Understanding PrEP and DoxyPEP
PrEP (Pre-Exposure Prophylaxis) and DoxyPEP (Doxycicline Post-Exposure Prophylaxis) are the cornerstones of combined prevention strategies promoted in new care models. PrEP is an antiretroviral medication taken by HIV-negative individuals to drastically reduce (up to 99%) the risk of contracting HIV through sexual relations. It comes in daily pill form or bi-monthly injections, preventing the virus from establishing itself in the body. Note: PrEP does not protect against other sexually transmitted infections (STIs), so condom use is still recommended.
DoxyPEP, on the other hand, is a strategy to prevent bacterial STIs (syphilis, chlamydia, and sometimes gonorrhea) by taking a dose of Doxicicline (an antibiotic) within 24 hours and no later than 72 hours after unprotected sex. It acts as a “morning-after pill” for bacterial STIs, providing an additional layer of protection, especially for men who have sex with men (MSM) and transgender women.
The Urgency of Combined Prevention
Luis Adrián Quiroz, general coordinator of DVVIMSS (Institute for IMSS Beneficiaries Living with HIV), emphasized the need to prioritize highly effective methods. While condoms remain a prevention tool, inconsistent use has contributed to the rise in new infections, particularly among young people and MSM.
Quiroz highlighted that moralistic bias in some health units discourages PrEP use, causing individuals to wait up to five months for access. “People should not be questioned about their sexual practices,” he stated. “If you approach it from a scientific standpoint, you’ll generate greater prevention actions than if you approach it from a moralistic bias perspective.”
Overcoming Barriers: The “PrEP in One Hour” Model
To circumvent these obstacles, DVVIMSS and the Infectious Diseases Hospital at the National Medical Center La Raza developed the “PrEP in One Hour” model in March 2024. This pioneering program in Latin America not only expedites PrEP access but also integrates it with a combined prevention and retention approach in a stigma-free unit.
Key elements making this comprehensive and appealing model include: no-bias care, ensuring a trusting environment with sensitized staff; speed and efficiency, redefining processes to ensure access within an hour; integral vaccination (Hepatitis A, B, and HPV), now guaranteed through negotiations with the Health Subsecretariat; and STI treatment, integrating DoxyPEP and Hepatitis C monitoring, creating a robust health offering.
This approach has proven successful with an 87% adherence rate at La Raza, motivating its expansion to UNAM students under the “PrEP Near Your Studies” initiative.
PrEP Near Your Workplace
The workplace campaign aims to facilitate PrEP access using the same “PrEP in One Hour” model and combined prevention, regardless of residence or affiliation. The program operates at Family Medicine Unit (UMF) No. 26, adjacent to General Hospital Zone No. 8, located in the Chilpancingo area (behind Metro Chilpancingo and Insurgentes Sur). Operating hours are Monday to Friday, 9:00 am – 7:00 pm.
This unit was strategically chosen for its high connectivity, allowing workers commuting through the area (even if they live far away) to receive treatment without limiting their access, integrating prevention into their daily routine.
The Big Leap in Prevention: 200,000 Patient Target
Quiroz outlined the IMSS’s challenge to scale prevention. Currently, the institution serves around 13,000 PrEP patients. However, the target with new model implementation is to integrate 200,000 individuals in the near future to “flatten the curve” and drastically reduce new HIV infections in Mexico.
“If we don’t reach the target of 200,000 individuals next year, we’ll progress increasingly slowly,” Quiroz warned, anticipating a “busy year” regarding this matter.
A Replicable Model for Public Health
Quiroz emphasized that this program aims not only to curb the HIV epidemic but also set a fundamental precedent for Mexican public health due to its agile, sensitive, and comprehensive service methodology.
“This model is entirely transferable,” Quiroz affirmed. “You can take it anywhere you want.” The methodology of identifying bottlenecks, eliminating stigma, and adapting services to population dynamics (whether student or labor-based) becomes a template for treating and preventing other chronic or infectious diseases.
The organization is already working to extend this approach to other regions and contexts, including:
- Coahuila: The program, within months, went from serving 4 individuals to over 200.
- High Concentration Corridors: Efforts are underway to establish a PrEP corridor between the Eastern State of Mexico and the Norte Delegation (Texcoco to Zaragoza) and another between Ojo de Agua and Indios Verdes, serving millions of workers.
- Rural Health: Collaboration with Chiapas state aims to adapt the strategy to rural service complexities and geography.
Quiroz concluded by stressing the importance of public participation and vigilance to ensure service quality remains high.
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