What you need to know:
- Jackline was barely two weeks’ old in the marriage but they had not been intimate yet.
- She found a tin of ARVs, which her husband had taken the previous day and forgot to hide.
- This is when she found out that her husband-to-be was HIV-positive.
Had it not been for her full bladder, which coincided with her thirst at 2.30am, her husband’s condition could have been a mystery to her for some time.
The memory of that night is as clear as day. As 31-year-old Jackline Akinyi Odhiambo got out of her bed for a short call, she bumped into a tin of antiretroviral drugs, which her husband had taken the previous day and forgot to hide.
She took the tin and placed it strategically on the table. In the morning when she woke up, it was missing.
On realising that she had seen the bottle, Samson Odhiambo became nervous and avoided his wife for some time.
Jackline played it cool and did not ask him about the drugs. She behaved as if everything was normal while waiting for him to start the conversation. But to no avail — no one was ready to go first.
Jackline was barely two weeks’ old in the marriage but as fate would have it, they had not been intimate yet. This was five years ago.
As a pastor in the Legio Maria Church and a strong believer of their rites, Samson had to go before the altar with his new lover to be ordained as husband and wife. This meant that the church did not allow them to engage in any sexual activity until the night after “approval”.
For the two weeks that Jackline was at Samson’s house, she was to get to know the man she was getting married to and if there was something she did not like about him, then she was to raise it before D-Day or forever remain silent.
This is when she found out that her husband-to-be was HIV-positive.
Every morning at exactly 7.30am, an alarm would ring and Samson would dash out of bed.
“I thought the alarm was for him to prepare to go to church because he would leave early to lead the morning worship. I was wrong, this was always a call to have drugs and keep his virus a sleep,” says Jackline.
“Out of curiosity, one morning I hid behind the door to monitor his movements. He went to shower and immediately I heard a rattling sound — the drug bottle made the noise.”
As usual, he was having his morning pills.
“Kindly show me what you are carrying, Jackline told Samson, who had the drugs in his hands ready to swallow.
“Why didn’t you tell me that you were infected? Why hide this from me? For how long have you been taking the drugs? Why do you want to kill me?” She asked him.
And there and then, their two-weeks-old marriage was under threat.
“I am sorry. Please keep my status a secret from my family and friends,” that’s all 44-year-old Samson asked of Jackline.
He had kept his status a secret since he did not want to lose his ‘God-sent woman’. The marriage had taken a sister-in-law to put together.
For 20 years that Samson worked in Mombasa, where he believes he might have contracted the disease.
Given that his friends and family were worried that he would never get married, one of his sisters-in-law, who was Jackline’s friend, approached her on his behalf.
For three months, Samson andJackline would communicate through the third party. Then they decided to meet in person. After three days of evening meetings, she gave in and moved in with him.
But after knowing his status and having no idea how to approach the matter, she called off the marriage and returned to her parents.
“At my age, I did not want to be married to not only a HIV-positive man but also a man 11 years older than me,” Jackline recalls.
At home, Jackline met her sister-in-law who had come visiting and narrated her story to her. To her surprise, the sister-in-law had been staying with Jackline’s step-brother who was HIV-positive, for four years.
They had brought forth four loving children who were HIV-negative.
The secret, she said, was to consistently keep taking Pre-exposure prophylaxis (PreP), a pill a day whenever she felt exposed and given that the husband was religiously taking his antiretroviral drugs, his viral load was undetected and there was no way he was going to transmit the virus to her, explained Jackline’s sister-in-law.
Jackline really wanted to understand how the concept works. Together with her sister-in-law, they went to the nearest hospital, Siaya County Referral Hospital. Here, a doctor assured her that provided Samson’s virus was suppressed, her chances of being exposed were negligible.
“All I needed was an expert’s voice to tell me that all was going to be well and that I was safe with him,” says Jackline.
She went back to Samsom after a series of negotiations but only on condition that their sex life be relegated to the ash heap of history.
“I wanted nothing to do with sex. All I wanted was for his viral load to be tested. And to get to know whether he could transmit the virus or not,” she says.
They went for several HIV viral load tests, and he was virally suppressed with less than 150 copies of HIV per milliliter of blood. He could not transmit the virus to his partner.
According to the Centre for Disease Control, an undetectable viral load is where antiretroviral treatment (ART) has reduced your HIV to such small quantities that it can no longer be detected by standard blood tests.
People living with HIV who have an undetectable viral load cannot pass on HIV through sex. But being undetectable does not mean your HIV is cured.
After counselling, Jackline was placed on PrEP that would prevent her from catching the virus while her HIV-positive partner continued with his life-prolonging and health-boosting antiretroviral drugs.
Normal sex life
PrEP gave her peace of mind. They were finally ordained as husband and wife and their normal sex life journey began.
The couple used condoms for some time and when they were ready to have a baby, they went for a test. Jackline was HIV-negative. She conceived and after every three months of the gestation period, she would test herself.
Jackline has since given birth to their first child, who has tested HIV-negative for the third time. Jackline has maintained the negative status. She feels that even though her husband’s virus is untransmutable, she still has to take a pill a day.
The couple admits that they were not using a condom though experts advocate for the consistent and correct use of condoms as part of infection prevention measures for discordant couples.
“For the last three years, I have been on PrEP and I must say that my choice to begin taking a highly-potent HIV drug wasn’t an easy one. And the decision to come out publicly as someone who’s on PrEP was not one that I took lightly. I have been stigmatised but at the end of the day I no longer have to deal with the stress and anxiety of possibly contracting HIV and AIDs.
“I am still HIV-negative, my husband’s virus is maintained, this is going to be my go to drug, it is a game changer in the fight against new HIV infections. I know that I’m constantly protected as long as I take a pill a day when at risk,” she says.
Oral PrEP is a HIV drug that “stops the virus from entering cells and replicating. This prevents HIV from establishing itself and the person remains HIV-negative.” It’s also been key to keeping discordant couples together, or couples where one person is HIV-negative, and the other is positive.
PrEP is offered free of charge in all public hospitals while in private hospitals, brand name drugs go for Sh3,700 for the 90-pack, while generic equivalents cost Sh412.
The PrEP initiative, which is spearheaded by the government in collaboration with partner organisations including Jhpiego, has taken years of clinical work, clinical trials and more than 50 demonstration projects in Kenya and around the world to get to the point where PrEP efficacy was proven.
Explaining how PreP works and how discordant couples and those at risk of getting HIV can stay safe and still retain their status, Dr Momanyi Ogeto, technical lead, care and treatment, Centre for Health Solutions, Kenya, tells Healthy Nation that the drug has been an integral part of keeping discordant couples together.
To achieve optimal levels of protection among discordant couples, Dr Momanyi advises that the drug must be taken daily. The principle of PrEP is similar to that of antimalarial tablets used to prevent malaria in foreigners travelling to tropical countries.
Somebody who does not have HIV takes enough PrEP to maintain high levels of the drugs in their bloodstream, genital tract and rectum before any exposure to HIV. If exposure occurs, the drug stops the virus from entering cells and replicating.
This prevents HIV from establishing itself and the person remains HIV-negative. Studies have shown that taking a pill a day reduces the risk of contracting HIV from sex by more than 90 per cent.
“PrEP only works if you take it. One has to have a certain level of drug in their body to be protected. This means that missed doses and missed appointments for refills, days and weeks not taking the preventive medication might lead to infection,” he said
However, with many coming up as PrEP champions and speaking about the benefits of the drugs like Jackline, the conversation is changing. “We need to stay on the drug as long as we are at risk,”she says.
Jackline has been at the forefront advocating for the drug and counseling countless women on the potential benefits and the consequences of dropping provided that one is still at risk.
Although oral PrEP is the only prevention option currently approved in Kenya for HIV prevention, other forms of ARV-based primary prevention, including the dapivirine vaginal ring and long-acting injectable cabotegravir are yet to be added to the PrEP toolbox in the country.
More youths, Dr Momanyi says, are not so keen at taking the drug every day and this may affect the effectiveness of the drug as long as one is still at risk.
“Taking drugs daily relies on good decision making like putting on a condom or a mask but this is very difficult for some populations, especially the youth, hence the need for less frequent and alternative dosing solutions like the longer-acting agents in different formulations and the vagina ring,” he says.
Besides taking a pill a day for prevention purposes, Dr Momanyi advises those at risk to also consider other options including the use of condoms since PreP takes one to three weeks to offer protection, depending on the sexual activity.
The drug doesn’t protect against other sexually transmitted infections.
“And even after starting the pill and taking a pill a day, one has to ensure that they get screened after every three months to check on their status,” he says.
“This drug saved my marriage, I am so poor at ‘tuning’ women and if my wife had left, I would not have gotten married again. I thank God we have a family, the drug has kept the fire burning after HIV,” says Samson, a sly smile dancing on the corners of his lips.
With the prevention drug in the picture, Jackline has vowed to love her husband and shield him from the stigma they face as a discordant couple.
She is now the number one supporter of her husband. Every day, she reminds him to swallow his drugs as she takes hers. She has decided to concentrate on their lives as a husband and a wife.
“What I have noticed is that with this disease, it does not want someone to be stressed, all you need peace of mind and clean bill of health, with that you will stay long. That is our focus. So help us God,” says the smiling Jackline.
Samson has since joined a community antiretroviral treatment support group where only stable HIV-positive Kenyans come together through their peer educator, who collects drugs for all members and decides on when to meet.
Currently in Siaya County alone, there are 3,322 community ART groups, 3,100 facility groups with a total of 84,000 people on treatment and over 60,000 stable patients.
“This concept has worked really well and comparing differentiated care with the standard care, studies have shown that with treatment adherence and viral suppression, the standard care stands at 90 per cent while the latter is 99 per cent,” Dr Momanyi tells the Healthy Nation.
For PrEP, over 8,000 HIV negative people in Siaya County are taking the drug.
Daniel Were, the lead of the Jilinde Programme in Kenya which has been working with the Ministry of Health to provide PrEP in eight counties, said PrEP should not be compared to ARVs, which is used for suppressing viruses.
“Those in need of PrEP take and use when they are in need, and would stop when not in need,” Dr Were said.
A study by Catherine Koss from the University of California in 2020 found that despite the discontinuances, PreP reduced the HIV incidence in the 15,000 persons who were vulnerable.
Dr Were saidcontinuous use was not the target of the Jilinde project.
In a study conducted by Dr Were and his colleagues at Jhpiego, people preferred getting the drugs for many months, not once in a month. The numerous visits to the hospital discouraged the PREP users.
“Unnecessary clinic visits burden the clients, and put a strain on the health system,” Dr Were said.
Dr Nelly Mugo, the principal research scientist at Kenya Medical Research Institute, who was a principal researcher on the PrEP efficacy trials conducted in Kenya, raises concerns that people at risk of HIV infection shy away from taking PrEP.
One of the main complaints is that its blue colour is similar to that of Viagra or drugs for mental health problems, while another complaint is that the pills make a rattling sound when being taken out of the container.
“Most people have complained that it looks like an antiretroviral drug (because of its size),” says Dr Mugo, adding that all these perceptions affect drug adherence for those who need protection the most.
She says while governments must come up with strategies to deliver PrEP to everyone who is in need of the drugs, a conversation with Jackline suggests that there are more challenges when it comes to access to the drug. Not all facilities in the country are stocking the drug.
The stigma associated with taking PrEP has not made its uptake easier. The drug is highly mistaken as a HIV drug.
Dr Mugo, however, warns that PrEP is not a magic bullet, and must be combined with safe sex practices like the use of condoms. Moreover, after every month of PrEP, one requires further screening to check levels of the drug in their blood and to check if they contracted HIV while on the drug.