It is extremely difficult to notice the scars that 26-year-old Alice Soko (not her real name) carries with her every day through her daily routine at Mbare Musika in Harare.
Always polite and ever ready to dazzle passers by a friendly smile, no one would guess at the secret she hides.
Sometime during the 2015 festive season, Soko thought her life was over after she became victim to one of the most clichéd and dastardly acts known to human kind: rape.
On the day of this heinous act, her uncle came to her house and had his way with her.
Her unheard cries for help seemed to aggravate him, as he raped her repeatedly – three times to be exact – and threatened to hurt his aunt and another uncle who she lived with.
Fortunately, she did not contract any infections from him, largely thanks to the PEP programme she enrolled in soon after the incident.
But the scars remain.
Soko is one of many rape victims who have benefited from post-exposure prophylaxis (PEP). PEP is a month-long course of emergency medication taken to keep HIV from replicating and spreading through the body.
She shared her story last week.
“He forced himself on me without wearing any protection. I tried fighting him by all means but he overpowered me by twisting my arms and threatening to hurt me more,” Soko narrated, her smile fading with each word.
“It was so painful and I cried till my voice got hoarse. My deepest fear was contracting HIV from him.
“Although no-one had shown me any medical proof that he was positive, his health didn’t look too well.
“It happened on a weekend. My aunt and her three children had gone to their rural home in Mberengwa for the Christmas holiday leaving me alone to take care of their house.
“While they were away, my uncle, who is a brother to my aunt’s husband, came home saying he had been sent by my aunt to give me money to buy electricity tokens.
“It was around 1900hrs when he came home and he asked for something to eat after telling me that he was starving. I gave him some food which I had reserved for the following day. Later on, he told me that he wanted to sleep over and go back to his house the following day because he was tired, so I gave him some blankets and he slept in the dining room.”
She went on: “After I had already locked all the doors and locked myself inside my room, he came knocking on my door asking for more blankets. When I opened the door, that is when he forced himself on me.”
Soko said the following morning she went to a health facility in Mbare where she was assisted in making a police report.
That same day, she received counselling on HIV testing and was initiated on PEP treatment.
“At the clinic, I tested HIV negative and thus they initiated me on PEP where I took some pills for four weeks as a way of preventing myself from contracting HIV. The nurses also gave me an emergency contraceptive pill and they monitored me as I was taking my PEP,” she narrated.
“Three months after taking the PEP, I went back to the clinic where I had another HIV test and I came out negative.”
Needless to say, she was relieved.
According to the National Aids Council, PEP can only be effective if the victim is initiated within 72 hours of exposure.
“PEP is a procedure of taking ARV drugs for 28 days as a preventive measure after one has been exposed to the HIV virus,” said NAC monitoring and evaluation director Mr Amon Mpofu.
“It could be after being raped by an HIV infected person or maybe when one is exposed to the HIV virus through sharing sharp objects with an infected person.
“However, the procedure has to be done within three days after the exposure. The earlier one is initiated on PEP after exposure, the more effective the treatment becomes.
“Since one would have already been exposed to HIV, the pill has an effect of depriving the virus from progressing.”
He said anyone who thinks they may have been exposed to HIV should be tested for HIV first before being initiated on PEP because it cannot be given to someone who already has the virus.
While PEP is an HIV preventive measure for someone who may have been exposed to the virus, pre-exposure prophylaxis (PrEP) is a preventive measure before one is exposed to HIV virus.
PrEP is where people who are at substantial risk of getting HIV take anti-HIV pills or medication as a way of preventing themselves from contracting the virus before getting exposed.
Mr Mpofu added: “During PrEP, the pill is taken before the HIV risky behaviours and it is only effective within a day. As such people who are into HIV risky behaviours take the pill daily.
“We have organisations which give PrEP to sex workers because they are in a HIV-high risk demographic.
“However, we always urge people who use PrEP to also consistently use condoms.”
Although using PEP and PrEP is effective in HIV prevention, the drugs can come with side effects.
Mr Mpofu added: “The problem of using PEP and PrEP can come when a person who has been using the measure for some time gets infected by HIV.
Such a person can have some resistance to anti-retroviral drugs which are meant to suppress the virus.
However, to avoid such cases, the person should be put in different regiment from the one he or she was using on either PrEP or PEP.”
According to World Health Organisation, PrEP may either be taken orally, using an anti-retroviral drug available for treatment of HIV infection (tenofovir plus emtricitabine), or topically as a vaginal gel containing tenofovir.
“The efficacy of oral PrEP has been shown in four randomised control trials and is high when the drug is used as directed. The efficacy of gel has been shown in one trial and is moderate. Making these drugs available for safe, effective prevention outside the clinical trial setting is the current challenge,” says WHO.
In September 2015, WHO recommended that people at substantial risk of HIV infection should be offered PrEP as an additional prevention choice, as part of a comprehensive prevention plan.
Zimbabwe is yet to roll out the guidelines as part of its national Aids control programme, and the drugs are only available in private pharmaceuticals.
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