Published On: December 14, 2017

Health Ministry Initiative Targets Youth

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Seeking to stem a sharp rise in HIV cases among young people, Brazil began offering a drug this month that can prevent infection to those deemed at high risk of contagion. Brazil is the first country in Latin America and among the first in the developing world to adopt the drug, known as PrEP, as an integral part of its preventive health care policy.

The Brazilian Health Ministry is paying Gilead Sciences, the American manufacturer of the drug, about 75 cents a dose, a fraction of the price users pay in the United States, where PrEP sells for upward of U$1,600 (5000 reais) for a month’s supply.

While the transmission of the virus from mother to child has been significantly reduced in Brazil, about 10 percent of gay men are HIV positive. Testing positive for HIV is linked directly to AIDS; however, there has been great success in treating HIV positive individuals with medication known as antiretrovirals that prevent them from contracting AIDS.

“Our hope is that with PrEP and other measures we can reduce the rate of new infections of HIV,” said Adele Benzaken, the director of the AIDS department at Brazil’s Health Ministry. “But it’s a big challenge.” Brazil has long been recognized for its strong response to the AIDS epidemic. It challenged pharmaceutical companies in the 1990s by producing generic versions of costly antiretroviral drugs, which lowered prices globally. Brazil’s government buys and distributes more condoms than any other country, and in 2013 it started providing antiretroviral therapy free to all HIV positive adults seeking care.

Carnaval in Brazil

Carnaval in Brazil

PrEP is being rolled out at a crucial time in Brazil, with the country’s health officials particularly alarmed by the rise of the HIV virus. Between 2006 and 2015, the number of AIDS cases in men aged 15-19 almost tripled. Among men 20-24, the rate almost doubled, according to U.N.AIDS, a United Nations agency that coordinates HIV prevention policy around the world. Approximately 48,000 new cases of HIV were reported in Brazil in 2016 and about 14,000 deaths related to AIDS, the agency said.

Proponents of the plan to distribute PrEP say Brazil’s experience will show the economic benefits of investing in prevention. “With the addition of PrEP, Brazil is using all of the strategies that we recommend,” said Georgiana Braga-Orillard, the director of U.N.AIDS Brazil. “This is a large-scale operation, and Brazil could become an example to all of Latin America that we need to see an integrated approach.”

Since the United States Federal Drug Administration approved PrEP as a prevention drug for HIV in 2012, several countries have sought to make it available and affordable to people at risk. The blue pill — which drastically reduces the risk of contracting the HIV virus when taken daily — will be made available at no cost to eligible Brazilians at 35 public health clinics in 22 cities during an inaugural phase of the program.

Truvada, the branded PrEP drug manufactured by Gilead. Credit: Dado Galdieri for The New York Times

Truvada, the branded PrEP drug manufactured by Gilead. Credit: Dado Galdieri for The New York Times

Two pharmaceutical companies have applied to Brazil’s health regulatory agency, Anvisa, for approval of generic versions of PrEP, which is marketed as Truvada. Because of the success seen in slowing the spread of AIDS, people have grown less concerned about it, leading to a decline in the use of condoms, said Jose Valdez Madruga of the São Paulo Health Secretariat, who was one of the coordinators of a PrEP trial in Brazil carried out ahead of its release.

PrEP, the new tool in Brazil’s effort to contain the spread of HIV is being deployed as budget shortfalls in some states have led to personnel and medicine shortages that have crippled several hospitals. Additionally, public schools that provide comprehensive sex education have come under attack from conservative politicians.

Still, health officials have high hopes for the impact PrEP can have on keeping people healthy. In order to promote it, they are considering partnering with popular YouTube personalities and advertising on online dating apps.

[This article originally appeared in The New York Times in slightly different form.]


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