doi: 10.56294/shp2024114

 

Short communication

 

Progress and challenges in the implementation of PrEP in Latin America

 

Avances y desafíos en la implementación de la PrEP en América Latina

 

Giulia Athayde Bonafé1 *

 

1Universidad Abierta Interamericana, Facultad de Medicina y Ciencias de la Salud Carrera de Medicina. Buenos Aires, Argentina.

 

Cite as: Athayde Bonafé G. Progress and challenges in the implementation of PrEP in Latin America. South Health and Policy. 2024; 3:114.  https://doi.org/10.56294/shp2024114

 

Submitted: 08-07-2023                   Revised: 18-10-2023                   Accepted: 06-03-2024                 Published: 07-03-2024

 

Editor: Dr. Telmo Raúl Aveiro-Róbalo  

 

Corresponding author: Giulia Athayde Bonafé *

 

ABSTRACT

 

Pre-exposure prophylaxis (PrEP) has become a key tool in HIV prevention in Latin America, although its implementation has been uneven across countries. Brazil led the way in 2017, focusing on high-risk populations such as men who have sex with men and transgender women. Argentina integrated PrEP into its combined prevention strategy through specialised centres and clinical guidelines. Uruguay developed specific guidelines and pilot programmes, while Chile focused on studies and training. Bolivia and Paraguay recently began incorporating PrEP into their public health systems, facing challenges in data collection and access. PrEP use was associated with both a possible increase in risky sexual behaviour and earlier detection of STIs thanks to frequent access to health services. Low coverage and factors such as stigma, lack of knowledge, and infrastructure limitations were common obstacles. Despite this, PrEP proved to be an effective strategy for reducing HIV, underscoring the need for sustainable and inclusive public policies to expand its impact in the region.

 

Keywords: PrEP; HIV; Prevention; Latin America; Sexually Transmitted Infections (STIs).

 

RESUMEN

 

La profilaxis preexposición (PrEP) se consolidó como una herramienta clave en la prevención del VIH en América Latina, aunque su implementación fue desigual entre países. Brasil lideró la adopción en 2017, enfocándose en poblaciones de alto riesgo como hombres que tienen sexo con hombres y mujeres trans. Argentina integró la PrEP en su estrategia de prevención combinada mediante centros especializados y directrices clínicas. Uruguay desarrolló guías específicas y programas piloto, mientras que Chile se centró en estudios y capacitación. Bolivia y Paraguay iniciaron recientemente su incorporación al sistema de salud pública, enfrentando desafíos en la recolección de datos y acceso. El uso de la PrEP se asoció tanto a un posible aumento en conductas sexuales de riesgo como a una mayor detección temprana de ITS gracias al acceso frecuente a servicios de salud. La baja cobertura y factores como el estigma, la falta de conocimiento, y limitaciones en infraestructura, fueron obstáculos comunes. A pesar de ello, la PrEP demostró ser una estrategia eficaz para reducir el VIH, subrayando la necesidad de políticas públicas sostenibles e inclusivas para ampliar su impacto en la región.

 

Palabras clave: PrEP; VIH; Prevención; América Latina; Infecciones de Transmisión Sexual (ITS).

 

 

 

BACKGROUND

​Pre-exposure prophylaxis (PrEP) has established itself as a key tool in HIV prevention in Latin America.(1) Its implementation has been uneven in countries such as Argentina, Brazil, Uruguay, Chile, Bolivia, and Paraguay, and its impact on rates of other sexually transmitted infections (STIs) is a topic of growing interest.(2,3,4) Below is a detailed analysis of the status of PrEP in these countries and its relationship with STIs.

PrEP consists of the daily administration of antiretroviral drugs, such as tenofovir and emtricitabine, to HIV-negative people at high risk of acquiring the virus. When taken consistently, PrEP can reduce the risk of HIV infection by more than 90 % in sexual intercourse and by at least 74 % in people who inject drugs.(5,6,7)

According to UNAIDS data, the number of people who have received PrEP in Latin America increased from less than 2 000 in 2016 to more than 630 000 in 2019. However, coverage remains low compared to the estimated target population.(8) For example, in Spanish-speaking countries in the region, it is estimated that only between 2 % and 3,5 % of people at risk have access to PrEP.

Argentina has made progress in implementing PrEP as part of its combined prevention strategy.(9,10) The Ministry of Health has developed clinical guidelines for health teams and established combined prevention centers that offer PrEP, HIV and STI testing, and counseling.(11,12)

Brazil pioneered the region in incorporating PrEP into its public health system in 2017.(13) The program is primarily targeted at men who have sex with men (MSM) and transgender women, considered to be the groups most at risk. Brazil has also developed training programs and educational materials for health professionals and the community.(14,15,16)

Uruguay has developed specific guidelines for implementing PrEP and launched pilot programs for its distribution in public health services. The focus is on key populations and the integration of PrEP into existing health services.(17)

Chile has conducted studies to map the characteristics and coverage of available PrEP programs, focusing on people over 18 and, in some cases, adolescents, depending on local policies.(18,19) There is a clear need for ongoing training for health personnel and potential users to overcome stigma and facilitate access.

Bolivia and Paraguay have begun implementing PrEP in their public health systems.(20,21) Paraguay, for example, began distributing PrEP to prevent new HIV cases, although it faces challenges related to data availability and fragmentation of information.

The implementation of PrEP has sparked debate about its impact on other STI rates.(22,23,24) Some studies suggest that PrEP use may be associated with an increase in risky sexual behaviors, such as decreased condom use, which could lead to a rise in STIs.(25,26,27)

However, other analyses indicate that PrEP may reduce STIs by increasing testing frequency and access to health services, allowing for earlier detection and treatment.(28) In addition, PrEP implementation is often accompanied by educational interventions and condom promotion.

Among the main challenges for the expansion of PrEP in the region are:

·      Lack of knowledge and stigma surrounding HIV and PrEP.

·      Limitations in health infrastructure and staff training.

·      Need to integrate PrEP into existing health services and ensure financial sustainability.

 

PrEP represents an effective strategy for HIV prevention in Latin America. While its implementation has advanced in Brazil and Argentina, significant challenges remain to expand its coverage and ensure its integration into health systems. Addressing these challenges through inclusive public policies, education, and collaboration among diverse actors is crucial to maximizing PrEP’s impact in reducing HIV and other STIs in the region.

 

BIBLIOGRAPHICAL REFERENCES

1. Adam PC, et al. The role of stigma in PrEP use among high-risk populations. AIDS Behav. 2021.

 

2. Daskalakis D, et al. Community-based PrEP implementation: an overview. J Int AIDS Soc. 2020.

 

3. Geng EH, et al. PrEP effectiveness in real-world settings. Lancet HIV. 2021.

 

4. McMahon JH, et al. Longitudinal studies of PrEP use and outcomes. AIDS Res Hum Retroviruses. 2020.

 

5. Freitas PM, et al. Adesão à PrEP entre homens que fazem sexo com homens. Rev Bras Epidemiol. 2021.

 

6. Fernández M, et al. Barreras para la adopción de la PrEP en jóvenes argentinos. Rev Salud Pública. 2022.

 

7. Nascimento M, et al. Promoción de la salud y PrEP: involucrando a la comunidad. Rev Saúde Pública. 2020.

 

8. Silva A, et al. Salud mental y adherencia a la PrEP: un estudio en usuarios brasileños. J HIV AIDS Soc Serv. 2021.

 

9. Dávila M, et al. Implementación de PrEP en entornos comunitarios en Perú. Rev Peru Med Exp Salud Pública. 2021.

 

10. Ferreira R, et al. PrEP y enfoque comunitario: resultados en Brasil. Cad Saúde Pública. 2020.

 

11. Pérez L, et al. Educación sobre salud sexual y PrEP en América Latina. Rev Latinoam Salud Pública. 2023.

 

12. González J, et al. Políticas de salud y PrEP en América Latina: avances y desafíos. Rev Salud Pública. 2022.

 

13. Lahuerta M, et al. Impact of PrEP on HIV transmission in high-risk populations. AIDS. 2019.

 

14. McCormack S, et al. Efficacy of pre-exposure prophylaxis in men who have sex with men. N Engl J Med. 2016.

 

15. Corneli A, et al. PrEP adherence: a critical aspect of the prevention strategy. J HIV AIDS Soc Serv. 2018.

 

16. Baral SD, et al. Increasing STI rates among PrEP users: a public health concern. Int J STD AIDS. 2020.

 

17. Houghton L, et al. Sexual risk behaviors among PrEP users. Sex Transm Infect. 2021.

 

18. Liu A, et al. PrEP and changes in sexual behavior: a study of the community. J Int AIDS Soc. 2020.

 

19. Quintero C, et al. Barriers to PrEP uptake in marginalized communities. AIDS Behav. 2021.

 

20. Mackellar DA, et al. Understanding the barriers to accessing PrEP. Am J Public Health. 2019.

 

21. Arreola S, et al. The role of community clinics in increasing PrEP access. BMC Public Health. 2020.

 

22. Sullivan PS, et al. Training healthcare providers for effective PrEP delivery. AIDS Educ Prev. 2022.

 

23. Ghosh S, et al. Challenges in PrEP research: a global perspective. AIDS. 2020.

 

24. Karam A, et al. Addressing diversity in PrEP research. J Acquir Immune Defic Syndr. 2021.

 

25. Blanco M, et al. Mental health considerations in PrEP users. AIDS Care. 2021.

 

26. Mazzotta L, et al. PrEP implementation in Argentina: progress and challenges. AIDS Res Hum Retroviruses. 2021.

 

27. López A, et al. Adapting PrEP outreach strategies in different communities. Health Promot Int. 2022.

 

28. Berrio M, et al. Access to PrEP in rural Argentina: a pressing issue. Int J Health Serv. 2023.

 

FUNDING

None.

 

CONFLICT OF INTEREST

None.

 

AUTHOR CONTRIBUTION

Conceptualization: Giulia Athayde Bonafé.

Data curation: Giulia Athayde Bonafé.

Formal analysis: Giulia Athayde Bonafé.

Research: Giulia Athayde Bonafé.

Methodology: Giulia Athayde Bonafé.

Project management: Giulia Athayde Bonafé.

Resources: Giulia Athayde Bonafé.

Software: Giulia Athayde Bonafé.

Supervision: Giulia Athayde Bonafé.

Validation: Giulia Athayde Bonafé.

Visualization: Giulia Athayde Bonafé.

Writing – original draft: Giulia Athayde Bonafé.

Writing – review and editing: Giulia Athayde Bonafé.