‘HIV has to be normalized, it can affect anyone’, says UN program director

More than a quarter of Brazilians diagnosed with HIV still do not receive antiretroviral treatments, and among the reasons for the lack of access is structural racism, says Claudia Velasquez, director and representative of Unaids (Joint United Nations Program on HIV/AIDS) in Brazil.

For her, this, combined with stigma and social inequalities, explains why in the last decade the country has seen a 9.8% drop in the proportion of AIDS cases among white people, while among black people there has been an increase of 12.9% .

“It’s the structural racism that exists and keeps people away from services”, says the 52-year-old biologist, with a master’s degree in international public health.

A UNAIDS study of 1,784 people with the HIV virus shows that 64% have already suffered some type of discrimination: 46% through comments from family members, neighbors and friends, 25% through verbal harassment and 20% lost a source of income or were rejected in a job offer.

The issue was addressed in a report released by the entity on Tuesday (29). Velasquez says that, given the increase in cases of infection among young people, the subject also needs to be more discussed in society and be included in the school curriculum.

“HIV has to be normalized, it is a disease that can affect anyone, like other diseases with sexual transmission.”

According to the 2023 budget forecast, the HIV/AIDS program could lose BRL 407 million. What is the impact of budget cuts in this area? Current investments to fight HIV both in Brazil and in other countries are no longer enough to end the threat that AIDS represents.

Brazil has always been a global reference against HIV, with a state policy consolidated over the years by different governments, and it was responsible for saving the lives of thousands of people. As a signatory of important commitments, including the guarantee of broad access to HIV diagnosis and treatment, the country needs to have the necessary budget, and we hope that this will be corrected, and the cuts will not occur.

What strategies are still lacking in Brazil to face the AIDS epidemic? There is still a lack of tools to fight against the inequalities that distance people from health services and to fight against stigma and discrimination.

Brazil has not yet met the targets [de que doença deixe de representar uma ameaça de saúde pública até 2030]we have a “gap”, 27% of people who have been diagnosed with HIV are not on treatment.

These are people who may even have started treatment, but withdrew from services for different reasons, such as discrimination and social factors. These people do not yet have an undetectable viral load and can transmit the virus.

Which What are the most striking inequalities in Brazil that stand in the way of this confrontation? Gender-based violence increases the risk of HIV infection for women and restricts access to health services for those living with the virus. Racism is also an obstacle. Between 2010 and 2020 there was a 9.8% drop in the proportion of AIDS cases among white people. Among blacks, there was an increase of almost 13%. Because? It is the structural racism that exists and keeps people away from services.

If we are talking about a black trans woman living on the streets with HIV, there is an accumulation of inequalities that make it practically impossible for her to have access to services and guarantee a healthy life. Inequalities bring many challenges to the HIV response.

And how to face these inequalities that go far beyond the area of health? A firm answer is needed. Inequalities kill. It’s not just a question of having services, because Brazil already has them, but breaking down these structural barriers that, yes, go beyond the health area.

There must be a multisectoral response, health with social assistance, health and education. This must also include overturning punitive and discriminatory laws and policies, replacing them with protective policies to ensure integration of efforts and resources.

We also need a lot of information for the public, which in recent times has been receiving a lot of fake news about what HIV, AIDS is. Within gender violence, we also need to face the toxic masculinity that exists in the culture of Brazil, Latin America and several other countries.

New HIV infections have been increasing among the young population. Are different strategies needed for this audience? We have a recent decision by the Ministry of Health to extend pre-exposure prophylaxis, PrEP, to young people from 15 years of age. It is a strong tool, but the challenge posed by inequalities to ensure access persists. How can this medicine reach communities that do not seek services due to discrimination, lack of money for transport or other factors?

Communities of people living with HIV should be integrated into planning [das políticas de saúde] from the beginning, it has to be a shared responsibility, knowing what barriers they face.

Several organizations point to setbacks regarding the discussion of the HIV issue in schools, for example. Is it important to resume this agenda? I know there may be resistance to talking about HIV in schools, but we can start by including it in the school health curriculum. HIV has to be normalized, it is a disease that can affect anyone, like other sexually transmitted diseases.

At the same time, the theme has to be worked on with the health professionals who will assist these adolescents, they cannot be prejudiced. Otherwise, they drive young people away from services.

Some countries are discussing creating specific services for young people, but this is not sustainable in the long term.

There is a recurring complaint of prejudice from health professionals. Is there still a lack of training? Yes, not only for health professionals but for leaders as well. Unaids has a virtual course aimed at health professionals that addresses this issue of stigma and discrimination. But we need to go beyond the doctors and nurses, also involve the guards, the receptionists, from the beginning [da jornada do paciente no sistema de saúde]🇧🇷

Shouldn’t primary health care be more integrated into care for people living with HIV-AIDS? Totally. I know that the Ministry of Health has been working on this integration, expanding the range of services so that it is not limited to a specialized area. But this has to be accompanied by strong training on how to serve each of these people, because needs vary greatly.

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Claudia Velasquez, 52, is director and representative of Unaids (Joint United Nations Program on HIV/AIDS) in Brazil since July 2020. Born in the United States, she holds a degree in biology and a master’s degree in international public health, with a focus on monitoring and evaluation and operations research, from Tulane University. She has served in UNAIDS offices in South Africa and Angola.