HIV pre-exposure prophylaxis in Latin America: Public policies, healthcare systems and human rights.

Objective: In concentrated HIV epidemics, combination prevention is recommended for key populations, including pre-exposure prophylaxis (PrEP). Our study analyzes PrEP's integration as a public policy in Spanish, Portuguese and French-speaking Latin American countries. Methods: We reviewed documents published through December 2024 from Ministries of Health, international organizations, relevant non-governmental organizations, and collected data on countries' human development index (HDI), healthcare system organization/expenditures, assessing compliance with human rights standards. Results: PrEP policies are described in 16 out of 20 countries reviewed. In Argentina, Brazil, Chile, Colombia, Cuba, El Salvador, Haiti, Mexico and Peru, PrEP is provided to key populations. In Costa Rica, Guatemala, Panama and Paraguay, PrEP is available through research or pilot projects. In the Dominican Republic, Ecuador, and Honduras, PrEP is being scaled up, but specifics remain unclear. Other countries have limited access to PrEP or no available information. Broad PrEP distribution occurs generally in countries with higher healthcare expenditures relative to gross domestic product and high HDI. However, its distribution free of charge is not correlated with universal access to public healthcare. Attention to human rights standards was noted in policies from Argentina, Brazil, Chile, Cuba, Ecuador, El Salvador, Haiti, Mexico, Peru and Uruguay, covering rights to healthcare access, information, informed decision-making, participation, equality, privacy, accountability, and benefits of scientific progress. Conclusions: As of December 2024, PrEP policies exist in some Latin American countries, but are limited or unavailable in others. Achieving universal healthcare and adhering to human rights norms can improve access/use of this essential HIV prevention tool.