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HIV Guidelines in Latin America
Reflections From EACS 2025: Implementing New HIV Treatment Guidelines in Latin America

Released: November 19, 2025

Claudia P. Cortes
Claudia P. Cortes, MD
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Key Takeaways
  • New EACS HIV Treatment Guidelines emphasize rapid initiation of ART, integrase-based regimens, holistic care for aging populations, and the integration of mental health, substance use, and comorbidity screening into HIV care.
  • In Latin America, structural and social factors are barriers to implementation of guideline recommendations. These include the heterogeneity of health systems, cost, regulatory timelines, and stigma.
  • Aligning science, policy, and practice is critical so that the current progress in HIV science translates into tangible benefits for every person living with HIV in Latin America and globally.

The European AIDS Clinical Society (EACS) 2025 Conference in Paris reaffirmed the remarkable pace of scientific progress in HIV medicine. The release of the updated EACS HIV Treatment Guidelines stood out as a key milestone—comprehensive, evidence-based, and forward-looking. Yet, as I listened to the presentations and panel discussions, I could not help but think about how these recommendations could, or could not, be readily implemented across Latin America.

Structural Barriers
The EACS guidelines continue to set a high standard for clinical management, emphasizing rapid initiation of antiretroviral therapy (ART), integrase-based regimens, holistic care for aging populations, and the integration of sexual health, mental health, substance use, and comorbidity screening, with follow-up and specialized care when needed. These are priorities we fully share. However, the translation of such recommendations into regional practice faces persistent structural and operational barriers.

Foremost among them is the heterogeneity of our health systems. In many countries, HIV care is still centralized in tertiary centers, creating inequities for people living outside major cities. The EACS recommendation for immediate ART initiation (accounting for an individual’s preferences and readiness), although ideal, often clashes with real-world delays in laboratory testing, medication availability, and administrative approvals. Strengthening decentralized service delivery and supply chain resilience is essential to bridge this gap.

Cost and regulatory timelines remain major barriers. Several preferred drugs in EACS-recommended ART regimens, particularly the newest fixed-dose combinations and long-acting formulations, are still unregistered or unavailable in most Latin American countries. Pricing negotiations, procurement processes, and intellectual property restrictions further delay their introduction. Many middle-income countries in the region are excluded from pharmaceutical subsidies or preferential pricing schemes, leaving medication costs entirely misaligned with local realities. Without regional coordination and political will to prioritize equitable access, the therapeutic gap between high- and middle-income settings will only widen.

Social Barriers
Implementation is further complicated by social determinants of health and stigma. The EACS guidelines advocate for person-centered, nondiscriminatory care, yet in many parts of our region, stigma—whether related to HIV, gender identity, or migration status—continues to deter people from seeking or remaining in care. Incorporating community-led approaches and culturally adapted communication strategies is critical if these guidelines are to achieve their intended impact.

Another major challenge is training. Although updating national protocols is a necessary step, it is equally important to ensure that healthcare professionals across all levels of care are equipped and confident to implement them. Sustained professional education and regional academic collaboration will be key to operationalizing recommendations on comorbidity screening, aging, and integrated management among others.

New Guidelines as a Road Forward
Despite these challenges, the EACS guidelines provide an invaluable roadmap. Their emphasis on ART simplification, integration of HIV care with other healthcare services, and quality of life resonates deeply with our regional priorities. They remind us that excellence in HIV care is not only about access to medications but also about equitable, humanized systems capable of adapting evidence to local realities.

The scientific discussions in Paris left me optimistic. Latin America has the expertise, creativity, and commitment to adapt these standards to our context. The next step is collective action. That is, aligning science, policy, and practice so that the progress celebrated at EACS translates into tangible benefits for every person living with HIV in our region.

Your Thoughts
What are some common barriers you face to implementation of best practices and guideline recommendations in your own clinical practice? What do you do to overcome these barriers? Leave a comment to join the discussion!

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