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Source: corresponsalesclave.org

Many years ago, pre-exposure antiretroviral prophylaxis was recommended as a tool to prevent HIV transmission within a larger package of combined prevention. Little by little, feasibility studies, such as ImPrEP, are setting the ground for its implementation in public policies of Latin American countries.

By Lídice López Tocón

On May 13, the ImPrEP project’s implementing teams met in Lima, Peru, to share progress made on the study that covers strategic aspects for PrEP implementation so that it can be included in national public policies and public services. Though the project is being developed only in three countries, its results are expected to have a positive impact in other Latin American countries.

Florentino Badial (Mexico) noted that homophobia and transphobia are major obstacles to access PrEP

Researchers from Brazil, Mexico and Peru revealed the most relevant aspects of the study, as well as the obstacles that may compromise real access to combined prevention services, including PrEP.

Brenda Hoaglan, ImPrEP project researcher in Brazil, highlighted the crucial factors for the program’s success: the support of the Ministry of Health, funding for activities with the community, having a community advisory committee, the presence of trained peer educators in all health centers that were part of the study, as well as training in PrEP-related services and training updates.

Florentino Badial, from Mexico, mentioned that over 150 infections were prevented through the PrEP project, and that people looking for PrEP—who were living with HIV without knowing it—got early diagnosis: 17 % of people tested to get PrEP got a positive diagnosis and were referred to health services that offer antiretroviral treatment.

Furthermore, Badial noted that homophobia and transphobia in health establishments are major obstacles to access PrEP and treatment for other STIs.

Peru

Juan Guanira talked about the project’s progress in Peru. He stated that around 1,080 people were registered from May last year until September 2018. Guanira highlighted that the protocol allows participants to register and start PrEP treatment on the same day; some even get to know about PrEP on the same day. He also said that some people abandon PrEP mainly because contact is lost, getting care services takes too long or patients had secondary effects and decided to abandon treatment.

Gaby Mariño talked about the community aspects of the Peruvian project

In a country where information about PrEP is just starting to be known and people rarely seek health services, the community aspect has been of great importance. We talked about it with Eduardo Juárez, community coordinator of the ImPrEP project in Peru. He stated that “since the project has a community aspect, (Gaby Mariño and I) analyzed organizations within the project’s intervention areas; we had focus groups and interviews to know the level of information (about PrEP), which was almost non-existent. Based on that, we had information meetings regarding the project. […] Since not the entire population is organized, we tried to reach them all through trans girls who work as hairstylists and are leaders in the community or through gay leaders that play in sports fields. They helped us reach other people and summon them.”

The ImPrEP project aims at developing information that impacts public policies and at making progress towards free access to pre-exposure antiretroviral prophylaxis in public services. In this respect, Juárez noted that “we should adopt Brazil’s strategy and work through peer educators. If the Ministry of Health already has an intervention as part of the public health system, we should work with them so they can be in charge of contacting, informing and referring interested individuals.”

This study reveals the needs of the health system, both for Peru and the other countries, and lists the characteristics required for integrating new technology into the combined prevention package. Carlos Benites, Director of Prevention and Control of STIs, HIV and Viral Hepatitis, states they are committed to make progress towards a public policy that covers PrEP (and self-testing).

There is still room for improvement, such as regarding homophobia and transphobia in health establishments, which happens in all countries, as well as the stigma related to HIV, which also affects and discourages key populations as they are scared to be confused with people with HIV.

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