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Implementing Biomedical HIV Prevention Advances in Ecuador and Peru

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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.

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Notes

  1. 1.

    “Alaska” is the name of a Spanish-Mexican singer who in 1986, together with her group, Dinarama popularized the song “A quien le importa” (Who cares) that became a gay hymn. This MSM/TG cohort chose the name “Alaska” to honor the singer.

  2. 2.

    Feasibility, acceptability and willingness to participate in a Male Circumcision Trial for the Prevention of HIV Acquisition in Men who Have Sex with Men (NIH grant P30 AI027757).

  3. 3.

    This information was collected during interviews with urologists during the conduct of a USAID sponsored research; “Introducing male neonatal circumcision in selected peruvian populations: a feasibility study considering medical, legal, economic, social and political implications” (RFP Nº 201002).

  4. 4.

    Impacta also conducted studies for the DAIDS sponsored AIDS Clinical Trials Group (ACTG) and the pharmaceutical industry.

  5. 5.

    In August of 2005, the Centers for Disease Control and Prevention sponsored the conduct of “CDC 4323,” a safety trial of the daily use, once a day of the antiretroviral drug tenofovir for the prevention of HIV infection in MSM. The study was conducted in collaboration with the San Francisco Department of Public Health, the AIDS Consortium of Atlanta and Fenway Health in Boston http://www.avac.org/ht/display/ContentDetails/i/1837/pid/1891.

  6. 6.

    “HPTN 036: HIV prevalence, incidence and HSV-2 prevalence among high-risk MSM in Lima, Peru” was a preparedness study to assess the capacity to enroll and retain a large cohort of participants at high risk of acquiring HIV and enrolled 254 MSM/TG in Lima, Peru.

  7. 7.

    Gilead Science Inc. submitted an application for licensure of Truvada to the Peruvian Directorate of Medicines, Supplies and Drugs (DIGEMID) in September 2012. At the time of the consultation in Ecuador, Truvada was not licensed in Ecuador either, but Gilead had already submitted an application in 2010. In October of 2012, the Ecuadorian MPH approved Truvada for the treatment of HIV infection.

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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

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Authors and Affiliations

  1. Gladstone Institute of Virology and Immunology/UCSF, J. David Gladstone Institutes, 1560 Owens Street, 94158, San Francisco, CA, USA

    Pedro Goicochea MSc, MA

  2. Investigaciones Medicas en Salud, Lima, Peru

    Pedro Goicochea MSc, MA

  3. Fundación Ecuatoriana Equidad, Quisquis 921, Guayaquil, Guayas, Ecuador

    Orlando Montoya

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  1. Pedro Goicochea MSc, MA
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Correspondence to Pedro Goicochea MSc, MA .

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Editors and Affiliations

  1. Dept. of Human Develop. & Family Studies, University of Connecticut, Storrs, Connecticut, USA

    Lisa A. Eaton

  2. Ctr for Health Intervention & Prevention, University of Connecticut, Storrs, Connecticut, USA

    Seth C. Kalichman

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Goicochea, P., Montoya, O. (2014). Implementing Biomedical HIV Prevention Advances in Ecuador and Peru. In: Eaton, L., Kalichman, S. (eds) Biomedical Advances in HIV Prevention. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8845-3_12

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