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SÃO
PAULO, Brazil — Seeking to stem a sharp rise in H.I.V. cases among
young people, Brazil began offering a drug this month that can prevent
infection to those deemed at high risk.
Brazil
is the first country in Latin America, and among the first in the
developing world, to adopt the pill Truvada, under a program known as
PrEP, short for pre-exposure prophylaxis, as an integral part of its
preventive health care policy.
The
blue pill — which drastically reduces the risk of contracting the virus
when taken daily — will be made available at no cost to eligible
Brazilians at 35 public health clinics in 22 cities during an inaugural
phase of the program.
The
Brazilian Health Ministry is paying Gilead Sciences, the American
manufacturer of the drug, about 75 cents a dose, a fraction of the price
users pay in the United States, where the pill sells for upward of
$1,600 for a month’s supply.
The
drug is being rolled out at a crucial time in Brazil, with the
country’s health officials particularly alarmed by the rise of the virus
among young men and other groups considered at higher risk.
Between
2006 and 2015, the number of AIDS cases in men aged 15-19 almost
tripled, to 6.9 cases per 100,000 people. Among men 20-24, the rate
almost doubled to 33.1 cases per 100,000, according to U.N.AIDS, a United Nations agency that coordinates H.I.V. prevention policy around the world.
Approximately
48,000 new cases of H.I.V. were reported in Brazil in 2016 and about
14,000 deaths related to AIDS, the agency said.
While
the transmission of the virus from mother to child has been
significantly reduced, about one in 10 men who have sex with men in
Brazil have H.I.V., the agency said.
“Our
hope is that with PrEP and other measures we can reduce the rate of new
infections,” said Adele Benzaken, the director of the AIDS department
at Brazil’s Health Ministry. “But it’s a big challenge.”
PrEP
is being made available to prostitutes, transgender people, men who
have sex with men, some drug users and people in relationships with
partners who have H.I.V.
Brazil
has long been recognized for its strong response to the H.I.V.
epidemic. It challenged pharmaceutical companies in the 1990s by
producing generic versions of costly antiretroviral drugs, which lowered
prices globally. Brazil’s government buys and distributes more condoms
than any other country, and in 2013 it started providing antiretroviral
therapy free to all H.I.V.-positive adults seeking care.
Proponents of PrEP say Brazil’s experience will show the economic benefits of investing in prevention.
“With
the addition of PrEP, Brazil is using all of the strategies that we
recommend,” said Georgiana Braga-Orillard, the director of U.N.AIDS
Brazil. “This is a large-scale operation, and Brazil could become an
example to all of Latin America that we need to see an integrated
approach.”
Since the United States Federal Drug Administration approved Truvada
as a prevention drug for H.I.V. in 2012, several countries have sought
to make it available and affordable to people at risk of contracting
H.I.V.
 |
| Bottles of Truvada, the branded PrEP drug manufactured by Gilead. Credit Dado Galdieri for The New York Times |
For
the first year of Brazil’s program, the Health Ministry spent $2.7
million for 3.6 million pills. Screening and additional care will be
provided at no cost at public clinics.
Ms.
Benzaken, the ministry official, said Brazil expected to spend less on
this preventive care next year as generic versions of the drug arrive in
the market.
“It was a good deal,” she said. “But we need to bring the price down even more.”
She
said two pharmaceutical companies, including Mylan, had applied to
Brazil’s health regulatory agency, Anvisa, for approval of generic
versions of Truvada.
People
have grown less concerned about H.I.V., leading to a decline in the use
of condoms, said Jose Valdez Madruga of the São Paulo Health
Secretariat, who was one of the coordinators of a PrEP trial in Brazil
carried out ahead of its implementation. The drug provides an additional
safeguard.
“With
PrEP, it puts the decision in the hands of one person, said Mr.
Madruga, the head of the secretariat’s AIDS and sexually transmitted
disease center. “You don’t need the agreement of the other partner, as
with condoms.”
According
to a survey in Brazil by the gay-dating app Hornet and U.N.AIDS, 36
percent of respondents said they would probably use PrEP if it were
available.
Critics of PrEP have said it incentivizes condomless sex, leading to the spread of other sexually transmitted diseases.
Marcio
Pierezan, 29, a patient who participated in the trial, said those fears
were overblown. He started taking the pill two years ago.
“It
was at a time when four close friends had tested positive for H.I.V.,
and I was in an open relationship with someone who had tested positive,”
he said. “I was in constant fear that I would be next, even though I
used condoms.”
Mr.
Pierezan says that the pill is as an added protection, but that he
never stopped using condoms. “It became part of my routine,” he said. “I
take it with coffee in the morning, and it’s been a huge relief for me,
my friends, my mother!”
Piero
Mori, 34, a systems analyst who is gay, says he never liked using
condoms, which meant new sexual encounters often brought weeks of
anxiety as he tested yet again for H.I.V.
“Condoms
will always be the most complete protection,” he said. “But for those
who just can’t or won’t use them, PrEP is a salvation. It protects you
against the most serious disease.”
The
new tool in Brazil’s effort to contain the spread of H.I.V. is being
deployed as budget shortfalls in some states have led to personnel and
medicine shortages that have crippled several hospitals. Additionally,
public schools that provide comprehensive sex education have come under
attack from conservative politicians.
Still,
health officials have high hopes for the impact PrEP can have on
keeping people healthy. In order to promote it, they are considering
partnering with popular YouTube personalities and advertising on online
dating apps.
“We don’t have all the answers yet,” Ms. Benzaken said. “But we are using all the tools at our disposal.”
Correction: December 12, 2017
An earlier version of this article misidentified the H.I.V. prevention pill to be given away in Brazil. The drug is Truvada, not PrEP, which describes the overall treatment strategy, pre-exposure prophylaxis.
An earlier version of this article misidentified the H.I.V. prevention pill to be given away in Brazil. The drug is Truvada, not PrEP, which describes the overall treatment strategy, pre-exposure prophylaxis.
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A version of this article appears in print on December 13, 2017, on Page A8 of the New York edition with the headline: Brazil Starts to Offer Preventive H.I.V. Drug To Fight Rise in Cases.
More articles from The New York Times, here
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