Dr Oluwafunke Odunlade is the World Health Organisation (WHO) Technical Officer for HIV, Viral Hepatitis and STIs in Nigeria. In this interview with NKECHI ONYEDIKA-UGOEZE, she explains how new pre-exposure prophylaxis (PrEP) options could expand access to HIV prevention and close existing gaps.

With advances in HIV prevention and treatment, people living with HIV can now live long, healthy and productive lives. What is pre-exposure prophylaxis (PrEP), and how effective is it in preventing HIV infection?

PrEP is medication used to prevent HIV infection. When taken as prescribed, it reduces the risk of acquiring HIV through sex by about 99 per cent.

Nigeria has adopted three options: daily oral PrEP, long-acting injectable cabotegravir (CAB-LA), administered every two months, and lenacapavir (LEN PrEP), administered every six months.

These medicines prevent HIV from establishing itself in the body following exposure. However, PrEP is for prevention, not treatment. Anyone who tests positive for HIV should be linked to appropriate treatment services.
Who is eligible for the different types of PrEP?

Anyone who is HIV-negative and at risk of acquiring HIV can use PrEP. However, because availability is limited, the government prioritises key populations, including female sex workers, people who inject drugs and men who have sex with men, who face a higher risk of infection.

Pregnant women who may be exposed to HIV can also use oral PrEP to protect themselves and reduce the risk of transmitting the virus to their unborn children.

Must an individual test negative for HIV before accessing PrEP?

Yes. Healthcare workers must conduct an HIV test before prescribing PrEP. Anyone who tests positive should be referred for treatment.

For those who test negative, the healthcare worker will assess their circumstances, medical history and preferences before recommending an option. Someone who may struggle to take a tablet daily might prefer an injectable, while someone who prefers tablets can use oral PrEP.

People with hepatitis B may benefit from oral PrEP because some of its medicines are also used to manage the infection. A healthcare professional should assess everyone and recommend the appropriate option.

Are there HIV-negative individuals who may not be eligible for PrEP, and what determines their suitability?

Eligibility depends on an assessment by a trained healthcare worker. Adherence is important because PrEP must be taken according to the prescribed schedule to remain effective. Missing doses or delaying injections can leave gaps in protection.

Nigeria currently provides oral PrEP to pregnant women and has not yet adopted injectable PrEP for this group, although some other African countries have introduced long-acting options.

PrEP does not prevent pregnancy or other sexually transmitted infections, including gonorrhoea, syphilis and chlamydia. We therefore advocate a combination prevention approach involving PrEP and condoms, alongside informed decisions about sexual health.

PrEP should also never be shared with another person or taken without proper medical guidance.
How available is event-driven PrEP?

Event-driven PrEP is an option for people who anticipate occasional sexual exposure rather than ongoing risk. However, it requires careful adherence to a specific dosing schedule and is not suitable for everyone.

People who face regular exposure should consider sustained PrEP under the guidance of a healthcare professional. We encourage individuals to discuss their circumstances with a trained provider to determine the most appropriate approach.
Is there an age limit for accessing PrEP?

Age and eligibility require careful consideration, particularly for adolescents. Healthcare workers must assess an individual’s circumstances, risk of exposure and applicable guidelines before prescribing PrEP.

HIV prevention involves several approaches, including delaying sexual activity until one is ready, mutual faithfulness, condom use and medication. Condoms help prevent HIV and other sexually transmitted infections and unintended pregnancy, while PrEP provides additional protection against HIV.

Nigeria also expects to expand prevention options as more medicines become available. The priority is ensuring that those who need PrEP can access it safely and appropriately.

Can people who have undergone cosmetic procedures, such as breast enhancement or Brazilian Butt Lift (BBL), or those taking hormone medication use PrEP?

These cases require individual assessment. CAB-LA is administered intramuscularly in the buttocks, so people who have undergone BBL should consult a trained healthcare provider before considering this option. Oral PrEP may be an alternative.

For people who have undergone procedures that alter fat distribution, the healthcare worker must assess suitable injection sites. Those taking hormone medications should also discuss their treatment with a provider, who can determine the most appropriate PrEP option.

People should not make these decisions independently because more evidence may be needed on some of these specific circumstances.

Where can people access PrEP in Nigeria?

Nigeria adopted oral PrEP in 2016, initially for couples in which one partner had HIV and the other did not. Access was expanded around 2020 to include key populations.

CAB-LA was introduced in 2025, initially through pilot programmes in Lagos and Gombe, before expansion to other states. In March this year, the Minister of Health and Social Welfare launched lenacapavir PrEP.

Oral PrEP is available across the country, including through some private healthcare facilities and pharmacies. People should seek advice from trained healthcare providers to ensure they receive appropriate testing and medication.

Lenacapavir is being piloted in designated facilities in Anambra, Ebonyi, Gombe, Kwara, Akwa Ibom, Cross River and Benue states, as well as the Federal Capital Territory. It is provided free at designated facilities.

The introduction of long-acting options gives people more choices beyond daily tablets and could help address barriers to consistent prevention.

What are the possible adverse effects of PrEP?

Most users tolerate PrEP well, although some taking oral medication may experience temporary nausea or vomiting.

With lenacapavir, injection-site reactions can occur. Proper administration and aftercare are important, and recipients should follow healthcare workers’ instructions rather than rub the injection site.

The government has mechanisms for monitoring adverse drug reactions through healthcare facilities and the National Agency for Food and Drug Administration and Control (NAFDAC). Anyone experiencing concerning symptoms should seek medical advice.