Six short videos were released last week describing how a Kenyan nonprofit organization tackles one of Africa’s toughest missions: helping young women protect themselves against H.I.V.
The videos, by LVCT Health and posted on the PrEPWatch website, are funded by American foreign aid and the Bill & Melinda Gates Foundation, part of an effort to get PrEP — pre-exposure prophylaxis — to African women.
Even though PrEP, in the form of a pill containing the anti-H.I.V. drug tenofovir, is over 99 percent effective when taken every day, it has been an uphill battle even to get gay American men to embrace it. (In the United States, the pill is sold as Truvada.)
South Africa and Kenya have both adopted it, but donors worry that it will be even harder for African women to accept, for many cultural reasons. The history of H.I.V. prevention in Africa, especially for women, has not been encouraging.
There is still no vaccine. Abstinence, fidelity and both male and female condoms have failed to turn the tide despite 30 years of often controversial publicity campaigns. Circumcision protects men, which in turns protects women — but it is expensive, and many men shy away.
Vaginal gels and rings releasing H.I.V.-killing drugs have failed in clinical trials — not because they don’t work, but because many trial participants threw them away and only pretended to have used them. In later interviews, the women said they feared being beaten by their husbands or boyfriends, or being gossiped about by neighbors who would accuse them of being promiscuous.
Protecting women is harder for purely physical reasons, too. Tenofovir reaches much higher concentrations in rectal tissue than in vaginal walls; a gay man can miss three doses a week and still be 96 percent protected, but a woman who t misses more than one dose becomes virtually defenseless.
The videos, created to help other African nonprofits roll out PrEP, describe how counselors from LVCT — which was founded in 2001 by the Liverpool School of Tropical Medicine — tackled various obstacles. For example:
* Because young women are afraid to be seen entering H.I.V. clinics, testers went door-to-door in villages and then found nonmedical places like schools in which to explain PrEP to small groups.
* Because women feared being caught with the pills, counselors taught them how to hide or disguise them.
* For working women, LVCT Health kept its clinics open at night; for those afraid of doctors, it arranged support groups led by counselors who gave out their own cellphone numbers.
* Because many PrEP users drop out in the first month because of headaches or diarrhea, the support groups included veteran users offering reassurances that the side effects usually disappear quickly.
* Perhaps most important, because even infected men sometimes forbid their wives or girlfriends to use PrEP, thinking it promotes promiscuity, LVCT had male counselors visit village chiefs and meet one-on-one with recalcitrant husbands. The best tactic with a stubborn man, one counselor said, was to ask who would raise his children if his wife died of AIDS.
PrEP distributors need to think less like doctors and more like salesmen, said Mitchell J. Warren, executive director of AVAC, a New York-based H.I.V.-prevention advocacy group working with LVCT Health.
“It needs to be marketed in ways that make it sound sexy and pleasurable,” he said. “Just saying ‘Take PrEP every day to prevent H.I.V.’ is the quickest way to make sure no one takes it.”
Mr. Warren spent years trying to get female condoms accepted in Africa, but failed because they were perceived as unpleasant or for use only by prostitutes.
“We should be learning lessons from what worked or didn’t work before,” he said. “We’re refighting a lot of the old battles.”