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HIVR4P: Migrant and Indigenous People in Latin America
Migrant and Indigenous People in Latin America: Reflections From HIVR4P

Released: November 05, 2024

Expiration: November 04, 2025

Emilia M. Jalil
Emilia M. Jalil, MD, PhD
Activity Information

Activity

Progress
1
Course Completed
Key Takeaways
  • Populations such as migrants and Indigenous people in Latin America need more robust HIV care.
  • São Paulo may serve as a model for other cities in Latin America to expand access to HIV prevention through increased flexibility and autonomy.

The HIVR4P conference, recently held in Lima, Peru, was an excellent opportunity to discuss the main challenges in the HIV response in Latin America. With more than 2 million people living with HIV in 2023, Latin America is one of the only regions where new HIV infections have continued to rise since 2010. Pre-exposure prophylaxis (PrEP) scale up in the region has been very slow, with the highest increases in HIV infections among men who have sex with men and transgender women.

Burden of the HIV Epidemic in Latin American Populations
A session dedicated to Latin America in the spotlight: "Caminos" to zero (OA04) brought together the discussion about the HIV epidemic in some Latin American populations, such as migrants and Indigenous people. These groups face multiple, intersecting forms of sociostructural disadvantages that can negatively impact their access to health, including HIV prevention and care. All presentations reinforced the systemic inequities that put those people at a disadvantage and may increase their vulnerability to HIV and other sexually transmitted infections (STIs).

The Proyecto Radiante was a mixed methods study aimed at exploring how synergistic migration- and sex work–related vulnerabilities drive the need for HIV/STI prevention and care services among Venezuelan cisgender women who are sex workers in Peru. Using peer recruiters from the population, 304 participants were enrolled between February and March 2024. Experiences of housing and food insecurity, intimate partner violence, and mental health issues were disproportionality high, regardless of the time of migration. In addition, many participants reported not being in control of their sex work.

On a separate note, the presentation performed by Purnell was applauded as one of the few at the conference to address the Indigenous population. In Latin America, Indigenous communities bear a high burden of the HIV epidemic, with alarming rates of HIV and poor outcomes in both HIV care and prevention. Purnell et al identified that Indigenous gay and bisexual men face a unique and compounded stigma related to both their sexual orientation and Indigenous identity. However, those reporting more of these experiences showed higher rates of PrEP uptake.

The discussions presented in the session reinforced the crucial understanding that the HIV response must encompass a broader range of components, particularly social inequities. Addressing HIV requires a comprehensive approach that considers the diverse social determinants of health that disproportionately affect marginalized populations. By integrating discussions of social inequities into the HIV response, we can identify the barriers that these groups encounter and create targeted interventions that promote equity in health outcomes.

A Successful Latin American Example
Oral PrEP was introduced in 2018 as a key biomedical strategy for HIV prevention in Brazil through the Brazilian public health system. The city of São Paulo, located in the Southeast region of Brazil, accounts for 40% of all PrEP users in the country. A well-attended oral presentation during the HIVR4P Conference, presented by Silva (OA0402), outlined the diverse strategies employed by the STI & AIDS program in São Paulo to tackle the HIV epidemic, particularly among youth. Epidemiologic data from the city showed a decline in HIV incidence for the 7th consecutive year, with a 54.6% reduction in cases between 2016 and 2023, and an even higher reduction of 57% among people aged 15 to 29 years. The largest decline occurred between 2022 and 2023, with a 22% reduction in new HIV cases.

One of the strategies implemented in the city is SPrEP (PrEP and post-exposure prophylaxis [PEP] online), an innovative approach to increasing access to PrEP and PEP through a dedicated channel in the municipal health app (e-saúdeSP), managed by the municipal health department. The channel offers telehealth services 7 days a week, with extended hours to 10 pm. Users can access options for PrEP initiation and follow-up assessments, PEP assessments, and consultations for any questions. (During the teleconsultation, users need only show an HIV-negative result performed within the last 7 days or an HIV self-test.) Users may pick up their medication in one of the health services distributed across the city, including 24-hour units, or from a dispensing machine.

Between June 2023 and April 2024, there were more than 2 million accesses, with 1129 PrEP initial consultations, 955 PEP visits, and 571 follow-up consultations. Most users preferred to pick up their medication at the 24-hour units.

This example from São Paulo demonstrates that employing a variety of strategies to expand access to HIV prevention, including PrEP, can play a crucial role in reducing new HIV cases. These diverse approaches, such as telehealth and extended service hours, are essential for removing barriers and reaching more vulnerable populations who benefit most from easier access to PrEP and PEP. These strategies may be adapted by other cities as a model for expanding access to HIV prevention through increased flexibility and autonomy in other parts of Latin America.

Your Thoughts?
How can you apply the lessons learned from these studies to your own practice? In terms of social inequities as barriers to HIV prevention, what commonalities exist between your region and Latin America? Get involved in the discussion by posting a comment below.