HIV is passed on through blood, semen, vaginal fluid, anal mucus and breast milk, if the person with the virus has a high viral load. Once you get it, there is no effective cure. You have to take antiretroviral (ARVs) treatment for life to avoid deteriorating into AIDS and death.

However, there is medicine you take after you have been exposed to a possible HIV infection to stop the virus from entering your body cells and taking hold. It is referred to as HIV post-exposure prophylaxis, or HIV PEP.

PEP is a short course of HIV medicines taken soon after a possible exposure to HIV. It was initially reserved for medical workers who would accidentally expose themselves to infected body fluids, especially blood. Now it is available in Uganda for anybody who is scared of a possible infection to access it.

According to the Ministry of Health, anyone who believes that they have been exposed to HIV infection can go to the next health centre for PEP. For example, if you have had unprotected sex with a person whose HIV status you do not know, you can go for PEP. Or if your condom ruptured during sex with a partner of unknown HIV status or a partner with HIV.

Dr Stephen Watiti, who has been working with people living with HIV since 2004, says PEP has been a four-week course of the drugs, taken soon after a person has been exposed to the virus, until new innovation in medicine brought it to just one tablet.

“The master card here is 72 hours. But, as a doctor, I encourage you to go as soon as possible. The sooner you start PEP after a possible HIV exposure, the better,” he says.

Dr Watiti, an HIV activist who is also living with HIV, says PEP is effective in preventing HIV infection when it is taken correctly, but it is not 100% effective. The best way of protecting yourself from HIV is to abstain, be faithful and, if you cannot, test to confirm the status of your sexual partner or use protection during sex.

Dr Augustine Lubanga, the national medical director of Uganda Cares, says they offer PEP to anyone who qualifies. And, to qualify for PEP, you must be HIV-negative. However, a few people show up for it.

“Uganda Cares at Kira Road Clinic registered 110 people who came for PEP in the three months of July, August and September. This is low. Seventy-seven of these were men and 33 were women. We know that women are statistically at a higher risk and wonder why their intake of PEP is low,” he says.

Taking PEP

Many reasons have been advanced for low PEP uptake and these include lack of awareness, possible bad side effects, unfriendly health caregivers and the lack of counselling.

Going through the process

To confirm or disprove these theories, I decided to take PEP myself.

On Monday morning, October 2, I went to Uganda Cares to experience PEP. My first discovery was from a bodaboda rider I asked to drop me off at Uganda Cares.

He responded: “Ogenda wali awa ba siriimu?” (Are you going to the clinic for people living with HIV?).

That alone was stigmatising and intimidating. I imagine if I did not want to be associated with HIV, or if the bodaboda man knew my girlfriend, I would have found the ride a prohibiting factor.

I was at Uganda Cares at 8:17am and asked the receptionist for PEP. She said I had to see a counsellor first and directed me to someone who was busy attending to a client. I was asked to wait.

Meeting the counsellor

I told her I had unprotected sex and my female partner could be positive. She gave me that admonishing look and responded: “You cannot see a counsellor after you have had sex. You are supposed to see a counsellor before you have sex. Uganda Cares is always open Monday through Friday. We sit here waiting for you and you do not come. You only come after sex.”

As I was rolling off several apologies, she continued: “Where is she now, the lady you slept with? You are supposed to come with her.”

I told her that I did not know where she was.

She continued: “I don’t feel sorry for those that come after sex because these services are here, free of charge: condoms, self-testing, and counselling. Why didn’t you test before sex?”

I just kept quiet, gazing at her. I realised that this is another barrier. An admonishing counsellor would be too much for a person who would have gathered courage to go for HIV services.

She then took my details, asked me when exactly I had sex and, picking a needle, she declared that they had to test me for HIV first to see if I qualified for PEP. Taking an HIV test could also be a barrier for people who are not sure of their status. It always has this scare: What if I am positive? Even for me, it was scaring.

My test was negative, so she qualified me for PEP. On my way to the pharmacy, I learnt that my counsellor was called Agnes Akello.

Experts explain

Dr Watiti says my experience must have been because I had not eaten something substantial. He thinks the people who gave me PEP should have explained the likely side effects and how to contain them.

“PEP should only be taken after eating something. The common side effects include nausea and vomiting. I always advise my clients to drink a lot of water — at least two litres a day. Some long-term side effects include weight gain and diabetes. You should eat healthy foods and do a lot of exercise,” he says.

Dr Joseph Ahimbisibwe, who works with Uganda Cares at the Naguru Hospital HIV Clinic, says PEP side effects are expected to last for one day.

“We don’t give the standard PEP to people with diabetes. That is why we ask patients about their other diseases or medications they are taking. It is always good not to hide anything from the doctor. If you have diabetes, we can give you another drug that can also help,” he says.

Dr Ahimbisibwe adds that after PEP, they expect to see the client again after seven days to assess the impact of these drugs on their body.

“If the side effects have persisted, we then put them on other treatments and drugs,” he says.

Effectiveness of PEP

Dr Ahimbisibwe says for all the time he has administered PEP, he has not registered anyone with bad results or a failed PEP that gives a positive HIV result.

“PEP works 99%, especially with this new three-in-one tablet. It has less side effects and is more effective when one comes in time. Earlier PEP had tablets that had to be taken for 28 days without skipping,” he says.

However, the two doctors advise against reckless sex just because there is PEP. Unprotected sex, they say, still exposes you to other risks such as sexually transmitted diseases.

Dr Augustine Lubanga, the national medical director at Uganda Cares, says PEP should not be associated with reckless sex. It is supposed to also help victims of rape, shared sharp objects, road accidents or fights where blood mixes or where you find yourself biting someone whose status you do not know. Even the bitten person should take PEP.

According to the latest report from the Uganda AIDS Commission, 1.4 million people are living with HIV in Uganda and 1.2 are on ARVs. The majority of these are teenage girls, aged between 15 and 25, contributing to 70%.

PEP is free of charge at all government health centres and HIV prevention clinics. In private pharmacies, it can go for sh40,000 to sh150,000. Last year, Uganda recorded over 52,000 new HIV infections. Some of these could have been stopped by PEP.

Taking my PEP

The pharmacist gave me one tin with a prescription of 1x1 and told me to go back to the counsellor. Akello told me to take it and return on November 2.

I headed to the office and took out the tablet. It was big and so scary. I took it after having a cup of tea.

About two hours later, I began to feel funny. I felt dizzy, got fatigued and started sweating. My head started to feel heavy on me and I could also feel some headaches. Soon after, I got a stomach upset and it started grumbling. The bloating made me fart almost every five minutes.

It did not wane. I slowly became weaker and developed a fever. That scared me, especially when I realised that I had not taken my counsellor, Agnes Akello’s phone number.

I called another HIV counsellor from Naguru Hospital, who advised me to take a painkiller and, if the situation persisted, to see him the next day

Way forward HIV

service providers should work hard on stigma issues. People may fear HIV service centres once bodaboda people start identifying the places with stigma.

Counsellors should be trained to desist from blame and admonishing demeanour and just listen, empathise and help. They should also explain the possible side effects, how to handle them and the fact that the effects are temporal.

They should explain that the medicines are safe and approved by WHO for human consumption.