Pedro Goicochea: Advocating for PrEP as Part of the National Strategy

Pedro Goicochea
Pedro Goicochea is a public health and communications professional with nearly three decades of experience in the fields of sexual health promotion and HIV/AIDS. His work on HIV/AIDS goes back to 1988, when he joined the Peruvian Ministry of Health (MoH) team to design and produce the first mass media AIDS prevention campaign in Peru with support from the USAID and technical assistance from Johns Hopkins University/Center for Communications Programs. He played a pivotal role coordinating communications, community engagement, recruitment and retention in the iPrEx study, the first trial to show the efficacy of pre-exposure prophylaxis for HIV prevention in gay, bisexual and transwomen who have sex with men. He is currently a senior research associate and policy analyst at the Forum for Collaborative HIV Research.

What got you involved in the AIDS movement and particularly around PrEP advocacy?

Back in 1985-1986, an incipient AIDS epidemic was already having an impact on the gay community in Lima, Peru. I was a recent college graduate in social communication and watching the international news and how the epidemic was being addressed in the other parts of the world. We learned that information and communication was the key to prevent the transmission and acquisition of the virus in the community.

A group of friends at the Lima Homosexual Movement (MHOL) started to work on producing very basic informational materials to raise awareness about the AIDS epidemic, HIV infection and the impact on our community. Basic messages then were: 1) ways the virus was transmitted, 2) ways the virus was not transmitted, and 3) the use of condoms.

What is an example of PrEP advocacy work you have engaged in recently? Is there a particular tactic or approach you have used in your advocacy that you can share?

I have collaborated with a few initiatives such as "My PrEP Experience" three years ago and more recently with HIVE.org and PleasePrEPMe.org. At a local level in Peru, together with one of the clinics that was an iPrEx study site, we are strategizing on how to supply PrEP to people who are interested. We believe that by having a group of early innovators benefiting from PrEP we can advocate for PrEP to be a national HIV prevention policy.

From your perspective, what are the top priorities for PrEP advocacy to advance an accelerated, more equitable response to AIDS?

The major challenge to address in the PrEP field is to broaden its access beyond the U.S. There are still communities in other parts of the world that need to have PrEP as an alternative prevention method. WHO has already released updated guidelines including PrEP but this should be discussed more broadly with country health policy decision makers to take PrEP into account. We should start with the countries that have hosted clinical trials. PrEP should be available, at reasonable prices, in these countries. Initiatives should be created and supported in these countries to make PrEP an alternative prevention strategy. This will require coordinated actions between communities, advocates, decision makers and the industry.

What concerns you about expanded PrEP use?

One of the challenges regarding the use of PrEP is the increase in STIs at community level. This is a fact that public health authorities have to think about when planning on incorporating PrEP as a preventive strategy. Another concern is the potential "informality" in the use of PrEP, for example, borrowing PrEP doses without formal evaluation from a physician first, especially in places where health services may be inaccessible.

If you were speaking to a young advocate interested in HIV and AIDS advocacy, what would you advise her/him about how to be effective?

I would start by telling these advocates "know your epidemic" followed by "know your community/ies". Explore and assess what the information gaps are in the community, what needs to be communicated and especially, what is understood by the community to whom you are communicating. Emphasize that: 1) PrEP is not for everyone, that there are different HIV prevention alternatives for people with different lifestyles, 2) PrEP is not for life but can be useful for certain periods of time in your life, and 3) PrEP does not prevent pregnancy or other STIs.