PEP, the (unfortunately) forgotten part of combination HIV prevention – Agência AIDS

One of the most striking events in the history of the HIV pandemic has undoubtedly been the evolution over time of the curve of new cases of infection recorded each year in the world. If in the 1980s and 1990s we witnessed an explosive growth in diagnosed cases, from the turn of the millennium, fortunately, the scenario changed. First, the incidence of this infection stopped growing and then entered a downward trend that continues to this day.

Now, if you think that what determined the variations of this incidence curve was simply the proportion of people who used condoms in their sexual relations and the number of sexual partners each individual had, know that you are far reality.

Much more than an isolated method of prevention or judgment of another’s sex life, the existence and combination of multiple and different prevention methods have been the main factors influencing the speed of growth of the HIV pandemic over the of his 40 years.

As with contraceptive methods, it wasn’t until it became clear that different people would adapt to different forms of prevention that the numbers started to improve. Imagine what the world would look like today if we only had sexual abstinence and condoms available to prevent unwanted pregnancies?

In the process of developing new methods of HIV prevention, the arrival of antiretroviral drugs has been what has caused the greatest slowdown in the growth of the pandemic. Whether used to treat people living with HIV or when prescribed to uninfected people, the use of antiretrovirals has been successful in reducing the risk of HIV transmission to negligible levels. Regardless of condom use, sexual practice or number of sexual encounters.

When used for prevention by people who are not infected with HIV, antiretrovirals are called prophylaxis. This use can be done in a programmed way, before sexual intercourse, which is called HIV Pre-Exposure Prophylaxis (PrEP), or in an emergency, after an unplanned sexual exposure, in the form of Post-Exposure Prophylaxis ( EPP).

Both drug prophylaxis against HIV have been available for years in the SUS (Unified Health System). However, while on the one hand PrEP has been growing in demand and distribution since its arrival in 2018, PEP distribution appears to have stagnated in the country.

In the state of São Paulo, which provides the most PEP care in the country, for example, according to data from the PEP panel of the Ministry of Health, between 2017 and 2020, the monthly demand for PEP remained stable, with no trend. growth, oscillating between 1,500 and 3,000 individuals. In 2020, due to the covid-19 pandemic, PEP demand dropped and then resumed a slightly higher average than before.

Around the world, different countries are reporting difficulties in expanding the distribution of PEP. Despite the very high protective efficacy against HIV and the virtual absence of side effects, many people, even knowing that they may have been exposed to the virus during unprotected sex, do not seek PEP for fear of intolerance to antiretrovirals.

Moreover, even among those who are aware of the existence, effectiveness and safety of PEP, there are often barriers to accessing this method of prevention, such as fear of judgment and exposure of the intimacies of sex life to a professional during services in health services.

In order to have maximum preventive efficacy, PEP must be started within 72 hours of risky sexual exposure and taken with good compliance for 28 days. Thus, if a person takes too long to decide whether or not to receive PEP, they may miss the opportunity to avoid HIV infection.

Some steps have been taken in recent years to try to break down these barriers to accessing PEP, such as increasing the number of services that offer this service (see list here) and training health professionals who offer this service.

With the regulation of online telehealth services due to the covid-19 pandemic, PEP has also gained another gateway. Similar to what is already done in Europe and the United States, it is now possible in the city of São Paulo to obtain PEP thanks to the teleservice and the delivery of a kit with antiretroviral drugs and HIV self-tests to the place of his choice. This is the promise of the partnership between the company VenLibre (www.venlibre.com.br) and the state and municipal HIV coordinators of São Paulo.

PEP is an effective HIV prevention method already proven and available in Brazil. We cannot not make it known, since the situations with a precise indication of its use must in fact be much more frequent than the few thousand that arrive every month in the health services in Brazil.

Barriers such as misinformation, lack of care and discrimination can be responsible for thousands of new HIV infections that could be prevented by PEP each year.

Finally, if the diversification of prevention methods has succeeded in modifying the historical curve and reducing the number of new HIV infections, only the widening of their access can reduce these cases to zero and finally control the pandemic.

Source: Viva Bem (UOL) / Chronicle Rico Vasconcelos

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