The Ministry of Health has expanded the HIV pre-exposure prophylaxis (PrEP) program to include adolescents aged 15 and over. Until early September, the minimum age to get the drug was 18.
The method is an additional protection strategy against the virus. Anyone weighing 35 kg or more who is sexually active and exposed to contexts of increased risk of HIV infection is eligible for prophylaxis.
The program was implemented in the country as public policy in 2017. The treatment consists of oral and daily use of a pill composed of antiretrovirals and allows the body to create a barrier against possible contact with HIV.
In post-exposure prophylaxis (PEP), treatment lasts 28 days and is given after a risky sexual activity or a biological accident (when, for example, an unprotected healthcare worker comes into contact with a patient’s blood) that has occurred in the last 72 hours at the latest .
Under the new protocol, adolescents are guaranteed access to services, guidance and counseling without the need for the presence or authorization of legal guardians. According to the ECA (Statute for childhood and adolescence), life-threatening situations and hospitalization, on the other hand, must be communicated to adults.
In all, 44,084 Brazilians use PrEP. Of these, 18,591 are in the state of São Paulo, points out the PrEP Panel, a tool of the Ministry of Health.
Gays and other men who have sex with men, trans people, transvestites, prostitutes and people with HIV-discordant partners (when one has HIV and the other doesn’t) are among the profiles most vulnerable to HIV infection. virus.
For Inês Dourado, an epidemiologist and professor at UFBA (Federal University of Bahia), the stigma towards these groups is an obstacle to seeking assistance.
But these are not the only parts of the population susceptible to contagion. Depending on sexual practices, anyone can be at risk of HIV infection. Those living with the virus do not necessarily develop AIDS, the most advanced stage of the disease.
Expanding access to PrEP was essential for Dourado. She is one of the coordinators of PrEP 1519, a project that is the only one in Latin America to study the effectiveness of the method in adolescents aged 15 to 19.
The survey, carried out from 2019 to 2021, followed 1,200 young Brazilians with profiles of greater vulnerability to HIV infection. “About 80 percent of adolescents had enough medication adherence to get adequate levels of HIV protection,” she says.
The study was funded by Unitaid, a United Nations (UN)-linked global health agency focused on solutions to prevent and treat serious diseases such as HIV/AIDS.
The Clinical Protocol and Therapeutic Guidelines (PCDT) of the Ministry of Health indicate 95% of the efficacy of PrEP in vulnerable groups with correct drug adherence. Prophylaxis, however, does not prevent other sexually transmitted infections (STIs), such as syphilis.
Rico Vasconcelos, an infectious disease specialist and researcher at USP (University of São Paulo), points to “combined prevention” as the best strategy when more than one method of protection is combined, such as the correct use of condoms, regular tests for HIV infection, early diagnosis and correct treatment of STIs. “Twenty years ago, condoms were enough. Today, this protection alone won’t work for everyone,” he says.
The doctor also highlights the contexts that make it difficult to reduce infection rates, including social inequality, stigma and violence against the LGBTQIA+ population. Vasconcelos also cites the lack of awareness campaigns.
According to the IEPS (Institute of Studies for Health Policies), the 2023 Budget proposal of the Ministry of Health provides for a cut of 407 million reais for the prevention, control and treatment of HIV/AIDS and other sexually transmissible.
“Before there were two big campaigns a year. In the last two years there wasn’t even one. We need to go back to talking about prevention,” says the infectious disease specialist.
When asked about the absence of prevention campaigns in the last two years and about the cuts for 2023, the Ministry of Health stated that more than R$ 18.7 million was invested in shares in 2020 and 2021 and that, in 2022, launched the campaign “The more combined, the better!” strengthen HIV prevention measures among young people.
Furthermore, he stated that no public policy will be interrupted and that he “will seek, in dialogue with the National Congress, the necessary adjustments in the budget proposal for 2023”.
Data from the agency’s latest epidemiological bulletin show that, in 2021, 2,080 Brazilians aged 15 to 19 were infected with HIV, mostly males (1,488). The increase was 11% compared to 2020, when 1,834 adolescents of this age group contracted the virus (1,234 men).
According to Claudia Velasquez, director and representative of Unaids in Brazil, to address prevention combined with young people, it is necessary to consider the spaces, languages and channels used by this audience.
“We try to take a priority look at young people in situations of greater vulnerability, who encounter barriers in accessing information and services for the prevention, diagnosis and treatment of HIV and AIDS”, he says.
Diego Uchoa, from Ceará, was 16 years old when he contracted HIV in 2004. At the time, PrEP did not exist. Orphan of both father and mother, he was ignorant of prevention methods. “I had little knowledge about condoms and I didn’t even know about HIV.”
When he was diagnosed, Uchoa went live on the radio in Jaguaribe, a municipality 135km from the Ceará capital, to tell his story. “I went to ask for help to get to Fortaleza. I was desperate. Everyone in the city knew it. That’s how I found the prejudice. Wherever I went, people separated cups, plates, towels,” he says, now 34.
The stigma caused him to go ten years without seeking assistance. During this time he lost weight and the condition evolved into AIDS, requiring retroviral drug therapy. When he arrived at the São José infectious disease hospital in the capital, he weighed 32 kg. Now recovered, he works at Casa Sol Nascente, an organization that welcomes adults and children affected by HIV/AIDS.
Rio Grande do Sul state attorney Lourenço Floriani Orlandini, 39, was introduced to PrEP when the drug was being studied for inclusion in the SUS. Four years ago, he volunteered for studies to understand treatment adherence in the public network.
Orlandini says he included PrEP as another preventative measure because, unconsciously, he tied his sexuality to death. “Homosexuality was strongly associated in adolescence with people becoming thin and dying from complications of the infection.”
The prosecutor understands that a positive diagnosis of the virus today does not indicate a death sentence. And he adds that PrEP doesn’t make him overlook other preventative methods. “It allows me to experience sexuality in a healthier way.”
Who can use prophylaxis
- Persons aged 15 and over, sexually active, with a body weight of 35 kg or more
- Key populations, made up of gay men and men who have sex with men, transgender people, transvestites and prostitutes
- Anyone in contexts of increased risk of HIV infection, having many partners, frequency of sexual practices without adequate protection and irregular use of condoms
- They have not been infected with HIV
- Repeated use of PEP (HIV post-exposure prophylaxis)
- They frequently contracted sexually transmitted infections
See here in which services SUS PrEP is available.
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