Every hour, 5 people were infected with HIV in Brazil in 2021

Anyone can get it, but the virus disproportionately impacts certain social groups, in a calculation crossed by inequalities and social vulnerabilities.

This characteristic of the Covid-19 pandemic is also a portrait of another pandemic that, even at the age of 40, is still loaded with the moral stigmas typical of a virus with mostly sexual transmission.

AIDS today disproportionately affects people of color, men who have sex with men, drug users and trans women, as shown in the annual report of UNAids, the United Nations program on HIV/AIDS.

In Brazil, every hour, at least five people were infected by the HIV virus in 2021. According to a UN estimate, over the past year Brazil had 50,000 new cases, which made the country reach the mark of 960,000 people living with HIV.

Worldwide, there are 38 million people living with the virus. In 2021, there were 650,000 deaths from AIDS in the world, 13,000 of them in Brazil.

“We have a stable pandemic with a very high number of annual deaths because there is very great inequality in the country that makes access to treatment and prevention and diagnosis measures unequal”, explains infectious disease specialist Esper Kallás.

Between 2010 and 2020, while the proportion of AIDS cases among white people in Brazil fell by 9.8%, among black people there was an increase of 12.9%, according to data from the Ministry of Health. Among AIDS deaths, the period records the same movement in opposite directions: a 10% drop among white people and a 10% increase among black people.

“Inequality directly impacts the response to HIV in the world, affecting more vulnerable populations, who have their risk of infection increased”, explains Ariadne Ribeiro Ferreiro, UNAids’s official for communities, gender and human rights in Brazil. “A trans woman in Brazil, for example, is 40 times more likely to be infected than the general population,” she illustrates.

According to her, this vulnerability is not explained only by biological factors. “Prejudice creates barriers that jeopardize access to biomedical technologies for prevention, diagnosis and treatment capable of interrupting the chain of transmission, even though all are available through the Unified Health System”, she says.

Rihanna Rios, 28, from Bahia, knows this story. “I’m tired of being the only trans woman in the queues to take the test. The girls were very afraid to access these services. They still are”, says she, who currently works with HIV/AIDS prevention with other trans women in São Paulo.

“It is an audience that accesses very little information and health services, despite being a target audience for HIV infections”, she evaluates.

In late 2018, Rios volunteered for a clinical study on a pre-exposure prophylaxis (Prep) therapy, adopted in groups at high risk of contamination.

“Girls were so afraid to participate [do estudo clínico de Prep]thinking it was a government program to kill transvestites”, she says, revealing the invisible abyss that still separates other trans women and transvestites from prevention and self-care in the public service.

She recalls that in 1987, Operation Tarantula, by the Civil Police of São Paulo, began to persecute transvestites under the pretext of fighting the virus. “They created a populist strategy that blamed people. Persecuting, killing and arresting transvestites was a way of cleaning up, in quotation marks, the streets of AIDS. Much of this imagery still exists where access to culture and education is lacking”, says Ariadne , over part of the origins of the current frame.

“In addition to affecting the well-being and lives of millions of people, the continuation of these barriers of inequality may prevent the goal of ending the AIDS pandemic, as a threat to public health, from being reached by 2030”, adds Claudia Velasquez. , director and representative of UNAids in Brazil.

Ending AIDS by 2030 is one of the UN’s Sustainable Development Goals. Factors such as the Covid-19 pandemic and the war in Ukraine, however, also affected this goal. According to the UN report, these emergencies have stifled countries’ capacities to respond to AIDS.

The UNAids report also shows that efforts to ensure access to antiretroviral treatment, which saves lives and interrupts the cycle of transmission, is failing. The target set at the United Nations, called 90-90-90, is that 90% of infected people are diagnosed. Of these, 90% are being treated with antiretroviral therapy (ART), which reduces the load of the HIV virus in the infected individual’s body. And among people on ART, 90% have a viral load so low that, in practice, they no longer transmit the virus.

In 2021, in the world, these numbers are 85-88-92. In Brazil, it’s 88-83-95.

For Esper Kallás, it is essential to expand access to treatment, the biggest bottleneck between the 90-90-90 target data, which especially affects the most vulnerable populations, impacted by other violations and violence.

Worldwide, the number of people on HIV treatment grew more slowly in 2021 than in the previous 10 years. While three quarters of all people living with HIV have access to antiretroviral treatment, there are still approximately 10 million people without access to medication.

“The safest sexual partner is the one who has HIV and who has it under control by antiretroviral treatment because the chance of him transmitting it is virtually zero”, explains the infectious disease specialist. “A person who does not have HIV can become infected in the course of a relationship and, in the acute phase, has a considerable chance of transmitting the virus.”

Only half (52%) of children living with HIV worldwide have access to life-saving medicines. The gap in treatment coverage between children and adults is widening rather than narrowing.

According to UNAids, ending AIDS will cost less money than not ending AIDS. And advances can better prepare the world to protect itself against the threats of future pandemics.