Profilaxis preexposición al VIH en España: situación política y administrativa / HIV pre-exposure prophylaxis (PrEP) in Spain: political and administrative situation

Este estudio se ha centrado en las actuaciones a nivel político y administrativo que se han realizado en España en relación con la implementación de la profilaxis preexposición (PrEP) al VIH. Se ha analizado todo tipo de iniciativas formales por parte de los actores políticos y administrativos implicados. Las fuentes utilizadas son las fuentes oficiales públicas. Hasta febrero de 2018, la PrEP no ha sido implementada. La decisión depende de los niveles estatal y autonómico. El Ministerio de Sanidad y algunas Comunidades Autónomas trabajan en diversas intervenciones sin establecer un calendario de implementación. Los partidos políticos por su parte han promovido escasas iniciativas relacionadas con la implementación de la PrEP. En el terreno jurídico, se han producido vaivenes legales relacionados con la extensión de la patente. El papel de los órganos intergubernamentales e interdepartamentales es vital para la implementación de la PrEP

This study focuses on actions at the political and administrative level in Spain in relation to the implementation of pre-exposure prophylaxis (PrEP). We analysed a whole range of different formal initiatives taken by the political and administrative actors involved. The information was obtained from official public data sources. As of February 2018, PrEP had not been implemented. The decision is dependent on both state and regional governments. The Ministry of Health and some Autonomous Regions are working on different interventions, but without providing an implementation timetable. The political parties have kept a very low profile in terms of initiatives related to the implementation of PrEP. From a legal point of view, proceedings are passing back and forth with the extension of the patent. The role of intergovernmental and interdepartmental institutions is very important for the implementation of PrEP in Spain

HIV pre-exposure prophylaxis (PrEP) in Spain: political and administrative situation. / Profilaxis preexposición al VIH en España: situación política y administrativa.

This study focuses on actions at the political and administrative level in Spain in relation to the implementation of pre-exposure prophylaxis (PrEP). We analysed a whole range of different formal initiatives taken by the political and administrative actors involved. The information was obtained from official public data sources. As of February 2018, PrEP had not been implemented. The decision is dependent on both state and regional governments. The Ministry of Health and some Autonomous Regions are working on different interventions, but without providing an implementation timetable. The political parties have kept a very low profile in terms of initiatives related to the implementation of PrEP. From a legal point of view, proceedings are passing back and forth with the extension of the patent. The role of intergovernmental and interdepartmental institutions is very important for the implementation of PrEP in Spain.

Magnitud de la infección por VIH, poblaciones vulnerables y barreras de acceso a la atención sanitaria / Burden of HIV infection, vulnerable populations and access barriers to healthcare

En España, los esfuerzos realizados en la prevención del VIH han sido insuficientes y, desde el año 2000, su incidencia permanece estable, por encima de la media europea. Se estima que en España viven entre 130.000 y 160.000 personas con VIH; de ellas, el 18% desconoce estar infectado y la mitad recibe el diagnóstico de forma tardía, lo que conlleva peor evolución, menor esperanza y calidad de vida, y mayores costes. El retraso diagnóstico es mayor en heterosexuales, usuarios de drogas inyectadas, mayores de 50 años e inmigrantes, mientras que los hombres que tienen sexo con hombres son el único grupo donde aumentan los nuevos diagnósticos. Se estima que hasta el 34% de las personas con VIH presentan carga viral detecta-ble, principalmente debido a barreras que dificultan su diagnóstico, como el insuficiente acceso a la prueba y la baja percepción del riesgo tanto por personas que desconocen estar infectadas como por los profesionales

In Spain, HIV incidence has remained stable and higher than the European average since 2000 due to insuf-ficient prevention measures. An estimated 130,000-160,000 people are believed to be living with HIV in Spain, including 18% who do not know they are infected, and half are late diagnoses, with a poorer clinical course, lower quality of life and life expectancy, as well as higher costs. Late diagnosis is more common in heterosexuals, intravenous drug users, people over 50 years of age and immigrants, whereas men who have sex with men are the only group where the rate of new diagnoses is increasing. An estimated 34% of people with HIV have a detectable viral load, mainly due to barriers that hinder diagnosis such as insufficient testing availability and the low risk perception of undiagnosed individuals and healthcare professionals

Prevención primaria / Primary prevention

La infección por VIH no está controlada en España. Se requieren nuevas estrategias para prevenir la transmisión, especialmente en los colectivos en que tiene mayor incidencia, mediante intervenciones combinadas. El diagnóstico precoz de la infección y el inicio de tratamiento es la estrategia más eficiente, que deben estar acompañados por intervenciones que promuevan cambios de conductas. Este tipo de campañas no solo se deben dirigir a la población general, sino que también es necesario llegar a grupos poblacionales clave de forma más específica. Las intervenciones biomédicas, como la profilaxis preexposición, utilizan una combinación de medios para reducir el riesgo de adquirir el VIH y suelen estar acompañadas por intervenciones conductuales. La influencia de factores estructurales y de justicia social, y la defensa de los derechos de las personas con VIH tienen importantes repercusiones en las estrategias de prevención. Las intervenciones estructurales tratan de incidir en estos factores y reducir la vulnerabilidad a la infección por VIH

HIV infection is still not controlled in Spain. New HIV infection prevention strategies are required, especially in populations of higher incidence, by means of combined interventions. Early diagnosis and treatment of HIV-infected individuals is the most cost-effective strategy to control the epidemic, including interventions designed to motivate behavioural changes. These types of campaigns must not only be directed to the general population through mass channels, but also to key populations through more specific channels and messages. Biomedical interventions like pre-exposure prophylaxis, uses a combination of biomedical tools to reduce the risk of HIV acquisition, and are usually accompanied of behavioural interventions. The influence of structural factors, social justice and defending the rights of people living with HIV have a significant impact on prevention strategies. Structural interventions are designed to influence these factors that make some individuals or populations more vulnerable to HIV infection

Burden of HIV infection, vulnerable populations and access barriers to healthcare. / Magnitud de la infección por VIH, poblaciones vulnerables y barreras de acceso a la atención sanitaria.

In Spain, HIV incidence has remained stable and higher than the European average since 2000 due to insuf-ficient prevention measures. An estimated 130,000-160,000 people are believed to be living with HIV in Spain, including 18% who do not know they are infected, and half are late diagnoses, with a poorer clinical course, lower quality of life and life expectancy, as well as higher costs. Late diagnosis is more common in heterosexuals, intravenous drug users, people over 50 years of age and immigrants, whereas men who have sex with men are the only group where the rate of new diagnoses is increasing. An estimated 34% of people with HIV have a detectable viral load, mainly due to barriers that hinder diagnosis such as insufficient testing availability and the low risk perception of undiagnosed individuals and healthcare professionals.

Primary prevention. / Prevención primaria.

HIV infection is still not controlled in Spain. New HIV infection prevention strategies are required, especially in populations of higher incidence, by means of combined interventions. Early diagnosis and treatment of HIV-infected individuals is the most cost-effective strategy to control the epidemic, including interventions designed to motivate behavioural changes. These types of campaigns must not only be directed to the general population through mass channels, but also to key populations through more specific channels and messages. Biomedical interventions like pre-exposure prophylaxis, uses a combination of biomedical tools to reduce the risk of HIV acquisition, and are usually accompanied of behavioural interventions. The influence of structural factors, social justice and defending the rights of people living with HIV have a significant impact on prevention strategies. Structural interventions are designed to influence these factors that make some individuals or populations more vulnerable to HIV infection.