The lost shield: PrEP crisis hits discordant couples, sex workers

Post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP) at the Kitengela sub-county hospital, on February 27, 2024. [File, Standard] Mary Auma chose love with open eyes. At just 19, she married a man living with HIV-armed not with denial, but with determination and daily doses of Pre-Exposure Prophylaxis (PrEP), the pill she believed would shield her from infection. But now, a year later, that shield is cracking. Since their marriage in early 2024, she has relied on PrEP- a medication taken by HIV-negative individuals before sex to reduce the risk of transmission from an HIV-positive partner. Auma believed PrEP would always be available, allowing her to maintain her HIV-negative status while enjoying a healthy marriage. But the once-reliable supply of PrEP, has dried up, and with it, Auma's sense of safety. In a small village in Homa Bay County, she sits in quiet anguish, torn between her commitment to her husband John Ooko and her growing fear of contracting the virus. "I knew the risks when I said 'yes' to a man living with HIV, but I also knew there was protection," she says. "The inability to access the PrEP is deeply troubling. I want to remain HIV-negative and still be with my family. Now I don't know what to do." She worries that the situation may reopen wounds caused by the stigma she faced from her own parents when she first disclosed her partner's status. "When I shared my husband's status with my parents last year, they strongly opposed the marriage," she recalled. Her parents even cut off communication when it became clear she had no intention of leaving him. Their anger has since cooled, but her concerns remain. "I withstood their pressure because of PrEP. I love my husband, but today I'm in a very difficult position," she said. Ooko explained that condoms haven't worked for them as a couple trying to expand their family. Love tested "We've tried using condoms, but they're not effective for us - we want a second child. Our son is now seven months old. How is that possible without PrEP?" Ooko asked. He described the PrEP shortage as a major setback. "Auma showed me true love even when her parents wanted us apart. I'm indebted to her. I don't want her to become infected. I'm appealing for the consistent supply of PrEP," he said. Auma and Ooko's story is emblematic of the growing struggles faced by discordant couples across Kenya due to the shortage of PrEP. The situation is equally dire for sex workers, who rely on PrEP as a frontline defence. Nancy Atieno, a sex worker based in Homa Bay Town, said PrEP is no longer as readily available as it was last year. "It's become increasingly difficult to access the drugs. We used to get PrEP in good supply at various hospitals, but now it's scarce. Only a few people manage to obtain it," Atieno said. She added that the shortage affects her work and income. Atieno warned that the unavailability of PrEP is putting sex workers and other vulnerable groups at serious risk of infection. She says she at times turn down some clients who want unprotected sex due to lack of PrEP. "I've had to turn down clients who want unprotected sex because I don't have PrEP. That affects my earnings," she says. "Unprotected sex pays better. People are in this business to make money, so most of my colleagues end up going without protection even when they don't have PrEP. That's how HIV spreads," she said. Recent statistics confirm the alarming trend. According to data presented at a training organised by the Media for Environment, Science, Health and Agriculture (MESHA) in Nairobi, PrEP initiation in Kenya dropped by 49 per cent - from 55,876 initiations between January and March 2024 to just 28,648 during the same period in 2025. The sharp decline has been linked to funding cuts by the United States government, following the disbandment of the United States Agency for International Development (USAid) programmes that once supported HIV prevention and treatment. Alternative funding Justus Ochola, Homa Bay County Department of Health's Co-ordinator for Research, Learning and Innovation, warned that the shortage is threatening hard-won progress in Kenya's HIV response. "The drop in PrEP supply exposes more discordant couples and sex workers to new HIV infections. The virus will inevitably spread to other groups in the community," Ochola said. He added that adolescents and young adults, being sexually active, are also at risk. He urged county governments to make an alternative budget line for purchasing PrEP. "Health is a devolved function and county governments should put an alternative budget line for purchasing drugs. They should also intensify anti HIV infection campaigns in the community. Failure to do so will escalate HIV infections," Ochola said. Patricia Jeckoniah, LVCT Health Programmes Manager for Policy, urged both the government and private sector to devise sustainable, domestic solutions to fund HIV interventions. "We mustn't allow more people to contract HIV simply because foreign funding has dried up. This is the time for public-private partnerships to ensure our health system can meet the needs of Kenyans," she said. She also called for increased sensitisation efforts, particularly among adolescents and young women, to reduce new infections. Names of Auma, Ooko and Atieno have been changed to protect their identities.

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