HIVR4P 2024: Context of PrEP in Latin America
7 October 2024. Related: Conference reports, Treatment access, HIV prevention and transmission, R4P 2024 Lima.
Only 46,000 people on PrEP among 430 million people in 16 countries
Richard Stern, Agua Buena Human Rights Association
The International AIDS Society’s 5th HIV Research for Prevention conference is taking place in Lima, Peru from 6–10 October 2024.
The entire and very comprehensive conference programme is linked here:
https://programme2024.hivr4p.org
And many of the presentations are indeed focused on the situation in Latin America, featuring well known advocates, scholars and international agency officials from around the region.
That the conference is occurring in Peru will hopefully focus attention on the fact that access to PrEP in Latin America is way behind other parts of the world and that the yearly number of new HIV diagnoses is still increasing at a rate of roughly 8% per year in spite of all the information available about prevention strategies. According to UNAIDS statistics, roughly 120,000 new HIV cases were reported in the region in 2023.
The following table illustrates the gravity of the situation.
Table 1: Number of people per country receiving PrEP in 2022 and 2023*
| Country | Population | Number of people on PrEP 2022 | Number of people on PrEP 2023 | Number of people living with HIV | |
| Cuba | 11,000,000 | 316 | 1541 | 36,000 | |
| Peru | 33,000,000 | 646 | 1259 | 98,000 | |
| Panama | 3,000,000 | 989 | 582 | 22,000 | |
| Costa Rica | 5,000,000 | 1110 | 2562 | 17,000 | |
| Chile | 19,500,000 | 1372 | 1893 | 84,000 | |
| Argentina | 46,000,000 | 1578 | 3927 | 140,000 | |
| Dominican Republic | 11,000,000 | 2411 | 3668 | 78,000 | |
| Guatemala | 16,000,000 | 2900 | 4224 | 31,000 | |
| El Salvador | 6,500,000 | 469 | 1348 | 25,000 | |
| Paraguay | 6,700,000 | 305 | 852 | 16,000 | |
| Mexico | 127,000,000 | 8,000 | 14,108 | 360,000 | |
| Ecuador | 18,000,000 | 300 | 1661 | 47,000 | |
| Bolivia | 12,000,000 | 34 | 34 | 19,000 | |
| Honduras | 10,000,000 | n/a | 2446 | 22,000 | |
| Uruguay | 3,500,000 | 40 | 240 | 15,000 | |
| Colombia | 50,000,000 | 700 | 5863 | 120,000 | |
TOTAL 430,000,000 21,170 46,180 1,160,000
* Data according to various sources and reported to UNAIDS. Information provided to PAHO and UNAIDS by the countries. Numbers generally reported at the end of the year but not always. Does not necessarily include data from 2024. (Table made by R. Stern).
Peru has nearly 100,000 people living with HIV and a population of 33 million and is still reporting that just 1259 people had access to PrEP in 2023, according to statistics provided by the Health Ministry to ONUSIDA.
These numbers may not reflect increases in 2024 but the number of newly diagnosed cases of HIV in Peru has remained stable during the past three years at between 9000 and 11,000 cases, with no reduction due to prevention interventions.
The question for this very promising conference to address is that in spite of being one of the dozens of comprehensive events, workshops, webinars, and meetings held over the past several years in Latin America, will it really impact on the numbers reflected in the table above? And, if so how will it insure that this occurs?
The amount of available information about combined prevention worldwide and in the region is huge, and this conference will certainly add a great deal of additional information. But will this finally translate into greater access to PrEP in the context of combined prevention after so much previous futility?
Will demonstrations and other forms of activism take place in the conference against the horribly inequitable price structure for the drug lenacapavir, recently announced by Gilead Sciences, considering the cost in most countries in the region remains at over US$40,000 yearly for an injectable long-acting drug with great promise for treatment as well as prevention or will such activism be stifled?
A Peruvian sex worker activist is quoted here with her permission. According to Angela Villon:
“For us it is a mockery, that there will be a prevention congress in Peru, but from the sex workers’ organisations we do not have condoms or PrEP: no public policies on prevention in the context of violence, the shortage of medicines, the lack of government, the disarticulation of the peer-to-peer strategy in some regions and we are not included in the proposals of the GLOBAL FUND. THERE IS NOTHING FOR SEX WORKERS, but we were invited to the meetings because they had no other choice because it was a requirement. But we always end up out of the proposal, we end up being the useful fools for the photo, but there is no will to include our population.”
Richard Stern has been an advocate for people living with HIV/AIDS in Latin America since 1996 and has worked in all Central American countries, as well as Ecuador, Peru and Bolivia, and the Dominican Republic, focussing on access to antiretroviral treatment as well as on the rights of LGBTQI people. For 15 years he was director of the Agua Buena Human Rights Association supported by several agencies including HIVOS as a direct recipient, USAID (PASCA), PAHO and others. (www.aguabuena.org). Their current priority is access to PrEP with the goal of ending the epidemic. The organisations continue to work for access to treatment for people with HIV who, for various reasons, are excluded from access to antiretrovirals. Dr. Stern was part of the Technical Advisory Commission on HIV/AIDS of the Pan American Health Organization for two years. He has never applied for or received funding from the Global Fund and is a volunteer. Rastern246@gmail.com