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Brazil has been at the forefront o f HIV treatment and prevention in Latin America, says the scientific journal

Brazil has been at the forefront of HIV treatment and prevention in Latin America. It has become the first country to provide free highly active antiretroviral therapy and has participated in a study that reported the efficacy of pre-exposure prophylaxis (PrEP) for HIV prevention among men who have sex with men (MSM) and transgender women. The conclusion has been drawn from an editorial published last week (18) by the scientific journal The Lancet HIV.

The editorial cites a study according to which the use of PrEP with daily oral emtricitabine and tenofovir disoproxil fumarate has been effective among HIV-vulnerable MSM and transgender women. The text also quotes another essay led by the Brazilian researcher Beatriz Grinsztejn, indicating the effectiveness of PrEP and its good adherence among this population. According to the publication, the present study might be a catalyst for other countries in the region, in order to implement PrEP.

The journal recalls that HIV epidemics in Latin America and much of the Caribbean are highly concentrated among men who have sex with men and transgender women, with remaining high infection rates in this population since 2010.

Peru is an illustrative case, with approximately 0.3% of adults from 15 to 49 years of age in the general population living with HIV, but with a prevalence rate of 15.2% among MSM and 13.8% among transgender women.

Statistics in Mexico are even worse, with an overall HIV prevalence of 0.2% versus 17.1% among MSM and 20% among trans women. However, this year, a few countries in Latin America and the Caribbean included PrEP in their national HIV prevention plans.

"Therefore, why has the PrEP implementation been so slow? Unfortunately, the usual suspects, including insufficient knowledge among decision-makers, fear of increased PrEP spending, criminalisation of sexual behaviors, and stigma and discrimination faced by men who have sex with men and transgender women have been conspiring to deny PrEP to these vulnerable populations in many parts of the region", says the statement.

"Luckily, this tide seems to be changing. In 2018, seven countries in Latin America and the Caribbean planned PrEP demonstration projects. Three other began to be implemented with local public funding". In addition, according to the publication, Latin American and Caribbean civil society is playing an increasingly important role in the demand and partnership with governments for the delivery of PrEP.

Regional activist groups such as GayLatino have stated a strong support for PrEP and websites like Quiero PrEP (I want PrEP) explain the definition of PrEP, how it works and how to promote access, positioning PrEP's availability as a human right. The Pan American Health Organization (PAHO) also played a vital role in advancing the PrEP agenda in the region by educating and supporting decision makers on the implementation, says the publication.

"As countries move forward with PrEP demonstration projects, they must ensure that equity in access is part of their programmes,otherwise they risk missing people who are often the hardest to engage because of the same conditions that make them more vulnerable to HIV", says the editorial.

Communities in Latin America and the Caribbean are mobilising for PrEP as the first substantial addition to the HIV prevention toolbox (which includes condoms, lubricants, education and counseling, STI tests and other support services) from the outset of the epidemic. The publication concluded affirming that Brazilian PrEP demonstration project has been decisive for other countries of the region.

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

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