Pre-exposure prophylaxis (PrEP) for HIV has proven to be an effective strategy for reducing transmission of the virus, especially among key populations such as men who have sex with men (MSM) and transgender people. In Brazil, its implementation in the Unified Health System (SUS) in 2018 represented a milestone in the fight against the HIV/AIDS epidemic. However, challenges persist regarding equity in access, expansion, and awareness among vulnerable groups. This is an observational, descriptive, historical series study using public data from the Health Surveillance Secretariat of the Ministry of Health (MS) regarding PrEP users between 2018 and 2024. The degree of correlation between the variation in the number of PrEP users and the number of municipalities and health services in Paraná that began offering the medication was assessed using Pearson’s correlation coefficient. Analysis of variance (ANOVA) for independent samples was used to identify differences between groups within each variable investigated, considering the mean and standard deviation across the entire study period. Since the beginning of PrEP provision in Brazil in 2018 until the end of 2024, the number of people accessing the prophylactic medication in public health services in Paraná increased by 2,116.7%. During this period, MSM predominated (p < 0.0001), particularly those aged 30 to 39 years (p = 0.0028). An increase in demand was observed among heterosexual men p = 0.00012; 0.98 (0.86; 0.99) and younger age groups, particularly 18-year-olds p = 0.038; 0.78 (0.07; 0.96). There was a discrete but significant rise in the proportion of transgender women using PrEP p = 0.017; 0.84 (0.25; 0.98), while the demand remained consistently low throughout the period among cisgender women p = 0.0907; 0.68 (–0.14; –0.94). There was also a predominance of use among individuals with white skin and more than 12 years of schooling. Demand for PrEP among cisgender individuals, whether heterosexual or homosexual, has increased since the strategy’s implementation, and this pattern is reproduced in Paraná. Significant vulnerabilities persist in access for transgender individuals, particularly related to structural transphobia.
Bremer et al. (Sun,) studied this question.