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PrEP Distribution in Chile Begins, Amid Criticism of the Ministry of Health’s Related Information Campaign

SANTIAGO—Chile has the highest HIV growth rate among Latin American countries: 34% between 2010 and 2018. The Ministry of Health has responded by establishing the delivery of the PrEP treatment. Although the delivery of this treatment has been celebrated, the dissemination of information related to it has been criticized as stigmatizing.

Last month, the Ministerio de Salud (Ministry of Health aka Minsal) presented data from the Joint United Nations Program on HIV/AIDS (UNAIDS) regarding the presence of the Human Immunodeficiency Virus (HIV) in Chile. The data revealed that there are 71,000 people living with HIV in Chile, an increase of 4,000, a 6% increase in just the last two years, and that between 2010 and 2018 the numbers increased by 34%, which makes Chile the Latin American country with the highest growth rate in HIV.

Minsal’s latest effort to prevent the spread of HIV began August 1, 2019, with the distribution of a treatment called Pre-Exposure Prophylaxis (PrEP). According to the World Health Organization (WHO), this treatment can reduce the risk of contracting HIV during sexual intercourse by more than 90%, as long as it is well managed.

What is PrEP?

According to Ending HIV, PrEP is taken on an ongoing basis before or throughout potential exposure to HIV. The analogy is to contraceptives used by women: “some would say it’s similar to ‘the pill’ that women take to prevent unplanned pregnancy.”

This treatment is based on a mixture of two antiretroviral drugs, Tenofovir and Emtricitabine, which “has demonstrated in solid controlled studies, solid scientific evidence in the reduction of HIV acquisition, especially in people of greater vulnerability and risk,” according to the Minsal.

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Implementation

The PrEP rollout was implemented as one of the prevention strategies of Minsal’s Plan Nacional VIH/SIDA (National HIV/AIDS Plan) 2018-2019, which is based on WHO and UNAIDS recommendations.

According to Minsal, this treatment is aimed at men who have sex with men, trans people, sex workers, and others with a higher-than-average risk of exposure to HIV.

At the moment, PrEP treatment is being administered by nine hospitals throughout Chile, divided into three macro-zones: North Zone, in the Hospital of Antofagasta; Central Zone, in the Luis Tisné, Padre Hurtado, and El Carmen hospitals in Maipú, Barros Luco, San José, and San Juan de Dios; and finally South Zone, in the Hospitals of Temuco and Puerto Montt.

Minsal also reports that this plan will have a progressive implementation so that its operation in the healthcare network and the surrounding populations’ responses can be monitored, with the aim of expanding access to PrEP to all regions of the country by 2020.

To access this treatment, users must have only two characteristics, be age 18 or over and be part of the Fondo Nacional de Salud (National Health Fund aka Fonasa).

Controversy Over Minsal’s Related Information Campaign

After the implementation, Minsal began disseminating information about the treatment, which has received a series of criticisms from various groups, especially from institutions linked to the LGBT community. The criticisms are primarily based on an infographic disseminated by Minsal which classifies as “risk groups” homosexuals, sex workers, and transgender people.

Marco Becerra, Director of Public Management of Acción Gay (Gay Action), a Chilean LGBT group, told Chile Today that although he and his organization welcome the availability of the treatment, they believe that “there was a lack of pedagogy in general to explain this strategy,” adding that “without doubts the ministry was wrong in how they presented it to the community.”

Franco Fuica, president of Organizando Trans Diversidades (Organizing Trans Diversities), in an interview with Diario and Radio Universidad de Chile, said that he “lamented the way in which Minsal has spread the delivery of the medicine.

Movimiento de Integración y Liberación Homosexual (Homosexual Integration and Liberation Movement aka Movilh) also complained. In a statement that likewise values the existence of PrEP in Chile, “they deeply regret” the “regressive speech by Minsal regarding the prevention of HIV,” because, again, the government is talking about “risk groups,” “focusing on gay or bisexual men, trans people and sex workers, which only enhances prejudice, stigma and ignorance.”

Movilh called on Minsal to clarify that “there are no ‘people or risk group.” There are only risky behaviors,” among which are sexual intercourse (vaginal and mainly anal) without a condom, as well as the fact of living with other sexually transmitted infections (syphilis, gonorrhea, herpes), among others.

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