Male Involvement Component Slows Down PrEP Uptake In Zimbabwe

POOR health seeking behavior by males, coupled with the patriarchal nature of society has slowed down the uptake of Pre-Exposure Prophylaxis (PrEP) in Zimbabwe.

By Michael Gwarisa

PrEP is the use of Antiretroviral (ARV) drugs by HIV-uninfected persons to prevent the acquisition of HIV before exposure to HIV. Most oral PrEP pills contain a combination of two ARVs- tenofovir disoproxil fumarate (TDF) and emtricatabine.

According to data that was shared by the Zimbabwe Association of Church related Hospitals
(ZACH) during a virtual media  briefing on PrEP, the uptake of PrEP by females is almost double that of males and in some instances, women have to seek to male consent in order to be initiated on PrEP.

Dr Annamore Mutisi, the ZACH  Technical Advisor (HIV Prevention Care and Treatment-Faith Community Initiative said PrEP uptake has been high in females as compared to males and Zimbabwe was yet to surpass the 40% mark in terms of males who have been initiated on PrEP.

From 2020 to 2021, we have been on a good steady increase of the number of clients who have been initiated on PrEP as well as the number of clients who been maintained on PrEP. We have been increasing the number of PrEP initiations which means we have been improving our numbers overtime.

“However, what’s worrisome is the comparison between females and males. The uptake of PrEP by Females in comparison to uptake by Males is almost double as 66% of clients initiated on PrEP being female versus 34% Males overall out of the 934 clients were initiated between  the July 2020 – December 2021 period,” said Dr Mtisi.

She added that there was need for male involvement and from July 2020 to Sept. 2021, the composition of the Clients on PrEP was maintained a 1:2 ratio for males versus female enrolled on PrEP.  In general, the uptake and continuation of PrEP is higher in Females than in males.

“The importance of male involvement in the uptake of PrEP in Zimbabwe is high as some of the challenges in uptake of PrEP by eligible clients have included a male involvement component. Poor uptake of PrEP by Males (34% Males versus 66% Females across ZACH supported sites). Eligible Females at times are not able to take up PrEP due to lack of/need of permission from Male partner/Husband.”

Zimbabwe commenced rollout of oral PrEP program in 2016 in bid o widen HIV prevention options for people that at high HIV infection risk. Zimbabwe National HIV Guidelines included a single daily oral PrEP pill containing 300mg tenofovir disoproxil fumarate (TDF) as part of HIV Prevention intervention. It can be used as a fixed-dose combination with 200mg Emtricitabine (FTC) or 300mg Lamivudine (3TC).

Dr Takunda Sola, the HIV Prevention and Key Populations Medical Officer in the Ministry of Health and Child Care (MoHCC) said 2021 saw an improvement on the number of people initiated on PrEP as the country surpassed the target despite COVID-19 hindrances. Lockdown restrictions

“In 2018, we had  a target of 10, 500 individuals whom we intended to initiate on PrEP but only 26 people actually took up the interventions. In 2019, 8,650 people actually took up PrEP at one moment or the other. In 2020 we had 13, 351 people that took up PrEP as an intervention. In 2021, the country actually did well in terms of PrEP uptake despite the lockdown,” said Dr Sola.

In 2021, a total 40, 395 people took up PrEP and the country surpassed the target they had
set for PrEP uptake from that period.

“What that means is that we have made a lot of strides in terms of PrEP but what it also means is that we have a lot work to do to ensure that people that are high HIV risk actually take u the interventions.”

Meanwhile, there are currently 1.3 million people living with HIV in Zimbabwe and young women make up the biggest number of new infections compared to males. Getrude Ncube, the National HIV Prevention Program Coordinator in the Ministry of Health said

“In 2020, our estimated infections were about 25,000 and for the young women aged 15 to 24, it’s about 7,200, and young men aged 15 to 24 about 2,300. There has been a decrease in HIV prevalence but if you look at the provinces in the Southern parts of the country, you find that HIV is still a very big issue.

“As a country, we are now looking at combination HIV prevention strategies and these combinations are there to achieve a sustained reduction in the new infections. We are looking at structural interventions, we are looking at behavioural interventions and we are looking at biomedical interventions,” said Ncube.

HIV and AIDS emerged as a public health threat in Zimbabwe in the mid-1980s, and remains one of the top heavily burdened countries. In Zimbabwe the epidemic is largely driven by unprotected heterosexual sex, with growing epidemics among key population groups at higher risk of HIV.





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