To end AIDS, high-risk countries will need to jab schoolgirls
persuading people to get tested is hard. People with HIV may experience no symptoms for years, and men are often reluctant to visit a clinic when they feel well. As for prevention, condoms work, but only when people use them, which many don’t.
So another tool is generating excitement: pre-exposure prophylaxis, or PrEP. Today this means a daily pill that dramatically cuts the odds of contracting HIV during sex. It works for gay men in rich countries, but is suboptimal for the largest high-risk group: heterosexual women in poor places where HIV is common.
Taking a daily pill is a hassle, and hard to conceal from a jealous boyfriend in a cramped home. A long-lasting injection would be more discreet, less bother and, unlike a condom, require no negotiation with a recalcitrant partner. ViiV, a British drug firm, offers a new jab that lasts two months and has licensed it to generic manufacturers.
Gilead, an American firm, is testing a drug that could last for six months. Some states and ngos already give prophylaxis to drug injectors and sex workers. If the six-month injection works, it should be routinely offered to teenage girls in high-risk countries (a fifth of South African adults are HIV positive).
Mass jabbing in schools would be controversial, but probably effective. Young people who are not yet having sex are unlikely to have the virus. In sub-Saharan Africa it is the girls who typically get it first, by sleeping with older men (who, unlike schoolboys, can pay for dates).
When the girls are older, they pass it on to partners closer to their own age. If transmission from “sugar daddies" to teenagers is broken, a younger age cohort could grow up virtually virus-free. Drug prices will need to be negotiated.
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