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** PrEP "Cycling": The dance of oral PrEP
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June 17, 2021

Dear Advocate,

The landscape for PrEP is in the midst of transformation, with opportunities to understand and improve HIV prevention. With increasing numbers taking oral PrEP and new products on the horizon, such as the Dapivirine Vaginal Ring and long-acting cabotegravir, the world must get rollout right. There are vital lessons to learn from how people use oral PrEP and critical questions to answer. AVACer Jeanne Baron’s blog, PrEP "Cycling": The dance of oral PrEP ([link removed]) , explores one key lesson from today’s PrEP-users that could mean a new definition of success with PrEP.

And be sure to check two recent reports from AVAC’s Prevention Market Manager (PMM) ([link removed]) project and Jhpiego ([link removed]) , Evaluating, Scaling up and Enhancing Strategies for Supporting PrEP Continuation and Effective Use ([link removed]) and Defining and Measuring the Effective Use of PrEP ([link removed]) which offer key recommendations for this evolving field.

PrEP "Cycling": The dance of oral PrEP
By Jeanne Baron

Oral PrEP, a daily pill first approved by the FDA in 2012, has changed a lot of things for the better for Josephine Aseme. At the start of 2021, more than a million people had at least started PrEP at some point since 2016 ([link removed]) —it's movement in the right direction, but still shockingly short of the global target to reach at least three million people in that time-frame. Still there’s no question, it’s an essential HIV prevention option for Josephine and for many of the 12,000 women in the organization she founded in 2015 for women at risk, the Nigeria-based Greater Women Initiative for Health and Rights ([link removed]) .

As a leader for sex workers’ rights, an advocate for poor and vulnerable women, an AVAC Fellow ([link removed]) and a sex worker herself, Josephine says she began taking PrEP in 2017 and quickly understood this pill would change her life. “PrEP really made a big impact for me. Clients cannot be trusted; they will deliberately misuse condoms, and I may not notice or be able to stop them. I was always scared of HIV. PrEP came along and empowered me to know that I can stay [HIV] negative.” So why is it that many PrEP users, including Josephine, sometimes “cycle off” PrEP, at least for a time? Understanding this question is imperative.

PrEP only works if you take it. For years, public health messaging, programs, services and data collection have attempted to reflect this fact of biology. A person has to have a certain level of drug in their body to be protected. This means that missed doses and missed appointments for refills, days and weeks not taking the preventive medication, represent a challenge, if not a serious problem. This in turn has led many to consider the discontinuation of PrEP as a potential failure; of programs and policies, of leadership and decision-makers, or even of users.

But the conversation is changing and stories from PrEP champions like Josephine, as well as data from studies, are leading the way. Josephine has counseled countless women on the potential benefits, risks and use of PrEP, and she herself has dropped her daily pill for periods of time only to later pick it up again.

A growing body of research about what’s behind this “cycling” points to a cross current of pressures. Many have been documented and are clearly barriers to PrEP use: side effects, stock outs, fear of disclosure to partners and family, stigma and access issues, among others. But some people consciously choose to stop taking their pills, keen to give their bodies a rest from daily medication as they enter a period of their lives when HIV’s shadow is not so long.

While programs must have the resources to deliver PrEP to everyone who can benefit from it, a conversation with Josephine Aseme suggests there’s much to learn and understand about these patterns of use, and how policies and programs can support people to take PrEP when they need it.

Read More ([link removed])

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