The Ministry of Health promises a 300% increase in the offer of prophylaxis that reduces to more than 90% the chance that a person will become infected with the virus.
Simple, free and very effective in protecting against the HIV virus. Pre-exposure prophylaxis, better known by the acronym PrEP, consists of the daily use of a combination of antiretroviral drugs (tenofovir + emtricitabine), which has a composition similar to that used in the treatment of HIV, which reduces the chance of a people become infected when exposed to the virus.
At the beginning of 2023, the introduction of PrEP in the Unified Health System (SUS) completed five years and consolidated itself as a tool in the fight to prevent more cases of infection in Brazil. The policy is also expanding.
“The expansion of PrEP was possible thanks to a series of policy adjustments and improvements, including: prescription by nurses and pharmacists in some states, the provision of PrEP in Primary Care services and the possibility of prescribing prophylaxis in private services for withdrawal from SUS. Dráurio Barreira, director of the Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections in the Ministry of Health said.
Data from the PrEP Panel, available on the government’s website, indicates that 118,000 people have started using PrEP across Brazil since 2018, the year the offer began. In the first three months of 2023 alone, there were 12,343 new users. In the same period last year, there were 8,393 in 2022.
The numbers consolidate Brazil as the leader in Latin America and, according to experts, help to explain the successive drops in new registered HIV cases: between 2019 and 2021, the number of HIV infection cases decreased by 11.1% in Brazil, with the highest rate reduction in the South (15.4%) and Southeast (15.3%) regions.
“The response to HIV is done in a multifactorial way. In a technical analysis of the folder, it is possible to identify a correlation between the relative number of PrEP dispensing in the municipalities and the trend of reduction in the incidence rate of HIV in the locality. The more proportion of the PrEP in the municipality the greater, the greater the reduction in the incidence of HIV. With this, it is possible to conclude that places with more prophylactic dispensing also have a more effective HIV care service, which, together, leads to a reduction in the incidence of the virus “, explained Barreira.
nonetheless, the positive data do not hide the differences in the PrEP initiative of the SUS, as the project is called in the Ministry of Health. São Paulo leads with almost 40 thousand initiations, followed by Rio de Janeiro with 8,302.
Although São Paulo’s large population justifies the high use of PrEP, the dedication to expanding services and reducing new HIV infections is notorious. In the capital, where almost 70% of PrEP users in the state of São Paulo are concentrated, despite the progressive increase in the number of rapid HIV tests performed each year, a reduction of about 40% in the detection rate of new cases. Even during the Covid-19 pandemic.
No state in the Northeast, in contrast, reached nearly 3,000 PrEP users, despite being the second region with the most HIV cases. “Unfortunately, we still have many municipalities that do not have access to this important prevention tool”, explains José Valdez Ramalho Madruga, infectologist and coordinator of the HIV/AIDS committee of the Brazilian Society of Infectology. There are only 770 health units that offer prophylaxis, most in the Southeast region.
Diving deeper, the data highlights even more concerns. For example, while HIV infection is increasing among people under 25, 64% of PrEP users are over 30. Similarly, white and more educated people make up the majority (57% and 72%, respectively). “The most vulnerable and least educated population doesn’t even know about PrEP. We need to capitalize on the information,” adds Madruga.
Additionally, 46% of PrEP users discontinued the program within five years. While personal choice determines PrEP use, it is unclear how much discontinuation could be avoided due to barriers such as fear or misinformation.
To circumvent the imposed limits, the Ministry of Health promises to increase the prescription up to 300% by 2027. “Just as we have condoms in the basic health units, we want the prophylaxis available to anyone who wants it”, explains Dráurio Barreira, emphasizing on the importance of prevention.
“For some diseases, you either have vaccines or you have medicine. In the case of HIV, when the elevation of the viral load is not detectable, the person is not transmitting something that is not in the blood. So, PrEP has become an absolute priority in terms of prevention “, adds the director.
The Ministry of Health, nonetheless, emphasized that PrEP is indicated only after the person has been tested for HIV, as it is contraindicated for users infected with the virus. In these cases, prophylaxis may cause resistance to treatment. For this reason, people already living with the virus will not adhere to prophylaxis, but will be referred for immediate treatment.
In addition, PrEP should be considered as an additional strategy in a series of preventive actions, called “combined prevention”, as a way to improve protection against HIV. Combination prevention includes regular testing, prenatal testing and treatment of pregnant women living with the virus, harm reduction for drug use, testing and treatment for other sexually transmitted infections (STIs) and viral hepatitis, external condom use and internal post-exposure prophylaxis. (PEP), further treatment to make the viral load undetectable.
HIV infection can be diagnosed through rapid tests. SUS provides laboratory tests and rapid tests that detect antibodies against the virus in about 30 minutes. Treatment is also accessible and essential to ensure quality of life for people living with HIV/AIDS.