Perfect pill
"This would be the perfect pill to protect my girls," he said.
According to the Centres for Disease Control and Prevention (CDC), PrEP is a medication that people take orally before sexual contact and reduces the risk of getting HIV by about 99 per cent. In 2015, the World Health Organisation (WHO) recommended oral PrEP for people at risk of getting infected by HIV. According to Dr Rose Wafula, the head of Nascop, people at risk include adolescents and young women.
This is how PrEP works, according to the CDC. It is taken before sexual contact, and it interferes with viral infection and its multiplication. It contains the drug Truvada, which is a combination of two medications emtricitabine and tenofovir disoproxil fumarate.
After learning about PrEP, John took his girls to Migori Level 5 Hospital again.
"They were tested, and when they turned out negative, the nurse educated them about how to take the medicine," John said.
John's fears do not occur in a vacuum.
At their age, below 25, young people cannot negotiate for safe sex.
Several studies that have involved the magnetic resonance imaging (MRI) of teenagers have shown that the prefrontal cortex - the part of the brain that controls impulses and complex reasoning - has not developed.
Ruth Nduati, a professor of paediatric medicine at the University of Nairobi, has repeatedly said that with brains still developing, teenagers and young people cannot negotiate or choose safe sex.
In 2015, the National Syndemic Diseases Control Council (NSDCC) reported that more than half (51 per cent) of all new HIV infections in Kenya occurred among young people aged between 15 and 24 years. The Ministry of Health reported that in 2022, there were 22,154 new HIV infections. One in five of the new infections (4,464) were in children under 14 years.
Biological reasons aside, poverty makes it impossible for young men and women to negotiate or choose safe sex.
Public health
The government has heightened public health campaigns promoting PrEP. Uptake has been steady but not as fast as the Ministry of Health targets.
In 2016, the government reported, less than 10,000 people were on PrEP. The number increased by more 4,000 per cent, to 438,003 users in December 2023.
Dr Patricia Ong'wen, a physician and HIV researcher at the Johns Hopkins Affiliate, Jhpiego, said that the queues, the lack of privacy, stigma, and the few staff at the health facilities discourage people from taking PrEP.
In response, and in another oddity like John's decision to encourage all his daughters to PrEP, Kenya is considering using private pharmacies to offer PrEP.
"Pharmacies can sort out the issues of privacy, distance and long waiting times because they are everywhere and they are already part of Kenyans' health-seeking behaviour, where they buy medicines," said Dr Ong'wen. As of May 2024, there were 7,425 active registered retail pharmacies in Kenya.
There were 2,391 active registered pharmacists (with a Bachelor of Pharmacy degree) and 9,471 pharmaceutical technologists, adequate numbers that can serve people without the worry about queues.
Dr Rose Wafula from Nascop said PrEP is now available free of charge in health facilities and Drop-In-Centres -these are clinics where one can pop in and pick PrEP and only serve men who have sex with men and sex workers.
The use of pharmacies makes Kenya among the first in the continent to adopt the World Health Organisation (WHO) evidence.
Two years ago, seven years after endorsing PrEP, the organisation saw the additional barriers that patients faced seeking PrEP from brick-and-mortar facilities.
Young women
The hospitals have queues and are not accessible to those who do not identify as a key population but are equally vulnerable to HIV infection such as adolescent girls and young women.
WHO then recommended that countries should deliver PrEP in a way that it meets people whenever, wherever. Pharmacies were floated in technical Working Groups, the little committees of experts that the government gathers to give answers to a particular problem.
Like all medicine, it is not as easy as decide and offer the next day.
Researchers had to show how the pharmacists would be integrated into the current algorithm of offering HIV care.
Besides, the country's regulation forbade pharmacists (degree holders) and pharmaceutical technologists (diploma graduates) to prescribe medications. They could, however, screen for HIV and other diseases and provide both prescription and over-the-counter medicines.
Dr Patricia Ong'wen, who is also the deputy director of a consortium of researchers called PharmPrEP, worked with other researchers and Nascop to test whether pharmacists would offer quality services.
The study which ran from 2022 to 2023 evaluated the effectiveness of using pharmacies to deliver PrEP in six counties with high numbers of HIV: Kiambu, Kisumu and Migori, Homa Bay, Nairobi and Siaya.