At first glance, HIV data in Spain seem to be improving, albeit slowly. The latest statistics offered by the Ministry of Health (from 2018) counted 3,244 new infections that year, 19.2% less than the previous year.
However, experts warn that the virus has not disappeared and that, around it, the numbers do not decrease significantly. “We are at a point in a stabilized epidemic of about 4,000 new diagnoses a year, far from the challenge we set ourselves in 2010 of reducing the number of new cases in Spain by 75%”, explains Ramón Espacio, president of the Coordinator State of HIV and AIDS (Cesida).
Espacio also points out another aspect that prevents further progress towards better results and that, at the same time, reflects the social realities of HIV: late diagnosis.
Abbreviated as DT in the annual reports on Epidemiological Surveillance of HIV and AIDSof the Ministry of Health, refers to cases in which HIV-positive people know of their infection when the virus has been in their body for a long time (sometimes years) and has significantly attacked their immune system.
This occurs when the CD4 lymphocyte count (white blood cells that fight infection and that HIV attacks and destroys) is below 350 per milliliter of blood.
Of the 3,244 new diagnoses in 2018, 47.6% were late, and the figures for the last five years do not drop below 45%, nor are there any forecasts, according to experts, that it will have decreased during 2019 and 2020. A figure close to the average European, situated at 49% , according to the European Center for Disease Prevention and Control (ECDC). For what is this?
On the one hand, experts point out that social awareness about the importance of taking an HIV test is low, either because of fear, because they consider themselves outside of a risk group or because of lack of information.
On the other hand, and although the tests are always confidential, many people are unaware that, beyond primary care, there are diagnostic centers and associations or NGOs in the fight against AIDS in which these tests are performed even without the need to give the name and completely anonymously, as indicated by Dr. Esteban Martínez, president of Gesida (Study Group of the Spanish Society of Infectious Diseases and Clinical Microbiology).
These same associations have asked, for years, that HIV tests be carried out more assiduously in primary care centers in the event of any suspicion: “For example, there are people who go to the doctor with a sexually transmitted disease, symptoms or diseases such as a pneumonia that could indicate that they have acquired the virus.
These patients should be tested and it is not done, ”says Espacio. When their case is notified, he continues, it is usually in the emergency room because they are already very sick.
SEMES estimates that at least 28% more possible HIV infections could be detected in the Emergency Department
The solution is early diagnosis, that is, one that is notified to the patient in a relatively short time after becoming infected. The reasons for achieving it are compelling. Living for many months and even years with the virus can irreparably damage the immune system, the target center for HIV.
This can cause the patient to develop opportunistic diseases such as pneumonia, tuberculosis or cephalopathies and, in the worst case, lead to death.
Dr. Juliana Reyes Urueña, a collaborating professor in the Health Sciences Studies at the Open University of Catalonia (UOC) and an epidemiologist at the Center for Epidemiological Studies on STIs and AIDS in Catalonia (Ceeiscat), warns that “late diagnosis can increase the risk of death when compared to people who are not diagnosed late ”.
In any case and for the most part, late diagnoses with months of treatment normally reduce the viral load in the blood and these patients can lead a normal life. However, the deterioration that their immune system has suffered makes them more likely to have a poorer quality of life in the long term.
“People diagnosed late have an irreparable loss of reserves in their immune system. And that may not lead to death in a direct way, but it will allow them to have more health problems or may have more chronic diseases. In short, early aging ”, explains Dr. Martínez from Gesida.
The most recent initiative in this regard has come from the Spanish Society of Emergency and Emergency Medicine (SEMES) which, under the name Leave your mark in the fight against HIV, will try to raise awareness throughout 2021 among emergency physicians about the importance of early diagnosis in its services, in which SEMES estimates that at least 28% of possible HIV infections could be detected.
The latest data from the Health report draw several groups that, due to various circumstances, are at greater risk of contracting HIV. Men continued to be the majority in 2018, 83.3% compared to 14.7% for women.
The mean age was 36 years, and the majority mode of transmission was sexual intercourse between men (56.4%), followed by heterosexuals (26.7%) and, quite far behind, cases among people who inject drugs (3.2%). Regarding the geographical area of origin, 56.6% were Spanish, 21.7% came from Latin America and 6.1%, from Sub-Saharan Africa.
It is necessary to compare these data with the figures for late diagnoses if we want to obtain a clearer radiograph of the existing problem. It is significant that the average profile of these diagnoses is that of heterosexual men over 55 years of age.
By sex, of the total of women diagnosed with HIV in 2018, 56.9% were late, compared to 46.1% of men. The approximate average age in late diagnoses in both sexes skyrockets: around 64% are over 50 years of age.
If the data handled are by the mode of transmission, more than 55% of the infections due to heterosexual relationships were late (58.5% men and 55.8% women), while by transmission by sex between men, that proportion is lower : 40.3%, despite this group being the one with the highest incidence in the total of diagnoses, early or not.
How are two such different profiles possible? Esteban Martínez affirms that late diagnoses have decreased in recent years among the group of men who have relationships with other men thanks to awareness, a fact that has not occurred, for example, among heterosexual people, who are not aware that the The virus can also attack them, or in unprotected groups such as immigrants or women who practice prostitution.
“In the same way, late diagnosis is more associated with small population centers,” says Martínez, “probably because awareness is lower. In any case, the results are extremely valuable for knowing where to act through education and information campaigns.
The fight against AIDS continues on all fronts. The work carried out in the last two decades in Spain has not been trivial. According to the latest data from the Ministry of Health (from November this year), 87% of positive cases are diagnosed;
Of these, 97.3% are under treatment, and of all these patients, 90.4% have an undetectable viral load, that is, the virus is not detected in the blood and they cannot transmit it to another person. Figures very much in line with the 90-90-90 Challenge that UNAIDS set out to meet this 2020 in the world (see graph).