GeSIDA recommends providing PrEP to everyone who might benefit from this HIV prevention intervention.
GeSIDA insists that PrEP be part of a program that also includes a combination of measures such as condom promotion, sexuality education, substance use assessment, early detection and treatment of STIs, and updating recommended vaccines.
To mark the fifth anniversary of the inclusion of PrEP (pre-exposure prophylaxis for HIV) in the core social services portfolio and the good results this prevention strategy has delivered – over 24,000 people have been reported to have benefited over the years. to data from the HIV, STI, Viral Hepatitis and Tuberculosis Control Unit of the Ministry of Health – GeSIDA invites competent administrations to consider expanding the access criteria, as well as providing this preventive treatment to more people, such as, for example, those who have hepatitis C or people with who do not have any of these criteria at the time of risk assessment, but who demonstrate a change in their situation in the near future, for example, stopping the systematic use of condoms.
To facilitate access to PrEP, which is based on drugs dispensed in hospitals, GeSIDA also plans to move this treatment closer from hospital pharmacies to the health care facilities that serve these users: STI (sexually transmitted infections) clinics or others. non-hospital centers such as primary health care centers or community centers.
PrEP should be prescribed and monitored by a physician experienced in treating HIV and other STIs, and should be trained in caring for and addressing sexual and gender diversity chemsex.
In addition, the role of specialized nursing is fundamental. For this proposal to be possible, hospital and community units must be provided with sufficient staff and resources to adequately meet demand and follow-up of users, and reduce waiting lists for access to PrEP.
This study group also emphasizes the importance of appropriate monitoring of people who should receive PrEP, which should include obtaining a complete clinical history, including toxic habits and sexual behavior; pre-prescription analytical assessment – to exclude pre-existing HIV infection, assess the serological status of hepatitis A, B and C viruses, or assess renal function; conducting full screening for other STIs; emphasize the importance of proper adherence to the therapeutic regimen; initiate vaccination against hepatitis A and B and HPV when necessary; assess drug tolerability and possible side effects; and periodically review indications for continued PrEP.
PrEP and other STIs other than HIV
In contrast to what has happened with HIV, the past two decades have seen an increase in the number of STI diagnoses in our community, especially gonorrhea, chlamydia and syphilis, and more recently hepatitis C among men who have sex with other men (MSM). For this reason, GeSIDA insists that “PrEP is part of a program that also includes a combination of measures such as condom promotion, sexuality education, substance use assessment, early detection and treatment of STIs, and updated guidelines.” vaccines,” emphasizes Dr. Rosario Palacios, president of this research group.
Today, it is still unclear whether the use of PrEP contributes to the increase in the incidence of STIs. For example, a study conducted in different centers providing PrEP in Spain did not find a significant increase in the incidence of some STIs, such as gonorrhea, chlamydia and syphilis.
Although various studies have disagreed about the possible increased incidence of STIs in PrEP users, systematic STI screening allows for timely detection and treatment of other STIs, which may reduce their transmission.
That’s why GeSIDA recommends being tested for syphilis, chlamydia and gonorrhea every three to six months, and being tested for hepatitis C every 6 to 12 months, depending on each person’s risk.
HIV situation in Spain
More than 40 years after its emergence, despite significant advances in diagnosis and, above all, treatment, HIV continues to remain a serious public health problem today. The rate of new diagnoses is similar to that of other Western European countries, although higher than the European Union average. According to the latest official data (Spain HIV Care Continuum Update 2021–2022), there are an estimated 136,000 to 162,000 people living with HIV in Spain. In 2022, there were 2956 new HIV diagnoses, of which 46.8% were late diagnoses.
Quite a number that clearly show that talking about HIV and AIDS is not a matter of the past, but, on the contrary, “something that requires ambitious action in the present and future, since we are talking about a disease from which we are still fighting.” There is no known cure and it continues to raise new questions for us, four decades after its discovery,” adds the GeSIDA President.
Unprotected sex between men ranks highest among transmission routes in the global data set. Therefore, the group of men who have sex with men (MSM) is a priority for prevention programs. Likewise, people from other countries accounted for nearly half of new HIV diagnoses in 2022. Their distinctive characteristics make it necessary to diversify prevention programs to adapt them to the needs of this socially and culturally very heterogeneous and particularly vulnerable group.