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Social Support at AIDS 2024
Enhancing Social Support to Improve HIV-Related Outcomes: Lessons From Latin America at AIDS 2024

Released: August 20, 2024

Expiration: August 19, 2025

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

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Key Takeaways
  • Food insecurity directly affected ART/PrEP adherence, and social support may contribute to improve HIV outcomes in people with or affected by HIV.
  • Among youth, peer support might improve not only HIV care and prevention but also other health issues such as substance use.

Although the rate of new HIV infections have decreased in many settings, Latin America has seen an increase in new HIV cases in recent years. The region has made important gains in expanding access to HIV prevention and treatment, but HIV still disproportionately affects the most vulnerable populations. Latin America is also facing threats to crucial social and human rights. Several abstracts at the AIDS 2024 conference addressed these critical aspects of the HIV epidemic in this region.

Food Insecurity
Latin America suffers from pronounced socioeconomic inequalities, which are a major driver of the HIV epidemic there. A compelling analysis presented by Luz assessed the effects of food insecurity on antiretroviral therapy (ART)/pre-exposure prophylaxis (PrEP) nonadherence in Brazil, using data from a cross-sectional web-based survey for adult sexual and gender minorities. This study assessed whether socioeconomic inequalities were a barrier to adherence, beyond just the cost of ART or PrEP. Investigators rationalized that cost of medication is unlikely to be a barrier to ART and PrEP in Brazil, where both are free to all who need them.

Among individuals accessing the survey, the analysis included 1230 persons with HIV receiving ART and 991 persons without HIV who were on daily oral PrEP. Investigators found that moderate to severe food insecurity was more common among participants with HIV (22%) compared to those without HIV (13%). Self-reported ART and PrEP nonadherence were approximately 40% and 7%, respectively. Ultimately, the effect of socioeconomic status on ART and PrEP adherence appeared to be mediated through food insecurity: Lower socioeconomic status was associated with higher food insecurity that, in turn, was associated with lower ART/PrEP adherence.

These findings confirm that adherence to medications is a result of complex factors, including social inequalities. Worsening social inequalities in Latin America, and especially Brazil, were recently exacerbated by the COVID-19 pandemic, spurring an increase in food insecurity among vulnerable populations. These results highlight the need for immediate, actionable interventions—such as access to food banks, provision of food baskets, or food vouchers in the short term – and increasing the minimum wage or providing financial assistance to low-income households in the long term. The provision of socioeconomic support could directly help people with or affected by HIV by improving their quality of life and controlling/preventing HIV infection, ultimately decreasing HIV transmission across the region.

Peer Support
Sexual and gender minorities face disproportionate vulnerability to HIV in Latin America, with a persistent increase in HIV cases. However, tailored interventions for this group are scarce. To address this gap in care, peer support as a strategy to reach, engage, and improve health outcomes among youth was one of the most discussed topics at AIDS 2024.

Jalil presented findings from the Conectad@s study, a peer-led, technology-based intervention study with respondent-driven sampling to improve HIV care and treatment. The study enrolled 409 young men who have sex with men and nonbinary individuals, including 40 people with HIV. All participants received weekly text messages via a social networking app and peer-led support for 24 weeks.

The intervention was accepted by all participants, with a high retention rate of 83.4%, and was associated with notable improvements in HIV-related outcomes:

  • Among participants with HIV, only 50% were aware of their HIV status at study entry compared with 100% at the end of the study.
  • Throughout the study, both linkage to HIV care and ART usage increased from 50.0% to 97.4%, and viral suppression increased from 40.0% to 81.6%.
  • Although a high proportion of participants were already aware of PrEP at study entry, investigators reported a truly remarkable increase in current PrEP use, which increased from 0.9% at study entry to 68.7% by study end.

If peer-led support can lead to such improvements in HIV-related outcomes, it is not much of a leap to think that peer support can also drastically improve other healthcare outcomes. Prior results of the BeT (Brilhar e Transcender) study among young transgender women in Brazil showed that involving peers in health services not only helped establish a welcoming setting for the transgender population, but it also improved HIV testing rates, PrEP use, and HIV care engagement.

New results from the BeT study, presented by Coutinho at AIDS 2024, sought to determine if peer-led support could also improve health outcomes related to substance use.

Although substance use was common among participants at study entry, investigators reported that, with peer-led support, moderate-risk/high-risk of problematic substance use decreased significantly for all substances from study entry to end, in particular with tobacco (57.7% vs 39.7%), alcohol (22.5% vs 0.9%), marijuana (62.9% vs 50.9%), crack or cocaine (8.6% vs 4.3%), amphetamines (3.4% vs 0.9%), and inhalants (8.6% vs 0.9%). No participants had high risk of problematic substance use at their 48-week follow-up.

Altogether, findings from these 2 studies reinforce the relevance of peer support not only for HIV care and prevention, but for other health issues among youth, specifically substance use. Simple interventions, adapted to their reality and combined with expanding PrEP options, can enhance engagement of youth in health services and has the potential to transform the landscape of the HIV epidemic in Latin America.

Your Thoughts?
Does your clinic employ peer-support programs for people with HIV? If not, do these results from Latin America motivate you to consider it? Leave a comment to join the discussion!