One morning in September 2020, Kwasi, a young Ghanaian man found himself at the fever's unit of Korle Bu Teaching Hospital (KBTH), not as a patient, but in search of antiretroviral (ARV) medication. He wasn't sick, but he feared he had been exposed to HIV. A friend had once been in a similar situation and had received the medication there. Confident that he was within the critical 48-hour window post-exposure, he approached the health worker, only to be met with anger and hesitation. The health worker was furious that someone had informed Kwasi about the availability of the drug and was reluctant to provide it.

I met Kwasi on his way back and what immediately struck me was his distraught and confusion. Kwasi’s experience left me questioning our approach to HIV prevention in Ghana. Are we truly focused on reducing the incidence of the virus, or are we merely content with treating those already infected?

According to the Ghana AIDS Commission, in 2023, there were 334,095 people living with HIV in Ghana. Despite various measures like education and free condom distribution, a survey I conducted revealed that about 90% of the people I interviewed were unaware that they could access ARVs as post-exposure prophylaxis (PEP). Interestingly, those who knew about it were mostly expatriates and tourists.

PEP involves taking ARVs shortly after potential exposure to HIV, ideally within 24-72 hours, and continuing the regimen for at least 28 days. On July 22, 2024, the World Health Organization (WHO) updated its guidelines to prioritize broader access to PEP, including community delivery and task sharing to ensure timely prevention. However, in Ghana, PEP is primarily used in healthcare settings, and many Ghanaians remain unaware of their eligibility for these drugs.

Cultural norms in Ghana often discourage individuals from seeking PEP. It is taboo to request ARVs, especially if one is unmarried, as society frowns upon premarital sex. This cultural barrier prevents many from accessing potentially life-saving medication.

Health workers may object to publicizing PEP, fearing it could lead to increased carelessness and irresponsibility. Concerns about the sufficiency of drug stock for both the infected and the exposed, the economic feasibility of importing more drugs, and the potential reduction in condom use are valid. However, denying PEP to exposed individuals could increase HIV incidence in the nation. Making these drugs available only to a select few is not a viable solution. In cases of rape, for instance, while emergency contraception is known, the need for HIV prevention is often overlooked.

If health workers react rudely to those seeking PEP, it discourages others from seeking help and spreading awareness. Are these health workers aware of their obligation to provide these drugs? This is a critical question that the Ghana Health Service needs to answer and provide needed training if the health workers are unaware of their obligation.

While increasing public awareness of PEP might lead to potential abuse and carelessness, these are rights that individuals possess. With proper education and monitoring, PEP can be safely integrated into society. Everyone has a right to healthcare, regardless of cultural or religious beliefs. Denying access to PEP based on these grounds is unjust.

In conclusion, targeted interventions such as community education, task sharing among healthcare providers, and ensuring a steady supply of ARVs are crucial. Addressing cultural barriers and stigma through sensitization programs can also help. While concerns about misuse are valid, they can be mitigated with stringent monitoring and regulation. Ultimately, the right to healthcare should prevail, ensuring that everyone has access to life-saving interventions like PEP.