Offered free of charge since 2019 by the Unified Health System (SUS) network, the drugs that make up Pre-Exposure Prophylaxis (PrEP) against the HIV virus are aimed at audiences at greater risk of contamination by the disease. However, four years after the start of its distribution, information is the main problem encountered to reach especially its priority targets, which are trans women, transvestites and call girls.
Infectologist Unaí Tupinambás explains that PrEP is a combination of two drugs that can “block” infection with the virus that causes AIDS. “Scientific studies show that those who use the medication correctly can achieve up to 97% protection against HIV infection. But, of course, it is important to use the so-called ‘combined prevention strategy’, which relies on other methods, such as the use of condoms, lubricant and testing”, he details.
PrEP has some criteria for use, which include the selection of people most vulnerable to HIV infection: gay men and other men who have sex with men (MSM); trans people and transvestites; sex workers; and serodifferent partnerships (one of the partnerships lives with HIV). It is also indicated for people who have frequent sex without using a condom, those who make repeated use of PEP (Post-Exposure Prophylaxis to HIV) or who have frequent episodes of Sexually Transmitted Infections (STIs); and also for those who have sex with HIV positive partners who are not undergoing treatment.
Social mobilizer and member of the Network of Adolescents and Young People Living and Living with HIV/AIDS in Minas Gerais, Rafael Sann Ribeiro argues that, despite being a very important drug to achieve the extinction of the AIDS epidemic across the planet , in the state, the publics that are most exposed to the virus are those that have less access to PrEP.
“Today, we see that the majority of users are young, upper-middle-class cis gay men, while very few transsexuals, transvestites and call girls are having access to this free drug. In my opinion, there is a lack of investment in the dissemination of this prevention mechanism for this most vulnerable part of our population, which, by the way, is the most exposed to the virus that causes AIDS”, he argues.
According to the municipal coordinator of Sexual Health and Attention to STIs, AIDS and Viral Hepatitis in Belo Horizonte, Christiane Hernandes, there are currently 1,221 active users of PrEP in the capital of Minas Gerais. She explains that, according to data from the Ministry of Health, between the start of medication distribution and June 30 this year, 95.2% of the drug users were cis men.
“Then come cis women (2.1%), trans women and transvestites (2%), trans men (0.4%) and non-binary (0.3%). The education data showed that 85% of the public has 12 or more years of study, 14%, between 8 and 11 years, and 1%, between 4 and 7 years”, details the professional.
Also according to Christiane, within the female gender, 24% of PrEP users reported exchanging sex for money, valuables, drugs, housing or services.
“The BH Program of Mãos Dadas contra a AIDS, which works through harm reduction efforts with vulnerable populations, including transvestites and program girls, works and makes this public aware on a daily basis about the importance of measures to prevent sexually transmitted infections in the context of combination prevention. The offer of PrEP is one of them”, he adds.
From January to August 2022, the program approached 12,952 female professionals, 2,296 trans women and transvestites, 599 male professionals and 67 trans men.
According to IBGE data from 2019, 1.4% of the 21.2 million miners declared themselves to be homosexual or bisexual, which corresponds to about 300 thousand people. At the same time, until August 2022, Minas Gerais had only 894 registered PrEP users, according to SES-MG, a very small number compared to the entire LGBTQIA+ population in the state.
In Belo Horizonte, PrEP data take into account the number of drug distributions (dispensations), which has increased in recent years. If in 2019 there were 1,802 dispensations and 1,696 in the first year of the pandemic, the number jumped to 2,580 in 2021 and, by July 2022, 2,396 medicines had already been distributed.
“People don’t know”, says transvestite
The transvestite Wanessa agrees that what is missing for PrEP to reach the population is publicity for this audience. “How would a company sell cheese bread if people didn’t know it existed? What’s missing is information, really publicity,” she says.
According to her, currently, knowledge about preventive medicine is restricted to a few people. “It had to be a natural thing, to be available in every neighborhood for everyone to have access to. It doesn’t have to be something that we need to be referred by someone, everyone needs to know about it. I cite the example of the Trans Ambulatory at the Eduardo de Menezes Hospital, to which some girls have access, but many others do not even know it exists”, pointed out Wanessa.
Infectious disease specialist Unaí Tupinambás highlights the importance of people at greater risk of contamination seeking the health service to first be tested for HIV and then to assess the use of PrEP. “Together, these combined strategy and prevention tools are very important for us to be able to eliminate the AIDS pandemic, who knows, by 2035”, explains the specialist.
Fall in HIV and rise in STIs
Data from the State Department of Health (SES-MG) indicate that, since the beginning of the distribution of the drug, the new diagnoses of people infected with AIDS have been falling every year. In 2019, there were 5,149 HIV infections. The following year, the number was reduced to 3,942, and in 2021, it reached 2,659.
On the other hand, Sexually Transmitted Infections (STIs) grew in recent years in the State, especially syphilis, which registered a 2,149% increase in 10 years. According to data from SES-MG, cases of acquired syphilis (transmitted from one person to another) increased from 712 in 2011 to 16,017 in 2021.
The folder was asked about numbers related to other STIs, such as genital herpes, chancroid, HPV, Pelvic Inflammatory Disease (PID), donovanosis and gonorrhea, among others. However, according to the secretary, among these diseases, only syphilis is notifiable. “Thus, SES-MG has epidemiological information referring only to this disease”, he replied.
In view of these numbers, infectious disease specialist Unaí Tupinambás highlights the importance of also using other prevention methods, especially condoms, since PrEP does not prevent against other Sexually Transmitted Infections (STIs). “Condom use has been falling around the world since before PrEP came along. Here, in Brazil, too, largely because of the lack of sex education campaigns and this conservative tide”, he concludes.
Questions and answers about PrEP
What is PrEP?
It is a combination of two drugs (tenofovir + emtricitabine).
What is it for?
Together, the substances are able to block some of the “pathways” that HIV uses to infect the body, thus preventing people from acquiring AIDS.
How is it taken?
It must be taken daily by its users to ensure greater protection. However, its so-called “on demand” use can also be indicated by specialists, consisting of ingestion 24 hours before exposure and in the three days following sexual practice.
However, according to the State Health Department (SES-MG), if the medication is not administered daily, “there may not be sufficient concentration in the bloodstream to block HIV”.
Where to get PrEP?
According to the Municipality of Belo Horizonte, PrEP is currently offered in four locations in the city, however, beforehand, it is necessary to make an appointment (at the indicated times), to go through a registration.
In other cities in Minas Gerais, people interested in using PrEP should look for one of the 29 units of Specialized Care Services (SAE) in the state. The list with all addresses can be accessed clicking here.
Check the addresses in BH:
– CTR DIP Orestes Diniz (Alameda Vereador Álvaro Celso, 241, Santa Efigênia): on Tuesdays and Fridays, from 2 pm to 5 pm.
– CTA-SAE Sagrada Família (Rua Joaquim Felício, 141): from Monday to Friday, from 7 am to 6 pm.
– CTA Caetés (466, Rua Caetés, Shopping Caetés): from Monday to Friday, from 9 am to 5 pm.
– URS Centro Sul (890, Rua Paraíba, Employees): on Wednesdays, from 1 pm to 4 pm, and Fridays, from 3 pm to 6 pm.
– CTR DIP Orestes Diniz.
– CTA-SAE Sagrada Familia.
– USSR Center South.
– SAE Eduardo de Menezes (Rua Dr. Cristiano Rezende, 2213, Bonsucesso, Barreiro).
Do I need to do a follow-up?
Yup. After the first consultation with an infectious disease specialist and carrying out clinical and laboratory tests, the person returns up to two weeks later to receive the results and the doctor to decide whether the use of PrEP will be indicated. After that, the patient is followed up through pre-scheduled consultations every three months. Once treatment has started, there is no waiting list for patient follow-up, according to the municipality.
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