Important note: Information in this article was accurate in 2008. The state of the art may have changed since the publication date.
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New Vision (Kampala) - November 9, 2008
Cathy Watson**
But anyone could see what she was feeling: shock, bewilderment, fear.
As I studied the photo, I wondered: Did anyone offer her PEP?
PEP stands for "post-exposure prophylaxis". "Prophylaxis" is an emergency short-term disease-specific treatment to reduce the likelihood of a particular infection.
That is quite a mouthful. But "PEP", as we most need to know it, is a 28-day course of ARVs taken after someone has been exposed to HIV.
If started within 72 hours of the exposure (and the sooner the better), PEP is highly effective in preventing HIV infection.
The ARV drugs block the virus from infecting a CD4 cell. So the virus cannot "take root" and start replicating itself in the body.
The Ministry of Health's "National Policy Guidelines on Post Exposure Prophylaxis for HIV, Hepatitis B and Hepatitis C" were published in November 2007. They explain that the exposure can be "occupational" - a midwife may accidentally stick herself with a used needle or a sexual assault or car accident where the blood of fellow passengers enters your wounds.
I first started thinking hard about PEP last year when I read an article about the Gender Violence Recovery Centre at Nairobi Woman's Hospital. Since it opened in 2001, the centre had given PEP to 6,500 people: 45% of them were girls aged less than 16 and 4% of them male. I tore out the article and kept it in my bag.
Then in January, I was in Nairobi. It was the height of the post-election violence and I took a taxi to Nairobi Women's Hospital. Clutching a Straight Talk annual report and explaining that I was a nurse, I introduced myself.
Sister Susan Maina took me around. On one bed was a man, aged 60, who had been sodomised by a gang of 11 young men. He anxiously thanked Sister Maina, who explained that he had just started PEP.
In another room was a toddler of two. Truly, sometimes our imaginations fail us: her rape had ripped her vagina through to her anus. She was on PEP and recovering from reconstructive surgery. Doctors had diverted her intestines so that her faeces emptied into a bag on her abdomen.
Then there were 14 females, aged 15 to 70, also on PEP.
As we walked around, Sister Maina said her unit had trained most hospitals in Kenya on PEP and that, as we spoke, 400 volunteers were in internally displaced people's camps in the Rift Valley, seeking out survivors to help. Of the 7,000 some people that her unit had assisted, only two had become HIV-positive. They had probably been in the window period and already infected, she said.
I left shaken and moved.
Four months later, Straight Talk was able to bring staff from Nairobi Women's Hospital to Gulu. Working with the district medical oficer, Dr Paul Onek, they trained 42 Straight Talk and district staff.
Since then, our Gulu Youth Centre has supported six young people through PEP: girls aged six, seven, 14, 15 and 19; a young woman aged 22; and a young man aged 20 who was bitten when breaking up a fight. In this, we were helped by medical workers at the Joint Clinical research Centre Gulu, Gulu Referral Hospital and Lalogi Health Centre
So although forced sex is always very bad news, PEP is very good news. Uganda has an excellent PEP policy, and any of the 279 health units that have ARVs can provide PEP. At an absolute minimum, no child need ever get HIV after defilement anymore.
Straight Talk is currently producing radio shows on PEP in 14 languages. Because PEP has been so little talked about, we were not sure what we would find in the field. In fact, we have found health workers very articulate about PEP and implementing it from Koboko to Busia, from Soroti to Kanungu. What is lacking is public knowledge.
When we approached the Ministry of Health to learn more about PEP, the senior medical officer, Dr Betty Kasanka, could not have been clearer. "If you are raped, PEP is your first priority," she said. "PEP is free for rape survivors."
** The writer is the executive director of Straight Talk Foundation
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