Hookers using anti-HIV drugs instead of condoms

In Zimbabwe, 1.2 million people are living with HIV, and there are around 100,000 new infections every year. Despite this, some sex workers are having unprotected sex - and taking antiretroviral drugs afterwards to cut the risk of infection.

"Let me tell you the truth about why many of us don't use condoms," says Sheila, who has been a prostitute in Mufakose slum for six years. We don't have money, and when you meet a client who offers to give you more money than you usually get, you have sex without protection even when you don't know his HIV status."

Sheila says she and other prostitutes can go to a clinic the next morning to get emergency anti-retrovirals, drugs that suppress the virus, if taken within 72 hours of infection.

"We use this medicine like condoms," says another sex worker, Pamela.

"It is intended to be used in emergencies. For example, it is given to victims of rape if their attacker is thought to be HIV-positive, or to medics who have been pricked by a potentially infected needle."

Some clinics will only give clients one course of PEP a year. They worry that if they hand the drugs out too freely, prostitutes will stop using condoms altogether.

This hasn't stopped Pamela using PEP four times in the past year.

"I didn't go to the same clinic where I got the first PEP tablets. I went to a different clinic where they don't have my records and lied that I was forced into unprotected sex," she says.

She didn't finish the full course because of the side-effects. "You feel bad, like vomiting, dizziness, and generally you just feel sick," she says. "So I stopped taking them."

Experts at the Aids Council of Zimbabwe say there is a place for anti-retrovirals among sex workers, but only when used in the right way.

"We know that despite fairly high rates of condom use in many sex-work communities, we still have very high rates of HIV so we need additional tools as well as what's already happening," says one expert, adding that emergency use of PEP was not the best approach

Instead, says the Council, it would be better for prostitutes to take a type of anti-retroviral designed to be taken before exposure to HIV, known as pre-exposure prophylaxis (PrEP).

These are taken daily, and contain fewer drugs than PEP, so there are fewer side-effects. But Dr Chiura, a specialist in HIV and AIDS related illness, says "they must be used as part of a wider package, including regular HIV testing to make sure that the patient is on the correct medication".

There are plans to run a pilot programme with sex workers in Zimbabwe to see if it could be practical for them to use PrEP as an extra layer of defence.

"Condoms are the single most effective way of preventing HIV, sexually transmitted infections and pregnancy," says Chiura. "PrEP is not a silver bullet that will suddenly take away all those other issues."