May 22, 2008
PEP, little-known HIV wonder drug
By Elizabeth Kameo

Mulago Hospital, being Uganda's biggest referral hospital, has always been known for huge numbers of patients seeking affordable treatment.

In the same way, one would think that ward 5A annex, where rape and abuse survivors, among others, are meant to receive help in the form of PEP, would be filled to capacity.

PEP (Post Exposure Prophylaxis) is a course of anti-retroviral drugs which is meant to reduce the risk of sero-conversion after high risk exposure to HIV (e.g. through rape, unprotected sex, needle-stick injuries, or sharing needles).

But even with a clear writing on the wall, the number of people seeking PEP treatment at the hospital is low.
"Generally there is not much information out there on the availability of PEP. There is a need for sensitisation so people know that the drugs are free for everyone," says Sister Emily Nakirijja, in charge of the ward.

For rape and/or defilement cases, a Police report is not a pre-condition for one to get PEP treatment.
"PEP is supposed to be given within 72 hours where there has been high risk exposure to HIV," says Nakirijja. "When survivors report here, we examine them; children are sent to the paediatric ward and treatment starts."
Adults are tested and can access PEP at the private wing room 4B of the hospital, says Nakirijja.
PEP treatment involves taking anti-HIV drugs for four weeks after exposure and must be started as soon as possible.

The treatment can have unpleasant side effects, including malaise, fatigue, diarrhoea, headaches, nausea and vomiting. But Anna Boto, a pharmacist at the International Hospital Kampala (IHK), where PEP is also administered free, says the advantages outweigh the side effects.
At IHK, counselling is also provided for rape and defilement survivors who seek PEP.

"Drugs are given free of charge since we get them from the Ministry of Health, we only charge for the doctor's consultation," says Boto.
PEP has been available for HIV prevention since the early-to mid-1990s for health workers who reported 'needle-stick' or similar injuries.

While the country's health guidelines on PEP provide for treatment of rape and or defilement survivors if it is assumed that the perpetrator is HIV positive, there is little information available to the public on how to access the drug.

As with other medications, the right amount of the drug should be taken and PEP works best when the right dose is taken at the right time, without missing doses.
Taking 2 or 3 anti-HIV drugs everyday for 4 weeks might stop the HIV before it gets a permanent hold in the body.
Since it takes time (hours or a few days) after HIV gets in someone's bloodstream for it to permanently affect them, it is believed that acting in that short gives one a good chance to stop HIV infection.

Drugs taken for the PEP regimen are the same 'combination therapy' taken by HIV-positive patients.
Dr. Ian Clarke of IHK says people need to know that the drug is available and also know what constitutes rape so they can seek treatment. "Most village women won't cry rape if someone they know raped them, so they may not seek PEP treatment," he said.