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HIV Prevention in Latin America
The Future of HIV Prevention in Latin America

Released: March 09, 2026

Emilia M. Jalil
Emilia M. Jalil, MD, PhD
Activity Information

Activity

Key Takeaways
  • In the ImPrEP CAB Brasil study, uptake and retention were high, but analysis of HIV acquisition among 4 individuals receiving LA CAB highlighted the critical clinical challenge of diagnosing HIV infection in this setting.
  • The IeDEA rapid survey documented widespread disruptions across the HIV care and prevention continuum following United States funding shifts, particularly in PEPFAR-supported countries, although there were no disruptions reported in Latin America.

With approximately 2.5 million people living with HIV in the region and 120,000 new infections in 2024, HIV incidence in Latin America remains concentrated among key populations. Recent data presented at CROI 2026 offer timely and practice-relevant insights for Latin America, with 2 studies being particularly relevant. First, Dr Parikh presented new findings on the characterization of HIV acquisitions on long-acting (LA) cabotegravir (CAB) pre-exposure prophylaxis (PrEP) from ImPrEP CAB Brasil, and Dr Brazier examined disruptions in HIV services from the IeDEA consortium, including in Latin America, following global funding shifts.

ImPrEP CAB Brasil: Real-world Experiences With LA CAB Implementation
ImPrEP CAB Brasil provides rare and valuable real-world evidence on LA CAB implementation within public health services. Beyond demonstrating high uptake and retention, the analysis of HIV acquisitions among individuals receiving LA CAB highlighted the critical clinical challenge of diagnosing HIV infection in this context. Four individuals acquired HIV in the study; 3 presented with low level viremia at diagnosis and delayed antibody detection, and only one developed a major integrase strand transfer inhibitor mutation.

For healthcare professionals working in routine services, especially in resource-constrained settings, these findings underscore the complexity of HIV diagnosis and clinical decision-making in the context of LA PrEP. They also reinforce the need for clear diagnostic algorithms, access to repeat testing, and pragmatic guidance that can be applied outside highly resourced research environments.

Currently, Latin America is preparing for the next phase of HIV prevention with the anticipated rollout of lenacapavir. In Brazil, the upcoming ImPrEP LEN study represents an important opportunity to build on the experience gained with LA CAB. However, the ImPrEP CAB Brasil data make clear that the success of LA PrEP depends not only on pharmacologic efficacy, but also on the readiness of health systems. As new technologies are introduced, implementation planning cannot assume that longer dosing intervals alone will solve long-standing barriers to prevention.

IeDEA Rapid Survey: Impact of Funding Shifts on HIV Care Continuum
Complementing these findings, the IeDEA rapid survey offered a sobering reminder of the fragility of HIV services in the face of funding instability. The survey documented widespread disruptions across the HIV care and prevention continuum, particularly in PEPFAR-supported countries, with nearly one half of survey responders reporting disruptions in prevention services, laboratory monitoring, and treatment delivery.

There were no disruptions reported in Latin America. However, for regions like Latin America, where HIV prevention delivery is largely through public health systems, these findings reinforce the central role of sustained public investment. Biomedical innovation alone cannot compensate for weakened service delivery platforms or interrupted funding streams.

Taken together, these studies reinforce a key principle: The future of HIV prevention in Latin America depends on aligning medical innovation with strong public health systems. As LA agents expand prevention options, their real-world impact will rely on the capacity of health systems to deliver them equitably and safely. The challenge ahead is not only to adopt new technologies, but also to ensure that health systems are prepared to implement them effectively, in particular for populations with increased vulnerability to HIV infection.

Your Thoughts
What challenges with implementation of LA PrEP have you experienced in your region, and how are they similar to the real-world experiences of Latin America? Leave a comment to join the discussion!