December 1 marks the 30th anniversary of World AIDS Day. At the global level, UN-SIDA offered the motto “know your state” for this opportunity, inviting all people to get tested for HIV.
In 2017, there were almost 37 million people living with HIV in the world, and 1.8 million people became infected in the same year, and 940,000 people died. The reason for this motto is based on the fact that the World Health Organization approved some time ago a prevention strategy all over the world called “90-90-90”, originally developed by our compatriot Professor Julio Montaner, which is mainly aimed at 2020:
-90% of people living with HIV know their HIV status
-90% of people diagnosed with HIV receive antiviral therapy
-90% of people receiving antiviral therapy have virus suppression.
To emphasize the importance of the role of treatment as a preventive measure, recent studies strongly suggest that when patients with HIV are detected and treated correctly, the possibility of transferring them to their heterogeneous or homosexual partners is literally “nil”. But in order for patients to be treated, and their virus was not detected, you first need to diagnose them (1st 90 of the strategy).
In Argentina, 122,000 people suffer from HIV, but only 70% are aware of this; Therefore, the slogan “I know your state” is also very suitable for our country and our city.
Unfortunately, numerous obstacles continue to hamper HIV testing. Stigma and discrimination also persist and do not encourage people to take tests, so patients are diagnosed late, when they already suffer from symptoms of the disease (AIDS), and, unfortunately, they have infected others; In our city, the percentage of late patients reaches 30%.
HIV testing programs need to be expanded, and all sexually active people should be tested for HIV in the same way that they control cholesterol or blood glucose levels; but do not disturb the vast majority
of these tests will be negative (approximately 99.6%), given that HIV prevalence is low in our country and very simple treatment will be offered, which will remain clinically asymptomatic and will not infect others.
Unfortunately, we cannot forget that the usefulness of using condoms has recently been questioned, so we must once again, and strictly say, “that condoms are very useful for the prevention of sexually transmitted diseases, including HIV. ". In addition, and in a different order, the use of a prophylactic is an indicator of the proven effectiveness of preventing unwanted pregnancies.
With regard to prophylaxis, new data has been published, which prevented the use of antiviral drugs in a prophylactic manner for people who are not infected (preliminary prevention or “preliminary assessment”), which is aimed at HIV infection, a person who does not have HIV infection does not become infected by taking pills every day; This strategy has proven to be extremely useful in some groups with a high risk of infection; it is not yet implemented in our
From the point of view of treating people infected with HIV, it is becoming more effective, with fewer side effects, and many of them in a single pill.
Finally, the final control of an infectious disease is achieved with a vaccine, as happened with smallpox and other infectious diseases; Despite several studies, it can be expected that the vaccine will not be available for HIV in the near future.
HIV infection was and will be “a viral, not a moral disease”; and, therefore, must be subject to the basic rules of medicine, such as early diagnosis (know your condition), access to treatment, and education for the community regarding preventive measures.
(*) Former Minister of Health of the municipality.