HIV Specialist - June 2021 - 39

A second consideration in implementing a successful PrEP policy is
to understand the sociopolitical landscape and the laws and regulations
that hinder access to HIV services. These policy barriers can include
laws that criminalize sex work, same-sex relations, and drug use.19
Thus, we need to analyze the barriers that could discourage the targeted
population from seeking and accessing the benefits of the treatment.
Of the 33 countries in the Latin American and Caribbean region, 19 have
legal systems that avoid criminalizing consensual same-sex sex acts and
there are no reports of people being prosecuted for such action. The other
13 had a partially adopted policy meaning that their law criminalizes samesex
sex or that their judicial system prosecutes those cases. Finally, the only
country that did not adopt any policy avoiding same-sex sex is Jamaica.
If governments want to adopt a policy, they must address criminalization,
stigma, and discrimination against MSM and create a
welcoming environment that does not deter this population from
accessing services.20 However, these policies require time to see
results. In countries where MSM still face stigma and discrimination,
it could be a good policy plan to implement PrEP in collaboration with
local NGOs and community-based approaches, since members of key
populations may be more comfortable accessing services through
these modalities rather than in government health centers .
Finally, countries seeking to implement PrEP policies should
learn from the experience of peer countries. In Latin America and the
Caribbean, only the Bahamas, Barbados, Brazil, Chile, and Suriname have
fully implemented PrEP policies. Brazil, the regional leader, provides
PrEP through the public health system, private clinics, the Internet,
and nongovernmental organizations.21 These experiences suggest that
given the discrimination and stigma barriers that PLHIV in Latin
America face, a good strategy might be to offer PrEP by home delivery,
peer network, or even through an online platform. By implementing
REFERENCES
1. HIV Policy Lab, 2020 Global HIV Policy Report: Policy
Barriers to HIV Progress (2020), available at: https://www.
hivpolicylab.org/reports/2020GlobalReport
2. See UNAIDS, 90-90-90: good progress, but the world is
off-track for hitting the 2020 targets, (Sept. 21 , 2020)
available at https://www.unaids.org/en/resources/
presscentre/featurestories/2020/
september/20200921_90-90-90
3. PAHO, UNAIDS , Pan American Health Organization and
Joint United Nations Programme on HIV/AIDS. HIV
Prevention in the Spotlight: An Analysis from the
Perspective of the Health Sector in Latin America and the
Caribbean, (2017).
4. UNAIDS. 2020 Global AIDS Update- Seizing the moment:
Tackling entrenched inequalities to end epidemics.
available at https://www.unaids.org/sites/default/files/
media_asset/2020_global-aids-report_en.pdf
5. UNAIDS, UNAIDS Data 2020, available https://www.
unaids.org/sites/default/files/
media_asset/2020_aids-data-book_en.pdf
6. UNAIDS, Evidence for eliminating HIV-related stigma and
discrimination (2020) available at https://www.unaids.
org/sites/default/ files/media_asset/eliminatingdiscrimination-guidance_en.pdf
; see A. Mahajan, J. Sayles,
V. Patel, R. Remien, S. Sawires, D. Ortiz, et al, Stigma in the
HIV/AIDS epidemic: a review of the literature and
recommendations for the way forward ,AIDS (2008) ,
2:S67-79
7. UNAIDS, supra 5
8. UNAIDS, supra note 4 ; UNAIDS, Miles to go, The
responses to HIV in Latin America (2018) [Hereinafter
UNAIDS Miles to go] , available at https://www.unaids.org/
sites/default/files/media_asset/
miles-to-go_latin-america_en.pdf
9. UNAIDS, Miles to go, supra note 9 ; UNAIDS supra note 5
10. HIV Policy Lab: TP 1 , Self-Testing, https://hivpolicylab.
org/policy/TP1
11. UNAIDS, Prevention Gap report (2016) available at https://
www.unaids.org/sites/default/files/
media_asset/2016-prevention-gap-report_en.pdf
12. De Boni RB, Veloso VG, Fernandes NM, Lessa F, Corrêa RG,
De Souza Lima R, et al., An internet-based HIV self-testing
program to increase HIV testing uptake among men who
have sex with men in Brazil: Descriptive cross-sectional
analysis , Journal of Medical Internet Research
2019;21(8):1-15. 10.2196/14145
13. UNAIDS, supra note 4
14. HIV Policy Lab, supra note 1
15. UNAIDS, HIV Prevention 2020 Road Map: Accelerating
HIV prevention to reduce new infections by 75% (2020) [
Hereinafter UNAIDS HIV Prevention 2020 Road Map]
available at: https://www.unaids.org/sites/default/files/
media_asset/hiv -prevention- 2020-road-map_en.pdf
16. HIV Policy Lab: TP 4: Age restrictions on testing &
treatment , https://hivpolicylab.org/policy/TP4
17. WHO, WHO expands recommendation on oral
pre-exposure prophylaxis of HIV infection (PrEP) (2015),
available at http://apps.who.int/iris/bitstream/
handle/10665/197906/WHO_HIV_2015.48_eng.
pdf?sequence=1
18. G. Ravasi, B. Grinsztejn, R. Baruch, J. V. Guanira, R. Luque,
C. F. Cáceres & M. Ghidinelli (2016), Towards a fair
consideration of PrEP as part of combination HIV
prevention in Latin America. Journal of the International
AIDS Society, 19(7(Suppl 6)), 211133 (2016)
19. UNAIDS HIV Prevention 2020 Road Map supra note 15
20. G. Ravasi, B. Grinsztejn, R. Baruch, J. V. Guanira, R. Luque,
C. F. Cáceres & M. Ghidinelli (2016), Towards a fair
consideration of PrEP as part of combination HIV
prevention in Latin America. Journal of the International
AIDS Society, 19(7(Suppl 6)), 211133 (2016)
21. UNAIDS, supra note 5
22. Dr. Kimberly Green and Davina Canagasabey , How can we
best deliver HIV pre-exposure prophylaxis (PrEP)? PATH
(Dec. 19, 2019) available at: https://www.path.org/articles/
how-can-we-deliver-hiv-prep/
differentiated community-based models,
governments can " democratize PrEP
access " and accelerate the results.22
There is an expression that says, " information
is power. " Having policy data from
all over the world in one place can speed
up the research phase. Policymakers and
NGOs need to continue building from
where others have left off. The information
lets us know what is working and
what is not, and in the latter case, learn
from mistakes and decide how to avoid
repeating them. Policy surveillance can
impact health, and when activists understand
the set of policies that are shown to
have the greatest impact on public health,
they can significantly increase the speed
and support for adoption. HIV
EZEQUIEL CARMAN is a global
health policy consultant at the O'Neill
Institute for National and Global
Health Law at Georgetown Law . His
studies focus on improving access to
medicine. He previously served as a legal advisor for
the Ministry of Justice of Buenos Aires, Argentina.
He holds a Law degree from Universidad Catolica
Argentina and a Master's degree in Law and
Economics from Universidad Torcuato Di Tella and
Ll.m in Global Health Law from Georgetown
University.
WWW.AAHIVM.ORG HIVSPECIALIST JUNE 2021 39
https://www.hivpolicylab.org/reports/2020GlobalReport https://www.hivpolicylab.org/policy/TP4 http://www.hivpolicylab.org/reports/2020GlobalReport https://www.unaids.org/sites/default/files/media_asset/miles-to-go_latin-america_en.pdf http://www.unaids.org/sites/default/files/media_asset/miles-to-go_latin-america_en.pdf http://apps.who.int/iris/bitstream/handle/10665/197906/WHO_HIV_2015.48_eng.pdf?sequence=1 http://apps.who.int/iris/bitstream/handle/10665/197906/WHO_HIV_2015.48_eng.pdf?sequence=1 https://www.unaids.org/en/resources/presscentre/featurestories/2020/september/20200921_90-90-90 https://hivpolicylab.org/policy/TPI http://hivpolicylab.org/policy/TPI https://www.unaids.org/sites/default/files/media_asset/2016-prevention-gap-report_en.pdf https://www.unaids.org/sites/default/files/media_asset/2016-prevention-gap-report_en.pdf https://www.unaids.org/sites/default/files/media_asset/2016-prevention-gap-report_en.pdf https://www.unaids.org/sites/default/files/media_asset/2020_global-aids-report_en.pdf https://www.unaids.org/sites/default/files/media_asset/2020_aids-data-book_en.pdf http://www.unaids.org/sites/default/files/media_asset/2020_aids-data-book_en.pdf https://www.unaids.org/sites/default/files/media_asset/eliminating-discrimination-guidance_en.pdf https://www.path.org/articles/how-can-we-deliver-hiv-prep/ http://www.unaids.org/sites/default/files/media_asset/eliminating-discrimination-guidance_en.pdf https://www.unaids.org/sites/default/files/media_asset/hiv-prevention-2020-road-map_en.pdf http://WWW.AAHIVM.ORG

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