SUS extends HIV prevention method to adolescents

The Ministry of Health has expanded the pre-exposure prophylaxis program (PrEP) to HIV, including adolescents aged 15 and over. Until the beginning of September, the minimum age to obtain the medication was 18 years old.

The method is an additional protection strategy against the virus. Any person with a body weight equal to or greater than 35 kg, sexually active and who is exposed to contexts of increased risk of HIV infection is eligible for prophylaxis.

The program was implemented in the country as a public policy in 2017. The treatment consists of the 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 risky sexual activity or biological accident (when, for example, a health professional without protection comes into contact with a patient’s blood) that occurred in the past maximum 72 hours.

According to the new protocol, access to services, guidance and consultations is guaranteed to adolescents without the need for the presence or authorization of legal guardians. According to the ECA (Child and Adolescent Statute), situations of risk to life and hospitalization, however, 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, sex workers and people who have serodiscordant partners (when one has HIV and the other does not) are among the profiles most vulnerable to infection by the virus.

For Inês Dourado, epidemiologist and professor at UFBA (Federal University of Bahia), the stigma against these groups is an obstacle in the search for assistance.

But these are not the only parts of the population that are susceptible to contagion. Depending on sexual practices, anyone can be at risk of HIV infection. Those who live with the virus do not necessarily develop AIDS, the most advanced stage of the disease.

For Dourado, expanding access to PrEP was essential. She is one of the coordinators of PrEP 1519, a project that is the only one in Latin America to investigate the effectiveness of the method in adolescents aged 15 to 19 years.

The survey, carried out from 2019 to 2021, followed 1,200 young Brazilians with profiles of greater vulnerability to HIV infection. “Around 80% of the teenagers had a rate of medication adherence that was sufficient to obtain adequate levels of protection against HIV”, he says.

The study was funded by Unitaid, a global health agency linked to the UN (United Nations) 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 indicates that PrEP is 95% effective in vulnerable groups with correct adherence to medication. Prophylaxis, however, does not prevent other sexually transmitted infections (STIs), such as syphilis.

Rico Vasconcelos, infectologist and researcher at USP (University of São Paulo), indicates “combined prevention” as the best strategy when combining more than one method of protection, such as correct use of condoms, regular testing for HIV infection, early diagnosis and proper treatment of STIs. “Twenty years ago, condoms were enough. Today, this protection alone won’t work for everyone,” he says.

The doctor also highlights contexts that make it difficult to reduce infection rates, including social inequality, stigma and violence against the LGBTQIA+ population. Vasconcelos also mentions the lack of awareness campaigns.

According to the IEPS (Institute of Studies for Health Policies), the Ministry of Health’s 2023 Budget proposal provides for a cut of BRL 407 million for the prevention, control and treatment of HIV/AIDS and other STIs.

“Before, there were two major campaigns per year. In the last two years, there wasn’t even one. We need to go back to talking about prevention”, says the infectologist.

Questioned about the absence of prevention campaigns in the last two years and about cuts for 2023, the Ministry of Health stated that more than R$ 18.7 million were invested in actions in the years 2020 and 2021 and that, in 2022, it launched the campaign “The more combined, the better!” to strengthen HIV prevention measures among young people.

In addition, he stated that no public policy will be interrupted and that “he will seek, in dialogue with the National Congress, 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 male (1,488). The increase was 11% compared to 2020, when 1,834 adolescents in this age group contracted the virus (1,234 men).

According to Claudia Velasquez, director and representative of Unaids in Brazil, to address combined prevention with young people, it is necessary to consider spaces, language and channels used by this public.

“We try to bring a priority look to young people in situations of greater vulnerability, who face barriers to accessing information and services for the prevention, diagnosis and treatment of HIV and AIDS”, she says.

Diego Uchoa, from Ceará, was 16 years old when he became infected with HIV, in 2004. At that time, PrEP did not exist. Orphan of both father and mother, he was unaware of prevention methods. “I had little understanding of condoms and didn’t even know about HIV.”

When diagnosed, Uchoa went live on a radio in Jaguaribe, a municipality 135 km from the capital of Ceará, to tell his story. “I went to ask for help to get to Fortaleza. I was desperate. Everyone in the city knew about it. That’s how I found prejudice. Wherever I arrived, people separated cups, plates, towels”, he says, now 34 years old.

The stigma made him go ten years without seeking assistance. During this period, he lost weight, and the condition evolved into Aids, which requires therapy with retrovirals. When he arrived at the São José Hospital for Infectious Diseases, in the capital, he weighed 32 kg. Now recovered, he works at Casa Sol Nascente, an organization that welcomes adults and children with HIV/AIDS.

The attorney for the State of Rio Grande do Sul, 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 adherence to treatment in the public network.

Orlandini says that he included PrEP as another preventive measure because, unconsciously, he tied his sexuality to death. “Homosexuality was very much associated, in adolescence, with people becoming thin and dying from complications of the infection.”

The prosecutor understands that a positive diagnosis for the virus today does not indicate a death sentence. And he adds that PrEP does not make him neglect other preventive methods. “It allows me to live sexuality in a healthier way.”

Who can use prophylaxis

• People aged 15 years and older, 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 sex workers
• Anyone in contexts of increased risk of HIV infection, who have many partners, frequency of sexual practices without adequate protection and irregular use of condoms
• Have not been infected with HIV
• Repeated use of PEP (post-exposure HIV prophylaxis)
• Have frequently contracted sexually transmitted infections

See here in which SUS services PrEP is available.