Advertisement

Implementing Biomedical HIV Prevention Advances in Ecuador and Peru

Chapter

Abstract

New effective clinical interventions for the control and prevention of HIV infection have been available for some time, however, the process of adopting these innovations have varied in different countries. Peru and Ecuador represent two case studies of Andean countries that have had some trajectory in the implementation of clinical research to evaluate a new HIV prevention technology, pre-exposure prophylaxis (PrEP) that had a successful outcome conducive to the approval of an antiretroviral medication for HIV prevention by the US Food and Drug Administration (FDA). This chapter describes the evolution of the national response to the HIV/AIDS epidemic in both countries with concentrated epidemics in men and transgender women who have sex with men (MSM/TG) and analyzes how health priorities, leadership, political will, cultural factors, financial resources, communication, and access to information affect the adoption of HIV prevention innovations that could make a difference in the epidemic in these countries. Nevertheless, the recent developments in the creation of HIV/AIDS Multisectorial Strategic Plans provide a perfect opportunity to generate a forum for the discussion about the incorporation of these new HIV prevention technologies in future strategies. Several people have contributed to writing this chapter providing time for interviews or facilitating access to sources of information that are not publicly available; however, the final text is the sole responsibility of the authors.

Keywords

Sexually Transmit Infection Global Fund Community Advisory Board Medical Male Circumcision PrEP Trial 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

This work could not have been possible without the collaboration of several people who took the time to provide us with interviews, documents, and information. I am grateful for their valuable contributions.

Carlos Caceres, HIV Prevention Investigator, Universidad Cayetano Heredia School of Public Health, Peru

Jose Luis Sebastian, former Coordinator, National HIV/AIDS/STI Strategy, MoH, Peru

Jose Pajuelo, Executive Director, National Multisectorial Commission on Health (CONAMUSA), Peru

Virginia Baffigo, CEO Social Security, former Country Coordinator, Global Fund to Fight AIDS, Tuberculosis and Malaria, Peru

Manuel Lujan, Adviser to the Minister of Health, Peru

Manuel Vargas, Former Director, General Directorate of Medications, Supplies and Drugs, MoH, Peru

Robinson Cabello, Executive Director, Via Libre

Steve Miralles, Advocacy Director, Asociacion Civil Espacio Comun—Epicentro

Rosario Leon, Community Educator, Invetigaciones Medicas en Salud (INMENSA)

Acela Trujillo, Coordinator, HIV/AIDS/STI Counseling Program, Province of Guayas HIV/AIDS/STI Strategy, Ecuador

Jose Muñoz, Coordinator, Province of Guayas HIV/AIDS/STI Strategy, Ecuador

Luis Mena, former Chief, Province of Guayas HIV/AIDS/STI Strategy, Ecuador

Juan Vasconez, UNAIDS Country Coordinator, Ecuador

Maria Elena Acosta, Corporacion Kimirina, Ex-Director, National HIV/AIDS Control Program, MoH, Ecuador

Rodrigo Tovar, Coordinator, National HIV/AIDS/STI Strategy, Ministry of Public Health, Ecuador

References

  1. 1.
    Kusunoki L, Nagles J. Análisis de Situación de VIH en la Subregión Andina 2003–2005. Organización Panamericana de la Salud, Organismo Andino de Salud, ONUSIDA, 2007 Aug 29. Report No.Google Scholar
  2. 2.
    UNAIDS. Global Report: UNAIDS report on the global AIDS epidemic 2012. 2012 Jul.Google Scholar
  3. 3.
    Garcia-Abreu A, Noguer I, Cowgill K, Garcia-Abreu A, Noguer I, Cowgill K. HIV/AIDS in Latin America: the challenges ahead. Washington DC: The International Bank for Reconstruction and Development/The World Bank; 2004.Google Scholar
  4. 4.
    Bautista CT, Sanchez JL, Montano SM, Laguna-Torres VA, Lama JR, Sanchez J, et al. Seroprevalence of and risk factors for HIV-1 infection among South American men who have sex with men. Sex Transm Infect. 2004;80:498–504 (PubMed PMID: 6549).PubMedCrossRefGoogle Scholar
  5. 5.
    Hierholzer J, Montano S, Hoelscher M, Negrete M, Hierholzer M, Avila MM, et al. Molecular epidemiology of HIV Type 1 in Ecuador, Peru, Bolivia, Uruguay, and Argentina. AIDS Res Hum Retroviruses. 2002 Dec 10;18(18):1339–50 (PubMed PMID: 12487805. Epub 2002/12/19. eng).PubMedCrossRefGoogle Scholar
  6. 6.
    Montano SM, Sanchez JL, Laguna-Torres A, Cuchi P, Avila MM, Weissenbacher M, et al. Prevalences, genotypes, and risk factors for HIV transmission in South America. J Acquir Immune Defic Syndr. 2005 Jul 28;40(1):57–64 (PubMed PMID: 16123683. eng).PubMedCrossRefGoogle Scholar
  7. 7.
    Baral S, Sifakis F, Cleghorn F, Beyrer C. Elevated risk for HIV infection among men who have sex with men in low- and middle-income countries 2000–2006: a systematic review. PLoS Med. Dec 2007;4(12):e3390001–11.PubMedCrossRefGoogle Scholar
  8. 8.
    Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010 Dec 30;363(27):2587–99 (PubMed PMID: 21091279; PubMed Central PMCID: 3079639).PubMedCrossRefGoogle Scholar
  9. 9.
    FDA. FDA approves first drug for reducing the risk of sexually acquired HIV infection Washington, DC: Food and Drug Administration. 2012. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm312210.html. Accessed 3 Feb 2013.
  10. 10.
    INEC. Población del Ecuador: Instituto Nacional de Estadística y Censos. 2010. http://www.inec.gob.ec/cpv/. Accessed 3 Feb 2013.
  11. 11.
    CIA. Country Fact Sheet: Ecuador 2013. 2013. https://http://www.cia.gov/library/publications/the-world-factbook/geos/ec.html. Accessed 3 Feb 2013.
  12. 12.
    A 30 años del primer caso de VIH, crece el número de afectados. El Universo. 2011 June 5th, 2011;Sect. Comunidad.Google Scholar
  13. 13.
    Kusunoki L, Navarro MdC, Guanira-Carranza JV, Velasquez C. Priorizacion para el Acceso Universal a la Prevención, Atención Integral, Cuidado y Apoyo en VIH/SIDA. Ecuador 2008–2013. 2008 April 2008. Report No.Google Scholar
  14. 14.
    MSP. Actualizacion del Plan Estrategico Multisectorial de la Respuesta Nacional al VIH/SIDA 2007–2015. Planes Operativos multisectoriales 2011–2013. Quito, Ecuador: Ministerio de Salud Pública. Porgrama Nacional de Prevención y Control del VIH/SIDA e ITS, 2011.Google Scholar
  15. 15.
    MSP. Informe Nacional sobre los Progresos Realizados en la Aplicación del UNGASS Ecuador. Periodo Enero 2008–Diciembre 2009. Quito, Ecuador: Ministerio de Salud Pública del Ecuador, 2010 April 19th, 2009. Report No.Google Scholar
  16. 16.
    Ley para la Prevención y Asistencia Integral del VIH SIDA, Ley 11 (2010).Google Scholar
  17. 17.
    MSP. Plan EstrateÌgico Multisectorial de la Respuesta Nacional al VIH/SIDA 2007–2015. Quito, Ecuador: Ministerio de Salud Publica del Ecuador, 2007 Jun 23. Report No.Google Scholar
  18. 18.
    INEI. Perú: Población total estimada y proyectada, según años calendarios: 1990–2050: Instituto Nacional de Estadistica e Informatica. 2013. http://www.inei.gob.pe. Accessed 3 Feb 2013.
  19. 19.
    Patrucco R. El Sindrome de Inmunodeficienica Adquirida en el Peru: Estudios Inmunologicos. Revista Diagnostico. 1985;16(5) (PubMed PMID: 4241).Google Scholar
  20. 20.
    HPI USAID. Política Nacional VIH-SIDA. 2007.Google Scholar
  21. 21.
    Cueto M. Culpa y coraje. Historia de las politicas sobre el VIH/SIDA en el Peru. Lima, Peru: Consorcio de Investigacion Economica y Social; 2001.Google Scholar
  22. 22.
    DGE. Boletin Epidemiológico Epidemiológico Mensual. Lima, Peru: Ministerio de Salud, 2012 Noviembre 2012. Report No.Google Scholar
  23. 23.
    MINSA. UNGASS: Informe Nacional sobre los Progresos Realizados en el País. Peru: Enero 2010–Diciembre 2011. 2012 May 27:1–246.Google Scholar
  24. 24.
    Bautista CT, Sanchez JL, Montano SM, Laguna-Torres A, Suarez L, Sanchez J, et al. Seroprevalence of and risk factors for HIV-1 infection among female commercial sex workers in South America. Sex Transm Infect. 2006 Aug 1;82(4):311–6 (PubMed PMID: 16877581. eng).PubMedCrossRefGoogle Scholar
  25. 25.
    Ley CONTRASIDA, 26626 (1996).Google Scholar
  26. 26.
    Ley CONTRASIDA ampliada y modificada, 28243 (2004).Google Scholar
  27. 27.
    Doctrina, Normas y Procedimientos para el Control de las ETS y el SIDA en el Perú, (1996).Google Scholar
  28. 28.
    Frasca T. AIDS in Latin America. New York: Palgrave Macmillan; 2005. p. 261.CrossRefGoogle Scholar
  29. 29.
    Situación de las ITS y el VIH/Sida en el Perú, 2006. Lima, Peru: Iniciativa de Políticas en Salud, 2006 Sep 09. Report No.Google Scholar
  30. 30.
    CONAMUSA. Plan Estratégico Multisectorial para la Prevención y control de las ITS y el VIH/SIDA en el Peru (2007–2011). Lima, Peru: Comisión Nacional Multisectorial de Salud, 2006 Nov 26. Report No.Google Scholar
  31. 31.
    MINSA. Evaluacion del Plan Estratégico Multisectorial VIH/SIDA 2007–2011. Lima, Peru: Ministerio de Salud del Peru, 2012.Google Scholar
  32. 32.
    MINSA. Plan EstrateÌgico Multisectorial de PrevencioÌn y Control de ITS y VIH. AnaÌlisis de situacioÌn de la epidemia y de la respuesta. 2012.Google Scholar
  33. 33.
    Modifican la RM N° 775–2012/MINSA a fin de ampliar periodo de duración del Plan Estratégico Multisectorial para la Prevención y Control de las ITS/VIH y Sida en el Perú, así como el plazo para su elaboración, N° 775–2012/MINSA (2013).Google Scholar
  34. 34.
    Fund TG. The Global Fund to Fight AIDS, Tuberculosis and Malaria 2013. Available from: http://www.theglobalfund.org.
  35. 35.
    Fund TG. Grant Portfolio—Ecuador: The Global Fund to Fight AIDS, Tuberculosis and Malaria. 2013. http://portfolio.theglobalfund.org/en/Country/Index/ECU. Accessed 3 Feb 2013
  36. 36.
    Fund TG. Grant Portfolio—Peru: The Global Fund to Fight AIDS, Tuberculosis and Malaria. 2013. http://portfolio.theglobalfund.org/en/Grant/Index/PER-202-G01-H-00. Accessed 3 Feb 2013
  37. 37.
    Ecuador MdSPd. Informe Nacional sobre los Progresos Realizados en la Aplicacion del UNGASS. Ecuador. Ministerio de Salud Publica del Ecuador, 2010 April 19th, 2010. Report No.Google Scholar
  38. 38.
    Cohen M, Chen Y, McCauley M. Prevention of HIV-1 infection with early antiretroviral therapy. New Eng J. 2011 Jan 1 (PubMed PMID: 13290838847807409145).Google Scholar
  39. 39.
    Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, Puren A. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med. 2005 Nov;2(11):e298 (PubMed PMID: 16231970. eng).PubMedCrossRefGoogle Scholar
  40. 40.
    Weiss HA, Halperin D, Bailey RC, Hayes RJ, Schmid G, Hankins CA. Male circumcision for HIV prevention: from evidence to action? AIDS. 2008 Mar 12;22(5):567–74 (PubMed PMID: 18316997. Epub 2008/03/05. eng).PubMedCrossRefGoogle Scholar
  41. 41.
    Gray RH, Kigozi G, Serwadda D, Makumbi F, Watya S, Nalugoda F, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet. 2007 Feb 24;369(9562):657–66 (PubMed PMID: 17321311. eng).PubMedCrossRefGoogle Scholar
  42. 42.
    WHO/UNAIDS. Male circumcision for HIV prevention in high HIV prevalence settings: what can mathematical modelling contribute to informed decision making? PLoS Med. 2009 Sep;6(9):e1000109 (PubMed PMID: 19901974; PubMed Central PMCID: 2731851. Epub 2009/11/11. eng).CrossRefGoogle Scholar
  43. 43.
    WHO/UNAIDS. Male circumcision for HIV prevention: the research evidence and some critical responses. Reprod Health Matters. 2007 May;15(29):9–10 (PubMed PMID: 17512368; Epub 2007/05/22. eng).CrossRefGoogle Scholar
  44. 44.
    WHO/UNAIDS. International AIDS Society conference update. Male circumcision as a prevention method? Study was controversial from day one. AIDS Alert. 2005 Sep;20(9):101–2 (PubMed PMID: 16206400; Epub 2005/10/07 eng).Google Scholar
  45. 45.
    WHO/UNAIDS. Male circumcision: global trends and determinants of prevalence, safety and acceptability. 2007.Google Scholar
  46. 46.
    WHO/UNAIDS. Safe, voluntary, informed male circumcision and comprehensive HIV prevention. 2008 Jan 1:34 (PubMed PMID: 7Je6PwAACAAJ).Google Scholar
  47. 47.
    WHO/UNAIDS. New data on male circumcision and HIV prevention: policy and programme implications. Montreux, Geneve: 2007.Google Scholar
  48. 48.
    WHO/UNAIDS. Male circumcision: global trends and determinants of prevalence, safety and acceptability. 2008 Aug 11. Report No.Google Scholar
  49. 49.
    WHO/UNAIDS. WHO/UNAIDS announce recommendations about male circumcision as HIV prevention. Strategy should be employed with care. AIDS Alert. 2007 Jun;22(6):66–7 (PubMed PMID: 17633775; Epub 2007/07/20. eng).Google Scholar
  50. 50.
    WHO/UNAIDS. Male circumcision for HIV prevention: research implications for policy and programming. WHO/UNAIDS technical consultation, 6–8 March 2007. Conclusions and recommendations (excerpts). Reprod Health Matters. 2007 May;15(29):11–4 (PubMed PMID: 17512369; Epub 2007/05/22. eng).CrossRefGoogle Scholar
  51. 51.
    Guanira JV, Lama JR, Goicochea P, Segura P, Montoya O, Sanchez J, editors. How willing are gay men to “cut off” the epidemic? Circumcision among MSM in the Andean Region. 4th IAS Conference on HIV Pathogenesis, Treatment and Prevention; 2007; Sydney, Australia.Google Scholar
  52. 52.
    Goicochea P, Sanchez J, Casapia M, Montoya O, Morales M, Grinsztejn B, et al., editors. Feasibility, acceptability and willingness to participate in a male circumcision trial for the prevention of HIV acquisition in men who have sex with men in the Andes. 5th International AIDS Society Conference; 2009 18–22 July 2009; Cape Town, South Africa.Google Scholar
  53. 53.
    Sánchez J, Sal yRVG, Hughes JP, Baeten JM, Fuchs J, Buchbinder SP, et al. Male circumcision and risk of HIV acquisition among men who have sex with men. AIDS. 2010 Nov;1:1.Google Scholar
  54. 54.
    Normas paralaElaboración de Documentos Normativos del Ministerio de Salud, (2011).Google Scholar
  55. 55.
    Adis International L. HIV gp120 vaccine—VaxGen: AIDSVAX, AIDSVAX B/B, AIDSVAX B/E, HIV gp120 vaccine—Genentech, HIV gp120 vaccine AIDSVAX—VaxGen, HIV vaccine AIDSVAX—VaxGen. Drugs in R & D. 2003;4(4):249–53 (PubMed PMID: 12848591. Epub 2003/07/10. eng).Google Scholar
  56. 56.
    Celum C, Wald A, Hughes J, Sanchez J, Reid S, Delany-Moretlwe S, et al. Effect of aciclovir on HIV-1 acquisition in herpes simplex virus 2 seropositive women and men who have sex with men: a randomised, double-blind, placebo-controlled trial. Lancet. 2008 Jun 21;371(9630):2109–19 (PubMed PMID: 18572080. eng).PubMedCrossRefGoogle Scholar
  57. 57.
    Galea JT, Kinsler JJ, Salazar X, Lee S-J, Giron M, Sayles JN, et al. Acceptability of pre-exposure prophylaxis as an HIV prevention strategy: barriers and facilitators to pre-exposure prophylaxis uptake among at-risk Peruvian populations. Int J STD AIDS. 2011 May 1;22(5):256–62 (PubMed PMID: 21571973. eng).PubMedCrossRefGoogle Scholar
  58. 58.
    iessdh. Consultation on New HIV Prevention Strategies in Peru—Executive Summary 13 12 11 final. 2011 Dec 13. Report No.Google Scholar
  59. 59.
    Grosskurth H, Mosha F, Todd J, Senkoro K, Newell J, Arnold K, et al. A community trial of the impact of improved sexually transmitted disease treatmen on the HIV epidemic in rural Tanzania: 2. Baseline survey results. AIDS. 1995;32676:919–26.Google Scholar
  60. 60.
    Sperling R, Shapire D, Coomvs R. Maternal viral load, zidovudine treatment and the risk of transmission of human immunodeficiency virus type 1 from mother to infant. N Engl J Med. 1996;335:7.Google Scholar
  61. 61.
    WHO/ILO. Joint WHO/ILO guidelines on post-exposure prophylaxis (PEP) to prevent HIV infection. Geneva: WHO; 2005.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Gladstone Institute of Virology and Immunology/UCSFJ. David Gladstone InstitutesSan FranciscoUSA
  2. 2.Investigaciones Medicas en SaludLimaPeru
  3. 3.Fundación Ecuatoriana EquidadGuayaquilEcuador

Personalised recommendations