People aged 15 to 45 who take HIV Pre-Exposure Prophylaxis (PrEP) will be included in the public for the HPV – human papillomavirus vaccine . The measure was announced through a technical note , published this Wednesday (3), on the Ministry of Health portal. With the expansion, it will be possible to further help in the prevention and treatment of sexually transmitted infections (STIs) and cancers caused by illness.

For Pedro Barbosa, 25 years old, this inclusion is extremely important. A resident of Uberlândia (MG), the nurse started treatment with PrEP in 2021 through the Unified Health System (SUS) . “I underwent periodic medical monitoring and examinations and, since then, I feel much more confident about my sexual health, allowing me to be more open about it. This is another step on the path to achieving fewer cases of sexually transmitted infections,” he says.

HPV is an STI and is associated with warts on the genitals and the development of cancer of the cervix, vulva, penis, anus and oropharynx. In addition to sexual transmission, the virus can also be passed through direct contact with infected skin or mucosa. There are more than 100 types, at least 14 of which are carcinogenic, known as high risk.

In Brazil, the prevalence of human papillomavirus was assessed by the Epidemiological Study on National HPV Prevalence (POP-Brazil), which included sexually active men and women between 16 and 25 years old. The overall number of HPV was 53.6%, with 35.2% having at least one of the high-risk genotypes. Of those interviewed, 50.7% reported using condoms routinely and 12.7% reported the presence of a previous STI.

The director of the Department of HIV, AIDS, Tuberculosis, Viral Hepatitis and STIs of the Secretariat for Health and Environmental Surveillance (SVSA) , Draurio Barreira, explains that providing access to the HPV4 vaccine for PrEP users is an action with an impact on preventing HPV-related neoplasms for populations most vulnerable to STIs.

“By March 2024, 82% of people using PrEP were men who have sex with men and 3.2% were trans and transvestite women. We know that several barriers related to social determinants, especially stigma, make these population segments more vulnerable to HIV, STIs and cancers caused by HPV”, he details.

Immunization

A safe and effective way to prevent infection is vaccination. The SUS offers the quadrivalent vaccine (HPV4), which protects against the main complications of the disease. Currently, the target audience is children and adolescents aged 9 to 14, on a single dose regimen; people aged 9 to 45 living with HIV and AIDS ; cancer patients, people with recurrent respiratory papillomatosis (RRP), and transplant recipients with three doses; and immunocompetent people aged 15 to 45 years who are victims of sexual violence. With these recommendations, Brazil is one of the countries in the Americas that most offer the vaccine.

According to the National Health Data Network (RNDS), since the start of HPV vaccination in the SUS, in 2014, 75.8% of the female public took the first dose and 58.2% took the second throughout Brazil. Male immunization registration, which began in 2017, is at 53.1% for the first dose and 33.2% for the second. The data is made available by states and municipalities and may change as the system is fed.

The single dose regimen for immunocompetent children and adolescents was recently adopted by the Ministry of Health. The idea is to intensify protection against cervical cancer and other complications associated with the virus. The strategy follows the most recent recommendations from the World Health Organization (WHO) and the Pan American Health Organization (PAHO). As a result, the folder practically doubles the immunization capacity of stocks available in the country.

Understand what PrEP is

PrEP is one of the ways to prevent HIV infection if exposure to the virus occurs. To do this, you need to take a pill daily that contains two medications: tenofovir and emtricitabine. However, it is important to emphasize that pre-exposure prophylaxis does not prevent infection with other STIs.

The medicine is indicated for people aged 15 and over, who are sexually active and who are at increased risk of acquiring HIV infection. It can be prescribed by nurses, pharmacists and doctors in primary health care or specialized services. Currently, there are 939 PrEP dispensing units (UDMs) in 540 Brazilian municipalities.

As of March 2024, approximately 84,926 people were using PrEP. Of these, 82% are men who have sex with men, 3.2% trans and transvestite women, 6.7% cisgender heterosexual men and 5.8% cisgender women.

Access to the HPV vaccine for PrEP users is an impactful action in preventing cancer in disproportionately affected populations, such as gay men and other men who have sex with men (MSM) and trans women. Furthermore, the expansion does not affect the initially targeted audience.

Resources

In 2023, the federal government resumed themes such as preventing violence and accidents, promoting a culture of peace and human rights, sexual and reproductive health, in addition to preventing HIV/STIs in schools. The Ministry of Health allocated more than R$90 million to municipalities that joined the School Health Program (PSE). The 2023/2024 cycle reached an all-time record for adhesions, with 99% of Brazilian cities eligible to receive the resource.

Source: Agência Brasil