title: Pre-exposure prophylaxis for men and transgender women who have sex with men in Brazil: opportunities and challenges.
abstract: BACKGROUND
  The World Health Organization recently released guidelines on the use of pre-exposure prophylaxis (PrEP) for prevention of HIV infection among men and transgender women (TGW) who have sex with men based on results of randomized clinical trials. The aim of this commentary is to discuss the opportunities and challenges of incorporating PrEP into the Brazilian continuum of HIV care and prevention for men who have sex with men (MSM) and TGW.
  
  
  CONCLUSIONS
  Key aspects of the AIDS epidemic among MSM and TGW in Brazil and the comprehensive Brazilian response to the epidemic are presented. The universal access to health care provided through the Brazilian Unified Health System (SUS) and the range of prevention and care services already available countrywide to HIV-positive individuals and at-risk MSM and TGW are identified as the main facilitators for the implementation of PrEP. Limited PrEP awareness among MSM, TGW and health care providers, low HIV testing frequency and low HIV risk perception among MSM and TGW represent the core challenges to be addressed. Data generated by demonstration projects in Brazil will provide an important contribution to PrEP rollout in Brazil.
  
  
  CONCLUSIONS
  The implementation of PrEP in Brazil is feasible. A synergistic rollout of treatment as prevention and PrEP will maximize public health and individual benefits of the country's comprehensive response to the AIDS epidemic.
authors.affiliation: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil; valdilea.veloso@ipec.fiocruz.br.
authors.forename: Valdilea G
authors.initials: VG
authors.lastname: Veloso
authors.affiliation: Departamento de Doenças Sexualmente Transmissíveis, AIDS e Hepatites Virais do Ministério da Saúde, Brasília, Brasil.
authors.forename: Fabio
authors.initials: F
authors.lastname: Mesquita
authors.affiliation: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Grinsztejn
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001938:Brazil; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D065129:Pre-Exposure Prophylaxis; D063106:Transgender Persons
chemical_list: D019380:Anti-HIV Agents
keywords: Brazil; MSM; TGW; health system; pre-exposure prophylaxis; prevention; resource-limited setting