Let’s say, hypothetically of course, that an American citizens was planning to spend 6 months in RJ next year and that this particular American citizen takes PrEP which is prescribed to him by his doctor in 90 day increments so the Rx will need to be refilled at least once but probably twice during the 6 month stay.

Minhas perguntas para vocês:

1. The gorgeous 25 year old that this American citizen will be be spending most of his time with says he gets his PrEP Rx for free by going to a public health clinic in RJ and telling the doctors there that he has sex with other men.  Gorgeous-25-year-old sees no reason why non-gorgeous-40-year-old-American can’t just come with him and also get free PrEP too from the clinic.

Could one of the esteemed members of the board confirm that Brazil will not actually in fact give PrEP - which is a rather expensive drug - to an American in the country on a tourist visa for free?

2. Is planning a mid-stay return trip to the States probably the best way to go about getting the Rx refilled?  Other factors will probably make at least one return trip necessary anyway so this is definitely an option.

The public health system SUS apparently offers health care to foreigners, anyone legally residing in Brazil. Whether you would fall into that category as a visitor is unclear. Why don’t you ask your young friend to inquire? Or there are citizens on this board that might weigh in. 

Only about 50,000 Brazilians are registered for PrEP uptake! 

I am pretty sure that Galdino Campos Clinic in Copacabana would provide care for a consult fee. They in fact do health testing for USA visas and I suspect HIV screening is common for that application. I had an eye infection and was treated there, paid the rate and paid for meds at the pharmacy near by. They may honor your health insurance that applies abroad in some cases, likely not the travel type that is usually emergencies, though I would consider the imperative of hot safe sex a qualifying emergency. Anyway, you can contact the Clinic ahead of time to see if they are a viable backup plan, etc 

Me, I only use on-demand basis and stockpile so that I have an ample overage above a trip length. Essentially extended on-demand, not 2-1-1 episodically, but continuous uptake for a few weeks at a time but with a prior week of daily priming prior to the sexcursion start-up.  I only have protected intercourse so missing an HIV test by a few weeks following a quarter is not a big deal. 

 

Maybe ask for a vacation exception, most insurances will give you it one tome a year. Just tell them that it will be during the crossover of almost being out and the refill date.

Not a guarantee, but I've used that excuse in the past.

Change plan to on-demand/2-1-1 or 4 pills a week (e.g. Mon, Wed, Fri, Sat)

4 hours ago, speedoo1 said:

Change plan to on-demand/2-1-1 or 4 pills a week (e.g. Mon, Wed, Fri, Sat)

Novarunner will know this first suggestion is absurd, no, strike that, it’s impractical because it is impractical to assiduously structure sexual activity in this manner. He might not consider the attempt to problem-solve outlandish. However, he already indicated he will need continuity over the duration.

The second suggestion is even more inane at a clinical level and extremely frowned upon, as he will already know, because the drug concentrations’ steady state level needed for protection will be inadequate. Though he may similarly not deem the well-intentioned attempt at a workaround solution to be absurd. I can only speak for myself. 

18 hours ago, Riobard said:

The second suggestion is even more inane at a clinical level and extremely frowned upon, as he will already know, because the drug concentrations’ steady state level needed for protection will be inadequate. 

I'm sorry but your assumption is not correct. A mere google search will reveal that for males 4 pills a week is adequate to protect during anal sex (it is not for women and vaginal intercourse). Ofc daily is better but the OP is short on PrEP pills he can make them last a little longer by reducing to 5 or even 4 pills a week without compromising the protection, in particular during days/periods of no un-protected sex.

This is important because you are unequivocally incorrect. 4 doses per week refers to the intermittent/on-demand research wherein trial subjects were allocated supplies predicated on the on-demand schedule of 2-1-1 and the assumption that the average uptake would be once weekly, that is, an average of one possible infection exposure per week around which the uptake would have been structured. Subjects did not take doses on alternate days or a fixed 4/7 schedule. If you go back and look again you will see that the context of 4 per week does not at all suggest this as a solution for a supply shortfall.

Moreover, no research team would entertain such a study as the bio-pharmacological aspects of dosing already support the notion that systemic levels of metabolized product support regular per diem uptake. In fact, it is recommended to adjust according to time zone for either intermittent or daily if a zone alteration via travel is plunked into the regimen.

Similarly, if you have taken the information that an occasional missed dose, not realized until 12 or more hours past the last dose, obviates the need to replace the missed dose at 12+ hours or at the subsequent dose (doubling) and you have extrapolated that this would be a means of repetitive supply-stretching that is entirely false. In your defence, perhaps there is some ambiguity surrounding the online info you had accessed. 

9 hours ago, speedoo1 said:

I'm sorry but your assumption is not correct. A mere google search will reveal that for males 4 pills a week is adequate to protect during anal sex (it is not for women and vaginal intercourse). Ofc daily is better but the OP is short on PrEP pills he can make them last a little longer by reducing to 5 or even 4 pills a week without compromising the protection, in particular during days/periods of no un-protected sex.

 

On 11/7/2022 at 7:43 PM, Novarunner said:

 

Let’s say, hypothetically of course, that an American citizens was planning to spend 6 months in RJ next year and that this particular American citizen takes PrEP which is prescribed to him by his doctor in 90 day increments so the Rx will need to be refilled at least once but probably twice during the 6 month stay.

Minhas perguntas para vocês:

1. The gorgeous 25 year old that this American citizen will be be spending most of his time with says he gets his PrEP Rx for free by going to a public health clinic in RJ and telling the doctors there that he has sex with other men.  Gorgeous-25-year-old sees no reason why non-gorgeous-40-year-old-American can’t just come with him and also get free PrEP too from the clinic.

Could one of the esteemed members of the board confirm that Brazil will not actually in fact give PrEP - which is a rather expensive drug - to an American in the country on a tourist visa for free?

2. Is planning a mid-stay return trip to the States probably the best way to go about getting the Rx refilled?  Other factors will probably make at least one return trip necessary anyway so this is definitely an option.

You can’t legally stay in Brazil for more than 90 days straight and 180 days total in any rolling year on a tourist visa. Does this hypothetical person have a resident card or some other kind of non-tourist visa?

if it’s a tourist visa, leave before the 90 days are up and return to Brazil with your new three-month supply of prescription drugs. OR have them shipped to you in Brazil (could be customs issues if not done properly). Riskiest move is having someone who is also traveling there bring them to you from your home country. That traveler could get busted for transporting prescription drugs without their own prescription.  

 

 

 

@Novarunner, I can't speak to getting an Rx filled in Brazil as an American, but you can now get generic Truvada in the US for about $30/month or $71/90 days with a GoodRx coupon. Provided you can get your doctor here to write you the prescriptions, you could fill one 90 day at pharmacy A through your insurance and another at pharmacy B with GoodRx and be set for 180 days. The difficult part might be getting a doctor to agree to this, because the prescribing guidelines require HIV screening every 3 months.

All of this information is pre Covid:

You can ask for and find clinics that handle HIV related issues in BR. Meds are dispensed at the clinic and only with the prescription of the MD at the free clinic. There is one adjacent to M Siq Campos near 202. Another is in Catete up the road towards a favella. Meds are free. You might only receive an emergent supply for one month. HIV meds are often not available at regular retail pharmacies/ druggists. 
it would be helpful to have printed medical records and an actual written prescription even if from abroad. Please bring your passport. You will likely be entered into Brazil’s health system. Please go to the clinic early in the morning - a same day overbook appointment can be possible (unheard of in many countries for our non emergencies here).
Speaking some PT and being very patient also helps. But please do not abuse such kindness to non Brazilians and keep in mind how stressed the national health is. 

Please be aware that several meds can be used as prep or for HIV care. Therefore you might be offered different meds than you use now. Yes, I know, not all studies say other meds are equally effective. But at least you can have meds vs not having any, and the new meds should be quite effective. You can check your country’s consulate in Rio as well. Swiss is just down the street from 117 !! They might know local doctors within your health plan or other ways to receive RX in Brazil. 
As for pill loading, AUC or area under the curve explains doses and timings to achieve needed anti viral levels. Having a good science or maybe engineering background really helps. Please do not suggest unsafe or ineffective doses or timings in the Forum.
Bringing lots of pills: one might think that explanation to your GP etc for 6 months of pills for a big trip would provide the needed RX. Every health plan is different and some meds might be affordable if obtained outside the health plan - some might be too dear to purchase outside the plan. 
I think Truvada and Kaletra can be used for prep. Some countries allow generics. See if your country does - it can lower costs dramatically. Rules for US or Canada or UK or Germany etc health plans and pills are all likely completely different. No idea if any travel insurances cover this - but I doubt it. Some countries allow travel health coverage but it is likely limited to things like broken legs and heart attacks. It can also be very expensive. 
 

The topic begs the question of should we develop a list of a few doctors or nurses for any needs abroad like in Brazil, Thailand, etc?

 

Edited December 18, 20223 yr by HiThereAll
Added information

Also

It looks like Drogasil (major chain pharmacy) sells generic Truvada for 140 BRL for a 30 day supply. The website does say "sale under medical prescription" but so do the generic Viagra boxes they sell there, and we know how strictly that is enforced: https://www.drogasil.com.br/binav-com-30-comprimidos-revestidos.html?origin=autocomplete

I would venture to guess it wouldn't be too difficult to find a pharmacy to sell you a box fairly cheaply if you don't want to deal with the hassle of the free HIV clinic system.

In Europe you can extend it to 4 to 5 months for travel reasons. 

And my doctor confirmed 4/5 pills a week should be enough for male-male sex.