Brazil starts distributing medicine for preventing HIV among key populations

Brasilia, 5 January 2018 - The Ministry of Health began in early December (1st) to distribute pre-exposure (PrEP) and post-exposure (PEP) prophylaxis to prevent HIV among key populations in 35 localities across the country.

Last December, a new report on HIV prevention prepared by the Pan American Health Organization (PAHO) and the Joint United Nations Programme on HIV / AIDS (UNAIDS) recommended expanding access to all available prevention options, including , PrEP, to reduce new HIV cases, which have remained at 120,000 per year since 2010 in Latin America and the Caribbean.

The Ministry of Health began in early December (1st) to distribute pre-exposure (PrEP) and post-exposure (PEP) prophylaxis to prevent HIV among key populations in 35 localities across the country.

The federal government estimated that in the first year PrEP will be offered to 9,000 men who have sex with men, sex workers and transgender people through the Unified Health System (SUS).

For the launch of the programme, the ministry is working with networks of men who have sex with men and transgender people in developing videos and messages to reach these populations and to know the benefits of pre-exposure prophylaxis, including people living in the poorest regions.

Like many other countries in Latin America and the Caribbean, the HIV epidemic in Brazil is concentrated in the population of men who have sex with men and trans women. The country has long been recognized for its innovative response to the HIV epidemic.

"PrEP will help keep Brazil and our region in line with the world's most advanced HIV responses, and we are confident that it will have a positive impact on reducing new infections," said Adele Benzaken, deputy director of the Department of Sexually Transmitted Infections ), HIV / AIDS and viral hepatitis of the Ministry of Health.

The Brazilian programme seeks to offer PrEP to 54,000 people over the next five years. Although the drug from the company that created it will only be offered in the first year, it is possible that generic drugs will be available soon.

Clinical trials show PrEP efficacy

There is strong evidence that PrEP works. Several clinical trials among several populations, including men who have sex with men and heterosexual men and women, have demonstrated that pre-exposure prophylaxis is very effective in reducing the substantial risk of contracting the infection.

Last December, a new report on HIV prevention prepared by the Pan American Health Organization (PAHO) and the Joint United Nations Program on HIV / AIDS (UNAIDS) recommended expanding access to all available prevention options, including PrEP, to reduce new HIV cases, which have remained at 120,000 per year since 2010 in Latin America and the Caribbean.

The implementation of a new biomedical intervention, considered controversial by some, almost always requires the political will of governments. PrEP is one of these interventions, including concern about the costs associated with including it in the public health system. These costs are not related to the drug itself, but also to the additional monitoring and personnel needed to provide PrEP safely and effectively.

The Ministry of Health is taking a decisive and constructive step. The national discussion on the scale-up of PrEP began in 2013 when the ministry funded five separate pre-exposure demonstration projects to better understand the operational challenges in delivering services.

 According to the social policy analyst of the Ministry of Health, Tatianna de Alencar, these projects were instrumental in helping to create understanding and generate demand among people and populations who can benefit from PrEP.

"As has been seen in many other settings, including countries like Australia, France, Thailand and the United Kingdom, civil society organizations have been a catalyst for advancing the agenda of implementing PrEP," said Tatianna.

The Brazilian projects that have offered PrEP so far are PrEP Brazil - FIOCRUZ (Rio de Janeiro, São Paulo, Manaus and Porto Alegre); Combina Project - with the University of São Paulo (cities of São Paulo, Curitiba, Ribeirão Preto, Fortaleza and Porto Alegre) - PEP and PrEP underway.

Other initiatives include PREPARADAS Project - FIOCRUZ: focused on trans women (Rio de Janeiro); Horizonte Project - Federal University of Minas Gerais (Belo Horizonte) - 3TC / FTC Phase I; Federal Trans Women Project of the University of Bahia - (Salvador): focused on the accessibility of PrEP.

We thank our UN Online Volunteer, Juliana Nogueira, for her contribution to the translation of this article.  Juliana is an online volunteer mobilised through www.onlinevolunteering.org.

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