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The figures provided in UNAIDS ‘”Ending Aids 2017″ report, associated with a 34% increase in new HIV cases in Chile, have led to the need for new strategies to implement more effective prevention and diagnostic measures.
To allow the sale and marketing of HIV virus rapid tests in private pharmacies and the possibility of accessing the delivery of Pre-Exposure Prophylaxis (PrEP) pills to prevent the virus (Truvada) would be one of the additional proposals of the annual program HIV / AIDS, which would be contemplating the Chilean government.
The World Health Organization (WHO) in its Consolidated Guidelines on HIV Prevention, Diagnosis and Treatment 2016 points to the importance of prevention in population groups at greater risk and vulnerability such as: Have sex with men, people who inject drugs, people in prisons and other closed environments, sex workers and transgender people. The guidelines seek to be a contribution in the development and improvement of access, coverage and use of programs and services that contribute to the increase of awareness.
In addition evidence from trials, according to WHO, would corroborate the efficacy of the antiretroviral drug tenofovir for use as PrEP and prevent HIV transmission.
Summary of WHO recommendations concerning key populations
HEALTH SECTOR INTERVENTIONS
HIV PREVENTION
1 The correct and consistent use of condoms with condom-compatible lubricants is recommended for all key populations to prevent sexual transmission of HIV and sexually transmitted infections (STIs).
2 Oral pre-exposure prophylaxis (PrEP) containing tenofovir disoproxil fumarate (TDF) should be offered as an additional prevention choice for key populations at substantial risk of HIV infection as part of combination HIV prevention approaches.
NEW RECOMMENDATION
3 Post-exposure prophylaxis (PEP) should be available to all eligible people from key populations on a voluntary basis after possible exposure to HIV.
4 Voluntary medical male circumcision (VMMC) is recommended as an additional, important strategy for the prevention of heterosexually acquired HIV infection in men, particularly in settings with hyperendemic and generalized HIV epidemics and low prevalence of male circumcision.
HARM REDUCTION FOR PEOPLE WHO USE DRUGS
5 All people from key populations who inject drugs should have access to sterile injecting equipment through needle and syringe programmes.
6 All people from key populations who are dependent on opioids should be offered and have access to opioid substitution therapy.
7 All people from key populations with harmful alcohol or other substance use should have access to evidence-based interventions, including brief psychosocial interventions involving assessment, specific feedback and advice.
8 People likely to witness an opioid overdose should have access to naloxone and be instructed in its use for emergency management of suspected opioid overdose. NEW RECOMMENDATION
HIV TESTING AND COUNSELLING (HTC)
9 Voluntary HTC should be routinely offered to all key populations both in the community and in clinical settings. Community-based HIV testing and counselling for key populations, linked to prevention, care and treatment services, is recommended, in addition to providerinitiated testing and counselling.
HIV TREATMENT AND CARE
10 Key populations living with HIV should have the same access to antiretroviral therapy (ART) and to ART management as other populations.
11 All pregnant women from key populations should have the same access to services for prevention of mother-to-child transmission (PMTCT) and follow the same recommendations as women in other populations.
PREVENTION AND MANAGEMENT OF COINFECTIONS AND CO-MORBIDITIES
12 Key populations should have the same access to tuberculosis (TB) prevention, screening and treatment services as other populations at risk of or living with HIV.
13 Key populations should have the same access to hepatitis B and C prevention, screening and treatment services as other populations at risk of or living with HIV.
14 Routine screening and management of mental health disorders (depression and psychosocial stress) should be provided for people from key populations living with HIV in order to optimize health outcomes and improve their adherence to ART. Management can range from cocounselling for HIV and depression to appropriate medical therapies.
SEXUAL AND REPRODUCTIVE HEALTH
15 Screening, diagnosis and treatment of sexually transmitted infections should be offered routinely as part of comprehensive HIV prevention and care for key populations.
16 People from key populations, including those living with HIV, should be able to experience full, pleasurable sex lives and have access to a range of reproductive options.
17 Abortion laws and services should protect the health and human rights of all women, including those from key populations.
18 It is important to offer cervical cancer screening to all women from key populations.
19 It is important that all women from key populations have the same support and access to services related to conception and pregnancy care, as women from other groups.
CRITICAL ENABLERS
1 Laws, policies and practices should be reviewed and, where necessary, revised by policymakers and government leaders, with meaningful engagement of stakeholders from key population groups, to allow and support the implementation and scale-up of health-care services for key populations.
2 Countries should work towards implementing and enforcing antidiscrimination and protective laws, derived from human rights standards, to eliminate stigma, discrimination and violence against people from key populations.
3 Health services should be made available, accessible and acceptable to key populations, based on the principles of medical ethics, avoidance of stigma, non-discrimination and the right to health.
4 Programmes should work toward implementing a package of interventions to enhance community empowerment among key populations.
5 Violence against people from key populations should be prevented and addressed in partnership with key population-led organizations. All violence against people from key populations should be monitored and reported, and redress mechanisms should be established to provide justice.