de Oliveira Alexandre Herta, Gruskin Sofia, Massuda Adriano, Bertolozzi Maria Rita, Segurado Aluisio Cotrim
Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 470, 05403-000 São Paulo, SP, Brazil.
Institute on Inequalities in Global Health, University of Southern California, 1845 N. Soto St., Los Angeles, CA 90032, USA.
Prev Med Rep. 2025 Apr 11;54:103070. doi: 10.1016/j.pmedr.2025.103070. eCollection 2025 Jun.
In concentrated HIV epidemics, combination prevention is recommended for key populations, including pre-exposure prophylaxis (PrEP). Our study analyzes PrEP's integration as a public policy in Spanish, Portuguese and French-speaking Latin American countries.
We reviewed documents published through December 2024 from Ministries of Health, international organizations, relevant non-governmental organizations, and collected data on countries' human development index (HDI), healthcare system organization/expenditures, assessing compliance with human rights standards.
PrEP policies are described in 16 out of 20 countries reviewed. In Argentina, Brazil, Chile, Colombia, Cuba, El Salvador, Haiti, Mexico and Peru, PrEP is provided to key populations. In Costa Rica, Guatemala, Panama and Paraguay, PrEP is available through research or pilot projects. In the Dominican Republic, Ecuador, and Honduras, PrEP is being scaled up, but specifics remain unclear. Other countries have limited access to PrEP or no available information. Broad PrEP distribution occurs generally in countries with higher healthcare expenditures relative to gross domestic product and high HDI. However, its distribution free of charge is not correlated with universal access to public healthcare. Attention to human rights standards was noted in policies from Argentina, Brazil, Chile, Cuba, Ecuador, El Salvador, Haiti, Mexico, Peru and Uruguay, covering rights to healthcare access, information, informed decision-making, participation, equality, privacy, accountability, and benefits of scientific progress.
As of December 2024, PrEP policies exist in some Latin American countries, but are limited or unavailable in others. Achieving universal healthcare and adhering to human rights norms can improve access/use of this essential HIV prevention tool.
在艾滋病高度流行的地区，建议对包括暴露前预防（PrEP）在内的重点人群采取综合预防措施。我们的研究分析了PrEP作为一项公共政策在讲西班牙语、葡萄牙语和法语的拉丁美洲国家的整合情况。
我们查阅了截至2024年12月由各国卫生部、国际组织、相关非政府组织发布的文件，并收集了各国的人类发展指数（HDI）、医疗体系组织/支出的数据，评估其对人权标准的遵守情况。
在所审查的20个国家中，有16个国家描述了PrEP政策。在阿根廷、巴西、智利、哥伦比亚、古巴、萨尔瓦多、海地、墨西哥和秘鲁，PrEP被提供给重点人群。在哥斯达黎加、危地马拉、巴拿马和巴拉圭，可通过研究或试点项目获得PrEP。在多米尼加共和国、厄瓜多尔和洪都拉斯，PrEP正在扩大推广，但具体情况仍不明确。其他国家获得PrEP的机会有限或没有可用信息。PrEP的广泛分发通常发生在医疗支出相对于国内生产总值较高且人类发展指数较高的国家。然而，其免费分发与公共医疗的普遍可及性并无关联。阿根廷、巴西、智利、古巴、厄瓜多尔、萨尔瓦多、海地、墨西哥、秘鲁和乌拉圭的政策中提到了对人权标准的关注，涵盖了医疗服务可及权、信息权、知情决策权、参与权、平等权、隐私权、问责制以及科学进步带来的益处等权利。
截至2024年12月，一些拉丁美洲国家存在PrEP政策，但在其他国家则有限或没有。实现全民医疗并遵守人权规范可以改善这种重要的艾滋病预防工具的可及性/使用率。
