The Brazilian Interdisciplinary AIDS Association cautiously receives the new World Health Organization (WHO) guideline recommending
that men who have sex with men (MSM) consider using antiretroviral medications as a way to prevent HIV infection. While the note is
relevant for expanding prevention technologies and techniques, a deeper analysis shows that there are factors that should be observed
We recognize that the homosexual population, in particular among young people, is the most affected by the epidemic. However, it is
important to consider the heterogeneity of MSM as a group formed by gays, bisexuals, male sex workers, transgender people (which may identify as women, sex workers, etc) and men who have sex with other men and do not identify themselves as gays or homosexuals.
Grouping these individuals together and affirming that there is an “explosion” of the epidemic in the MSM population creates a moral
panic, reproduces the idea of risk groups, and distorts the social differences of these sub-populations. It is important to consider the
fact that these groups can have different infection rates, and as such, should be observed according their specificities.
We further understand that it is a mistake to think that one technology (in this case, Pre-exposure Prophylaxis (PrEP), or rather,
the use of medication to protect against HIV) associated with condom use could be a broad response to the epidemic. All forms
of prevention are welcome, as long as they form part of a range of possibilities and choices that each person can make, whether they
belong, or not, to vulnerable population groups. Prevention strategies must occur in/for/with social contexts and should be adapted to the
diversities and demands of those who receive them.
Although we recognize the notable contribution of biomedical strategies in confronting the epidemic and resulting in new prevention technologies, ABIA defends a response to AIDS that goes beyond the biomedical and considers the cultural, social, and human aspects of AIDS, and that the disease continues to be highly stigmatized. The debate about the political and human rights aspects of AIDS needs to be revived to re-politicize the response to the epidemic in a positive way.
The WHO’s decision and its broad repercussion in the media on the eve of the International AIDS Conference in Melbourne, Australia,
dialogues with the power of the pharmaceutical industry and medicalization without a critical reflection on the epidemic. It also
further reinforces the actions of global scientists that fight to secure funding for epidemiological studies.
The WHO document consolidates a series of guidelines for prevention, diagnosis and treatment among the populations who are most exposed to HIV infection (MSM, people who use drugs, people in prison and other closed settings, sex workers and transgender people). Based on our first reading of these guidelines, ABIA recommends:
* Include the method of “treatment as prevention” among the five WHO prevention guidelines, along with other techniques such as
condoms, PrEP, PEP and other methods currently in a research phase (such as vaccines and microbicides) with the goal of offering all options;
* Improve the debate about these methods;
* Reinforce efforts to enable combination prevention, that does not only use biomedical approaches, but also socio-political ones such as structural interventions;
* Revive the dialogue with society on constructing a response to the epidemic Rio de Janeiro, July 15th, 2014