Give Me Sex and Give Me Drugs. Condoms? No Thanks

In Kenya 1.5 million people are living with HIV, and there are about 100,000 new infections every year. Despite this, some sex workers are having unprotected sex - and taking antiretroviral drugs afterwards to cut the infection risk. How reckless is this?

"Let me tell you the truth about why many of us don't use condoms," says Sheila who has been a prostitute in Nairobi's Korogocho 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 antiretrovirals - drugs which suppress the virus, if taken within 72 hours of infection, and in many cases stop its progression.

"We use this medicine like condoms," she says.

The type of antiretroviral in question is known as post-exposure prophylaxis, or PEP.

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.

There are no definitive figures to show how well PEP works. It's far better, experts say, to prevent exposure the virus in the first place, by using condoms.

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 24-year-old sex worker Pamela using PEP four times in the past year.

"I had unprotected sex when I was very drunk one night and the following morning 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."

Peter Godfrey-Faussett, senior science adviser with UNAIDS, says there is a place for antiretrovirals 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," he says.

• Antiretroviral therapy (ART) - treatment for HIV positive patients
• Post-exposure prophylaxis (PEP) - emergency drug reduces risk of infection after exposure
• Pre-exposure prophylaxis (PrEP) - taken daily to reduce chance of getting infected
• ARVs can be given to pregnant and breastfeeding women, to prevent mother to child transmission

However, emergency use of PEP is not the best way to go about it, he says. Instead it would be better for prostitutes to take a type of antiretroviral 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 Godfrey-Faussett stresses that 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 Kenya to see if it could be practical for them to use PrEP as an extra layer of defence.

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 24-year-old sex worker Pamela using PEP four times in the past year.

"I had unprotected sex when I was very drunk one night and the following morning 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."

Peter Godfrey-Faussett, senior science adviser with UNAIDS, says there is a place for antiretrovirals 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," he says.

The drugs are not cheap, though.

In the US, PrEP costs around $14,000 (£8,700) a year at the full price, although people on low incomes can get it much cheaper, or even free.

In developing countries, where generic copies of the drugs are used, the cost may be about $150 (£93) a year.

Godfrey-Faussett stresses that the cheapest line of defence is, in this case, the strongest.

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

Culled from BBC Health where it appears as: 

"Sex workers using anti-HIV drugs instead of condoms" by Zainab Deen

"Agan" the masquerade that kills women | Funke Egbemode - Sunday Sun

I am on vacation, the longest vacation I have been permitted to have in five years. And it is sweet. So as I sat on the balcony of my hotel room watching the waves pounding relentlessly the shores and marvelling at the beauty of the rays of the sun glistening on the waters, I decided to do one of the things being an editor doesn’t allow you to do, read for pleasure, in my pyjamas at 9 a.m. Go on, go green with envy.

With my cup of tea beside me, I flipped to Page 391 of the History of the Yorubas by Samuel Johnson and discovered fresh facts about one of the historical figures of Yoruba history, Iyalode Efunsetan Aniwura.

I bet the story of Efunsetan  that you know is the one I also believed, until this morning. That she was one mean, very powerful  Ibadan women leader who lost her only daughter to childbirth complications and consequently became a nightmare Ibadan people could not wait to wake up from. That she killed her slaves, especially the female ones who dared to get pregnant. But this morning, I found out I didn’t know the full story all these years. I just assumed I did.

I first came in contact with Efunsetan’s  story around 1977 when I watched the television drama, Efunsetan Aniwura produced by late Ishola Ogunshola (Isho Pepper) . He played the role of Itawuyi, the slave who impregnated Adetutu. The play was based on Professor Akinwumi Ishola’s book.

After watching that play, I hated Iyalode Efunsetan Aniwura passionately. How could a woman be so mean? Though when I lost my daughter in January 1999, I understood the pain of that kind of loss. Holding the still warm body of a child, screaming her name, willing her to smile just one more time, watching the nurses take her away, her eyes closed forever… the pain, 14 years later…

Let’s go back to Ibadan.

At the time Efunsetan Aniwura was Iyalode of Ibadan, Aare Latoosa was the Commander-in-Chief. He fought and won many wars for Ibadan. He was a powerful man. Efunsetan was a powerful woman too, perhaps the most powerful woman during the time. She was reputed to be very wealthy, having 2,000 slaves working on her farms alone, apart from the ones in her home. Her economic ascendancy made not a few men in the town uncomfortable. And she wasn’t a quiet woman either. She confronted the powers that be. She confronted power, in a male dominated Yoruba kingdom in the 19th century. Very daring but Efunsetan wasn’t from the regular assembly line.

Upon his return from the Ado war in December, 1873, Aare Latoosa decided it was time to cut Efunsetan to size and remind her who was in charge. Did I tell you women are called ordinary beings who urinate from the back? Yeah, we don’t have a ‘nozzle’ to hold and pee upfront like men. Anyway,  Latoosa came up with a three-count charge why Efunsetan must be deposed or be killed or both. Both eventually happened. Count 1: that you, Efunsetan Aniwura, did not accompany me to war. Count 2: that you Efunsetan Aniwura did not send supplies to me. Count 3: that you Efunsetan Aniwura did not come in person to welcome me outside the town walls upon my return from the war front.

Flimsy charges, trumped –up but it held all the same. On May 1 (today’s workers day) 1874, Iyalode Efunsetan Aniwura was deposed and her second-in-command, Iya Ola, was told to step into her shoes. She was reluctant but when she was told she could take the title or leave town with one wrapper and one head tie, she chose the former. To avoid death, Efunsetan Aniwura paid all the fines imposed on her but apparently, what Aare Latoosa wanted was the head of his Iyalode because all pleas on behalf of Efunsetan and her fines were ‘all to no purpose’ according to Samuel Johnson.

However, pretending that all was well after the deposition, on June22,1874 Efunsetan was publicly disgraced but  told she was pardoned. A few nights later, the sound of Agan, the masquerade that killed women, was heard. Against the laws of the land, Efunsetan Aniwura’s death had been resolved upon. But it wasn’t a death sentence that could be carried out like the ones for criminals. So, Efunsetan’s adopted son, Kumuyilo was paid handsomely to kill his mother. He eventually got assassins through the roof and they smashed the head of Efunsetan Aniwura. The following morning, the town gave her a public burial befitting her status as an Iyalode, like they were not aware of how she died.

It’s a long story and since you guys are not on vacation and my breakfast just arrived, I’ll leave it here.

Breakfast over. But I read a few Nigerian newspapers online while eating and one of the headlines that hit me in between the eyes is the one about the House of Representatives Committee on Aviation’s likely recommendation in favour of the sack of Aviation Minister, Princess Stella Oduah. The newspaper report said Oduah may be sacked for exceeding the official limit in approving the purchase of two armoured BMW cars by NCAA. After or before the sack, the bullet-proof cars will be returned to Coscharis Motors. The N225m cost of the cars will be retrieved. The transaction with the First Bank will be terminated. And then a member of the panel actually admitted that the cars were not bought in Oduah’s name. Her only offence was attending to a memo and writing PLEASE DO THE NEEDFUL.

And I remember the number of times I wrote, to my deputies and assistants, Please treat. They knew it didn’t mean let the story go. They knew it meant the story had to be processed. It wasn’t a directive to lead the paper with it or use the story at all. On several occasions, such stories were returned to the reporters for further work or dropped entirely. My deputies knew I do not like lawyers, so once they saw half a line of libel, they alerted me. I trusted them and they did their jobs. So, why are we hanging the minister for telling NCAA to do its job? I thought that was what we pay them to do? Or is there another memo that said, please buy two armoured BMWs immediately?

Maybe because the new  historical facts on Efunsetan Aniwura is still fresh on my mind, but I see a few parallels. Why kill the Iyalode after she had paid all the fines, for instance? Were women leaders supposed to accompany the Aare to war? But a powerful woman had to be brought to her knees and Aare Latoosa did what he had to do. Has Oduah become too powerful? Has she become too big for her designer shoes? Is she making life difficult for some people who had preyed on the aviation sector for years? The cars are not hers. If we retrieve the money and return the cars, is it still fair to send Kumuyilo to smash her head in the night like they did to Efunsetan for daring to dare the men?

No, Princess Stella Oduah shouldn’t  have gone beyond her limit as a minister. My people say ‘eni a n so ko pee mu.’ It is easy to catch a man you are trailing. Was the aviation minister being trailed? Was the whistleblower the one trailing her?

I do not see the need for armoured vehicles, really. They do not prevent ‘anything’. So, I am for let’s return those two bought by NCAA. In fact, we must return all the other armoured cars in every government official’s fleet. We do not need them. It is a waste of tax payers’ money. But to sack Oduah after the fines, is like throwing away the baby and the bath water. Or are we saying the only thing she has done in 29 months is write PLEASE DO THE NEEDFUL? Are we? Are we saying some airports have not been remodelled? International flights resumed on Wednesday at the Mallam  Aminu Kano International Airport, Kano; true or false? Madam Aviation can certainly do more but are we going to behead those minsters who are only heard of when their photos are taken at every Wednesday FEC meeting?

The Tambuwal-led House of Representatives is the most stable since 1999 and I plead with them to take the cantankerous bullet-proof BMW cars and spare Oduah. Not just because she is beautiful and a woman like me but she is hardworking. Please don’t bring out  the ‘Agan’,  the masquerade that kills women.

The dumper and the dumpee - Funke Egbemode (Sunday Sun, November 17, 2013)

When a man is done with a relationship, he’s done. He may not look like he’s even lacing up his boots, yet he might have left you weeks ago. So, a girl needs to know how to read the signs and what to do. Unlike women who are sentimental about such stuff calling it quits with a relationship that is going nowhere, men are logical beings.

If they want out, they head for the door. Some try to be nice about it, not that I think there’s a nice way to dump a girl, but a man who is through with a woman is through. Trying to stop him most of the time is a waste of time and energy. When a man finds himself in a tight corner, the first person he looks out for is his great self. He may not set out to hurt but that is what happens when someone gets dumped. The dumper is more hurt than the ‘dumpee’, if you get my meaning. I guess that is why the stench from all dump sites is always so terrible. Dumping is simply bad business.

So, how do you know if you are being dumped or if you are the ‘dumpee’ even this minute? First, let us all agree that not all relationships end up in ‘I do’. Many actually end up in ‘I don’t’. If a man no longer wants to ‘do’, you will do well, my sister, to learn to let him go. Not that you can stop him if he’s eyeing the door anyway but it is easier on the ‘dumpee’ if she holds a meeting with her heart and head and they resolve not to cause a scene over the dumping.

Here’s one way to know you are no longer what you used to be to your man. He will stop asking for elaborate explanations about your movements. If he used to check on you three times between the time you left the office and the time you got home and all he asks these days is ‘how was your day?’and  then he nicely changes the subject when you attempt to give him the full gist, let the romance light in your head move from green to amber. If you tell him you have a dinner to attend after work and all he says is okay without asking who is hosting the dinner, the venue and what you are wearing, you are losing grip. As far as he’s concerned, you can go jump in the acid lake.

He will also stop giving you elaborate explanations about his life and movements too. If you see a girl in his car and stop him, if he is a nice dumper, he will stop, say hello and tell you he is in a hurry. Note: he did not introduce the girl or tell the girl who you are. Count yourself lucky he stopped and keep the amber light on in your head. You are no longer as important as you used to be. Or did you actually believe the I’m-in-a-hurry story?

If you have already met a few members of his family, put your thinking cap on if you sense unease in the air when next you visit. Watch out for the smiles that do not reach their eyes, the pitying looks and the almost audible sigh of relief when you tell them you are leaving. Poor folks, they like you but the dumper has introduced another girl to them and told them he was done with you.

When a man begins to make himself unavailable and unapproachable, he’s telling the woman who thinks she is still in his life the deal is off. If you were spending the weekends together and now there is always something keeping him busy every weekend, don’t ignore the alarm ringing behind your left ear. You want to go to  his apartment and see things for yourself? Great idea, you will most likely find what you are looking for, your replacement.

If the man who, once upon a time, could not keep his hands and eyes off you behind every closed door (office, car and kitchen doors inclusive) suddenly looks at you in lingerie, adjusts his glasses and returns to his laptop or I-pad, you are on your way to the dumpsite, most likely. I’m assuming you had a great sex life, of course. Now, he sees you in the shower and he’s still walking normal, not adjusting his zipper or joining you, ah? There is cause for alarm and concern, believe me.

You used to call each other like 10 times a day and now it has dwindled to one call a day or fizzled out altogether, you are a ‘dumpee’ waiting for certification. That man has moved on, I suggest you do too. Yes, in my capacity as the Chairman, National Assembly Joint Committee on Intimate Affairs.