods that have emerged in recent years: vaginal rings, daily pills and bimonthly injections.persuading risky women HIV However, using them can be a challenge.
A vaginal ring, an insertable silicone device that releases antiretroviral drugs Drugs and must be changed every month, can reduce the risk of HIV The infection rate is as high as 50%. But “it won’t be to everyone’s liking,” Dr. Bekker admits.
daily PrEP pills, which contain antiretroviral drugs Drugs that have been used in Africa for many years. But determining its effectiveness has been tricky because few women have consistently used it even in clinical trials.Some studies estimate that, when used correctly, these pills can reduce the risk of HIV The infection rate is as high as 90%. But it can be difficult to take the drug discreetly at work or school, or to hide it from a parent or boyfriend.
If people think they take the pill because they have HIVMany people, especially young people, are not very good at remembering to take their pills every day, Dr. Bekker said. “They had enthusiasm, they started, but quickly lost their will,” she said. Some people also choose to take the medication only before and after sex. A study of 427 girls and young women in Africa published in 2019 found that a year after starting such preventive measures, only 9% had blood levels of the drug that indicated they were still taking it regularly.
The most promising option is the injectable form PrEP. This contains a long-acting form of cabotegravir, which stops an important phase of replication HIV in the host cell.It is given as an injection, initially once a month, then every two months, and is listed by the World Health Organization on HIV prevention last year. It was nearly 90% more effective than oral medication in clinical trials on African women PrEPRegulators in Zimbabwe and South Africa approved it late last year; other African countries are expected to follow suit.
The injectable birth control pill is already the most popular form of birth control in Africa, so women in the region are likely to opt for it PrEP Easier than a vaginal ring or pill. A more convenient version is in clinical trials. Lenocaprivir, which is injected every six months, is in late-stage trials. Unlike cabotevir, which is given intramuscularly, lenocaprevir is given subcutaneously. This means it can be administered by community health workers rather than nurses, or even self-administered. Its timing will also align with the most popular injectable birth control pill, which is taken every three months.Women who go to family planning clinics can get their HIV was also shot, and “no one is going to know about it,” said Nina Russell of the charity Bill & Melinda Gates Foundation.
The impact can be significant.The model was published earlier this year in Lancet Introducing injectable cabotegravir in sub-Saharan Africa finds nearly PrEP to 46% of those who needed it, and about 28% if it hadn’t been introduced.The authors estimate that this would prevent 29% of new HIV Infected for more than 20 years and brought cases to HIV– Elimination threshold of 1 new infection per 1,000 people.
Much depends on the cost of the injection PrEP. this Lancet The study estimates a one-year supply of cabotegravir at about $60, which is about the same as the cost of the oral drug PrEPViiv, the company that makes the drug, says it will provide it at a nonprofit price to public programs in sub-Saharan Africa until a generic version becomes available, though it hasn’t revealed the price (it’s in the US). It has signed an agreement with the Medicines Patent Pool, United NationsSupported organizations that promote the manufacture of generic versions of patented medicines for poor countries. But setting up production in low-cost factories, perhaps in India or Africa, will take time. Meanwhile, African countries will need aid organizations to help pay for new medicines.
Long-term effects may take a while PrEP Drugs are everywhere in Africa. But here they are.With them, finally, the hope of ending this war HIV Epidemics on the continent. ■
