On a humid afternoon in western Kenya, a nurse named Miriam sits under the corrugated iron awning of a small fishing cooperative and counts blister packs. She speaks with a quiet authority, one honed through years of balancing the ledger of human urgency and structural scarcity. Around her, fishermen drift in and out—men who spend long days on Lake Victoria and nights in transient communities along its edge. They come here not for medical care in the traditional sense, but for something closer to negotiation: how to stay safe amid circumstances that rarely bend to individual will. On the table between them lies a small box of pre-exposure prophylaxis, or PrEP, the daily pill that—if taken reliably—reduces the risk of acquiring HIV to nearly zero.