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HIV Prevention: Latin America
Improving HIV Prevention in Latin American Countries

Released: May 18, 2023

Brenda E. Crabtree Ramírez
Brenda E. Crabtree Ramírez, MD
Activity Information

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Key Takeaways
  • Improvements in PrEP awareness, knowledge, acceptance, access, and persistence are needed in Latin American countries to reduce the incidence of new HIV infections.
  • HIV and PrEP awareness campaigns should ensure that everyone is more aware of how to prevent HIV acquisition.

When it comes to HIV testing and pre-exposure prophylaxis (PrEP) use in people living in Latin America, we must focus on HIV knowledge and education, PrEP awareness, risk perception, acceptability, access, and persistence to ensure timely and appropriate HIV prevention.

Knowledge and Education
Knowledge of how HIV is acquired and who is at risk is a key component of HIV education. For example, cisgender women living in Latin America—as well as many cisgender women living around the globe—do not perceive themselves as being at risk for acquiring HIV, and they may not get tested for HIV or access PrEP. Cisgender women in Latin America are not considered a key population who may be indicated for PrEP; HIV and PrEP education more often is targeted toward at-risk populations, such as men who have sex with men, sex workers, people who inject drugs, and transgender women. Even with this targeted education, transgender women living in Latin America are the least frequent users of PrEP among these key populations.

Creating more and better-focused educational campaigns regarding HIV testing of everyone who is sexually active—especially with key populations as partners—is important to make them more accessible to the entire Latin American population. 

HIV Prevention Awareness
Once a person is aware that they are at risk of acquiring HIV, it is important for that person to understand what is known about HIV prevention therapies. Unfortunately, HIV prevention awareness is lacking among people living in Latin America, and the incidence of HIV is increasing, not decreasing. In Latin America, there are very few PrEP advertisements, and campaigns focused on the use of antiretrovirals for preventing acquisition of HIV are limited. We need to do more to ensure that people receive timely, correct information about PrEP.

Acceptability and Access
After risk awareness and knowledge of PrEP options, acceptability of PrEP is the next step for people to consider. There always will be people who will not engage in prevention programs that require regular HIV testing and medications. In Mexico, many people think natural remedies are preferred to taking prescribed medications because there is a perception of harm associated with medications. We need to do a better job educating people that taking medication to prevent something like HIV is advantageous—we need to make preventive medication better accepted within society.

In Latin America, PrEP is underused, and many countries still are working on how to best deploy PrEP to the people who are indicated and wish to receive it. For example, in Mexico, PrEP access is centralized in huge programs in Mexico City. Although the population of people who are at risk of acquiring HIV is more concentrated within Mexico City, these programs are not universal throughout the country, so not all people who can benefit from PrEP have access. In some Latin American countries, PrEP is available through the public sector, whereas in other countries, PrEP is accessible through private practice healthcare professionals, through the Internet, or by enrolling in a research study. Wider and less variable PrEP access is needed to ensure better utilization.

PrEP Persistence
Once PrEP is started, it is important to acknowledge the importance of PrEP persistence and the possibility of a person taking it almost indefinitely. PrEP persistence may change based on an individual’s personal circumstances and the social environment. The ImPREP PrEP implementation study conducted in Peru, Brazil, and Mexico found decreased PrEP adherence and long-term engagement for certain groups, including transgender women and younger participants. Therefore, implementing strategies for retention to prevention programs is key.

Late HIV Diagnosis
Lastly, late HIV diagnoses are prevalent in the Latin American region and are, in many ways, a consequence of many of the items discussed above and more: centralized or lack of HIV testing, lack of educational campaigns about HIV and PrEP, limited PrEP access, misperception of risk, and stigma and discrimination. By doing better in each of these areas, we can improve access to and use of HIV testing and PrEP so that we avoid any diagnosis of HIV.

Your Thoughts?
What barriers to HIV testing and PrEP access exist in your country or region? What strategies do you use to overcome these barriers? Join the conversation by posting a comment below.