By Maria Cristina Abbate, STD/AIDS Coordination Office of São Paulo, Brazil

Promoting access to HIV services for populations disproportionately affected by the HIV epidemic is a global challenge that requires reaching beyond the confines of health units. To address this, the STD/AIDS Coordination Office of São Paulo has implemented initiatives that integrate HIV prevention into daily life.  

The Coordination Office has provided internal and external condoms in over 90 bus terminals and stations across the city, a compact health unit within a subway station, and the “PrEP on the Street” project, which brings services to open high-traffic areas. In addition, it has installed automated dispensing machines for PrEP, PEP and HIV self-tests at two subway stations serving more than 180,000 passengers daily.  

This effort has significantly expanded access to prevention via the SPrEP – PrEP and PEP Online platform, which offers teleconsultations every day (including  holidays and weekends) through a free app provided by the Municipal Health Department. Through this online service, users receive their prescriptions and a QR code for access to the prophylactics at the machines. 

In the first five months of operation, these machines registered over 1,000 distributions, showing a continuous increase in access for all users. Among women, for instance, there has been an increase in PEP access, indicating a demand for this preventive method and demonstrating the viability of meeting this demand by expanding the availability of prophylactics.  

These initiatives were developed based on epidemiological assessments that helped guide the design and mapping of practices. However, the primary driver of all innovations introduced in São Paulo since the arrival of PrEP in 2018 has been understanding people’s realities and bridging the gap between them and the increasingly advanced technologies available in Brazil’s Unified Health System (SUS). This approach brings the goal of ending horizontal HIV transmission in São Paulo closer to reality; vertical transmission has already been eliminated.