PrEP, which stands for pre-exposure prophylaxis, is the use of medication that radically reduces the risk of an HIV-negative individual getting infected through sexual contact with an HIV-positive partner. WHO recommends offering PrEP to anyone who is at substantial risk of HIV infection. Groups considered at risk include men who have sex with men, sex workers and people who inject drugs.
Following an individual assessment, PrEP may be recommended as an additional prevention choice in a comprehensive package of services that includes safer sex practices, condoms, early HIV testing and counselling, and full access to treatment for everyone living with HIV.
PrEP recently became available in Ukraine, and for Georgii Onyschuk, a 29-year-old marketing professional from Kyiv, it has become a normal part of life as a young gay man.
“I’m pretty sure the first time I heard about it was 7 or 8 years ago on gay dating apps – some people say they are on PrEP on their profiles and I was curious about what that meant,” he recalls.
“It was usually people from the United States because that is where it was rolled out first. I searched for it online and found out that PrEP was a pill that, if taken daily, reduces the chances of getting infected with HIV. I don’t think I believed it first. I also wasn’t a very big fan because it seemed to me that people who were on PrEP back then just used it as an excuse to have unprotected sex and I didn’t like that.”
The opportunity to benefit from PrEP came 3 years ago, when Georgii came back to Kyiv after living abroad. A worker at a nongovernmental organization (NGO) focused on health in the gay community, where he periodically got tested for HIV, told him more about PrEP.
Taking PrEP means having peace of mind
“He told me they were going to roll out PrEP in Ukraine and there would be a chance of getting it for free. He asked if I would be interested and I said I was. He put my name on the list and a few months later someone contacted me and told me the programme had started and asked me if I would like to participate. I said yes.”
Georgii describes the positive impact of this decision: “I have protected sex most of the time, but now and again something happens, you don’t have a condom or … it just happens. I was always worried about these situations later. There is a 3-month window to check if you got infected or not, and so for 3 months it would be on my mind and it’s not a nice feeling. It’s a mixture of self-blame, almost self-hatred, and anxiety – why did I do it and what do I do now? Many gay people are familiar with this, maybe not only gay people. Taking PrEP meant having peace of mind and not having the 3-month wait.”
“Once I started taking it, it just felt so natural,” he explains. “It’s 1 pill a day, I take it in the morning with my vitamins and I feel safer. … I hope I will never have to come off PrEP unless I decide to settle down and only have one sexual partner.”
Get some good advice
Georgii is keen to encourage and reassure anyone who might be thinking about taking PrEP.
“Do it! I had no side effects and I’m feeling good emotionally and physically. Get some advice – the more the workers in the gay health NGO explained it to me, the more I was open to it. Some people decline PrEP because there are myths and they think it’s bad for your health, but nothing feels better than being confident that you are healthy.”
Dr Masoud Dara, Coordinator for Communicable Diseases and Programme Manager for the Joint Tuberculosis, HIV & Viral Hepatitis Programme at WHO/Europe, commented: “It is encouraging to hear stories like Georgii’s, where he has been able to benefit from evidence-based advice and state-of-the-art treatment to protect his health and well-being.”
Dr Dara points out that, “Unfortunately, our latest data show that there were about 160 000 new diagnoses of HIV in 2017. Measures like PrEP can change this situation and reverse the epidemic that has claimed so many lives. We are therefore supporting more countries in rolling out and implementing PrEP.”
He notes that the regional consultation on 22–23 January 2019 in Berlin, Germany, presented a unique opportunity for countries and national and international partners to exchange experiences of implementing the WHO recommendations on PrEP.