In Kenya 1. Despite this, some sex workers are having unprotected sex - and taking antiretroviral drugs afterwards to cut the infection risk. How reckless is this? Sheila says she and other prostitutes can go to a clinic the next morning to get emergency antiretrovirals - drugs which suppress the virus, if taken within 72 hours of infection, and in many cases stop its progression. The type of antiretroviral in question is known as post-exposure prophylaxis, or PEP.
It is intended to be used in emergencies. For example, it is given to victims of rape if their attacker is thought to be HIV-positive, or to medics who have been pricked by a potentially infected needle. There are no definitive figures to show how well PEP works. It's far better, experts say, to prevent exposure to the virus in the first place, by using condoms. Some clinics will only give clients one course of PEP a year. They worry that if they hand the drugs out too freely, prostitutes will stop using condoms altogether.
This hasn't stopped year-old sex worker Pamela using PEP four times in the past year. I went to a different clinic where they don't have my records, and lied that I was forced into unprotected sex," she says. She didn't finish the full course because of the side-effects. Peter Godfrey-Faussett, senior science adviser with UNAIDS, says there is a place for antiretrovirals among sex workers, but only when used in the right way.
However, emergency use of PEP is not the best way to go about it, he says. Instead it would be better for prostitutes to take a type of antiretroviral designed to be taken before exposure to HIV - known as Pre-exposure prophylaxis PrEP. These are taken daily, and contain fewer drugs than PEP, so there are fewer side effects. But Godfrey-Faussett stresses that they must be used as part of a wider package, including regular HIV testing to make sure that the patient is on the correct medication.
There are plans to run a pilot programme with sex workers in Kenya to see if it could be practical for them to use PrEP as an extra layer of defence. Godfrey-Faussett stresses that the cheapest line of defence is, in this case, the strongest. Additional reporting by Alison Gee in London. By Zainab Deen. The drugs are not cheap, though.
