Pre-exposure prophylaxis (PrEP) is the use of oral antiretroviral medication (ARVs) by HIV-negative people to prevent HIV infection, and should ideally form part of a comprehensive package of voluntary HIV prevention services offered to all populations at substantial risk of HIV infection. PrEP should be prioritised for populations with an HIV incidence of about 3 per 100 person years or higher.
For this reason, PrEP should be offered to AGYW, or those in specific locations or those amongst specific sub-populations (such as sex workers and young sexually exploited girls), who meet these criteria. Programmes should seek to reach out to these AGYW, taking various factors into consideration to ensure effective services.
TOOL: Questions for consideration in PrEP programmes for AGYW
What delivery methods would work best for AGYW?
How can we reach out to AGYW who would benefit most?
How can we support AGYW to understand their HIV risk?
How can we improve AGYW’s ability to negotiate PrEP use with their partners?
How can we mitigate their risk of harm (e.g. gender-based violence) when using PrEP?
How can we promote adherence, while still ensuring services are voluntary?
The Pluspills programme in Cape Town and Soweto in South Africa offers oral PrEP to men and women aged 15–19 years. Adherence is supported through weekly or daily SMS messages, WhatsApp chat groups and PrEP adherence clubs. Young people assess their risk using an Internet app (the risk rater) that helps young people visualize their risk and the impact of prevention.
Post-exposure prophylaxis (PEP) uses ARVs to prevent HIV transmission immediately after an HIV exposure (ideally within 72 hours).
PEP should be offered to all AGYW who experience an HIV exposure that has the potential to transmit HIV, on the basis of voluntary and informed consent, with a full discussion of the risks, benefits and need for adherence.
In the event of sexual violence towards AGYW, PEP should form part of a comprehensive package of care that includes emergency contraception and counselling.
The organisation is able to work with national bodies to ensure that antiretroviral medicines for PrEP and PEP are registered for use, and that there are national guidelines for implementation.
The organisation is able to identify relevant delivery models for AGYW in the country context and make PrEP and PEP available through a range of different mechanisms.
The organisation has the capacity to develop and provide adherence counselling and strengthen social support.