PrEP in Brazil

[Novarunner]

I have made several trips to Thailand and in the years just prior to the pandemic the boys there generally knew what PrEP was and many of them were on it themselves.  I’ll be making my first trip to Brazil in a few months and am wondering what the situation is like there.  I have no interest in anything but condoms for new guys I meet in the sauna - I think that’s best for both of us since there are other things out there besides HIV - but since I usually like to see the same guy multiple times after I find one that I click with, what is the chance he will know what PrEP is?  What is the chance that he will be on it himself?

I’m traveling to São Paulo and Rio.

[Latbear4blk]

All the boys have been with in Rio and Salvador knew what PrEP was, most of them were in PrEP, condoms is standard in saunas.

[Riobard]

IMO, the ‘ativo’ garotos de programa that identify as straight, even if they tolerate protected receptive anal, tend to be less informed about HIV pharmacological exposure prophylaxis and the risks of insertive anal without a condom.

Moreover, unless things have changed since I last investigated, PrEP is issued to males without cost if they declare their risk-group status ... MSM, commercial sex work, etc. Some of the fellows would never suck up the sense of stigma regarding attendance at dispensing centres and the requirement of regular testing for HIV, kidney function, etc.

Personally, I always assume that each of them has an STD that I don’t want transmitted. 

The more expensive Gilead’s Truvada is the sole product, generics not having yet made their way into Brazil uptake. It is estimated that about 30,000 of brasileiros consume it, slowly upticking to the goal of 50,000 by end of 2022 that was set end of 2017 when 5,000 was the target.

Assuming, say, 5% of the adult male population age 16-65 have sex with males, only about one in 100 are likely taking PrEP.

Even if those demographics are inaccurate by a considerable margin, the story is fairly clear.

Edited January 16, 2021 by Riobard

[Riobard]

Rio de Janeiro, the city with among the highest HIV rates in Latin America, has initiated teleconsultation procedures enabling online digital interactions that can yield delivery of up to a 4-month supply of PrEP (free obviously) and a few rapid-test home kits, all in one go. This may, indeed, have expanded to other areas; PrEP organizational systems tend to be nationally centralized there. 

If this program takes hold more permanently it may lead to more uptake for those with embarrassment-based hesitancy. (Just have to possibly explain to relatives at home what’s in the package ... a substantial portion of a year’s employment income worth of tablets)

The idea of Montreal being this organized this quickly is laughable. “Sorry, we’re closed for PrEP services”, has been the position of community health centres. Otherwise, If you are fortunate, you may have found a primary care practitioner who is also willing to organize your regular lab work and PrEP prescriptions. Many gay men are on a wait list for a regular doctor. 

Sometimes, along with legalization of affordable trade, Brazil gets it right. 

[Correction: I think that Brazil rejected Gilead’s patent monopoly a few years ago, thus enabling generic versions. However, I do not know if Gilead’s Truvada is the only version utilized there. Since PrEP is free of charge, it is not very relevant at the consumer level. ]

Edited January 16, 2021 by Riobard