EDITORIAL: Prep works and doesn’t promote recklessness

For decades, public health officials have feared that HIV prevention drugs might lead to reckless sexual behaviour, potentially fuelling other sexually transmitted infections.

The introduction of long-acting injections like Lenacapavir in Kenya rekindled those anxieties.

But recent research from Kisumu challenges this assumption and delivers a clear message: effective HIV prevention does not equate to moral hazard.

A study tracking 650 women for a year found that those taking oral pre-exposure prophylaxis (PrEP) did not engage in riskier sex nor experience higher rates of STIs compared to women who declined the medication.

In other words, access to preventive drugs did not encourage dangerous behaviour; instead, it empowered women to protect themselves while maintaining responsible sexual practices.

What stands out even more is the stark difference in HIV infection rates. Of the four new HIV infections recorded during the study, three occurred among women who refused PrEP.

No woman who adhered consistently to the medication contracted the virus.

This is a tragic reminder of missed opportunities in HIV prevention, and a testament to PrEP’s life-saving potential when properly utilised.

The findings also highlight the broader benefits of PrEP programmes.

Women on the drugs receive regular counselling, increasing awareness of sexual health risks, and demonstrating that support and education are as critical as the medication itself.

As Kenya rolls out long-acting injectable PrEP across multiple counties, policymakers and communities must resist outdated narratives of risk compensation.

Rather than promoting recklessness, these interventions are enabling women to take control of their sexual health safely and effectively.

HIV prevention is not a licence for irresponsibility—it is a tool for empowerment.

With evidence-backed programmes and sustained public education, Kenya has the opportunity to reduce infections, strengthen women’s health, and break cycles of fear and stigma surrounding HIV.