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The Learning Curve - IAS Special Day 2

The Learning Curve - IAS Special Day 2

‘Is the rise in STIS under PrEP acceptable?’ 

Hello everyone,

We just entered the second day and I chose a very interesting panel to share with you today.

With the advance of PREP distribution programs in the world, more data has been addressing the increasing number of STIs in PREP users. This incites important discussion with different perspectives on the financing of PREP:

On one side we have politicians who see this and asks if the STIs numbers rise, why finance PREP when we can invest on in condoms. On the other side we have physicians and scientist explaining that condoms alone are not enough.

And we still have the community demanding treatment for curable STIs and PREP.

This show us how the subject is not so simple, the demands are valid and real, but they come with a cost that we should be discussing together.

The panel also showed how this increase in STIs happens in sub-groups inside PREP users:

Chemsex: an increase in chemsex users in the last five years. In diverse manners, different drugs and frequency.

New strategies

COVID-19 moved us to an eHealth and mHealth era, so more than just microbiology access we must think in public health strategies. These tools can help us with self-testing.

This discussion makes me think how we must prepare, act, not only react to numbers of STIs and HIV infection, but we also have the data to prepare and test strategies to try to dimmish the arising of this infections.

HIV Vaccine is going to happen, it is a matter of time, what are we doing to prepare for this? Can we use data from PREP users, intermittent PREP users, STIs rise, to think ahead?

The idea of risk compensation should help us understand sexual behavior, not to stop us to offer PREP, PEP or vaccines.

In Brazil there is data suggesting that you can use one swab for self-testing, lowering the costs for the labs and programs.

Self-sampling by itself lowers the costs. In some countries COVID self-testing are freely available, why not HIV?

During the panel, and in the scientific research available so far, we see a larger focus on MSM, but is PREP being advertised for women? MSM are in a higher risk and prevalence, but women are more vulnerable.

The data on this is lacking, we must work to dimmish this gap but to have in mind that: Transexual women should be prioritized.