For the first time since 1981, when the first HIV infection was confirmed, the city of São Paulo had a drop for five consecutive years in the number of newly infected people.
The city had never recorded a reduction for more than three years in a row.
This period also interrupted an upward trend in new cases that marked the beginning of the last decade.
From 2017 onwards, registrations dropped year by year, until they reached the lowest level in ten years (see chart below).
The capital of São Paulo registered 2,351 new cases of HIV in 2021, according to the most recent Epidemiological Bulletin of the Municipal Health Secretariat (SMS).
There were almost 1,500 less than in 2016, when there were 3,761 new registrations – a reduction of 37.5%.
The rate is much more expressive than that of the State of São Paulo in the same period, which was 20.5%, according to a survey by the federal government.
It is also more than triple the reduction recorded in Brazil as a whole, which had 11.7% fewer new cases.
With fewer registered cases, the capital of São Paulo also had a drop in the mortality rate due to HIV.
Between 2016 and 2021, the rate went from 6.3 deaths per 100,000 inhabitants to 4.3 per 100,000, a decrease of 31.7%.
Faster diagnosis and initiation of treatment, new medications and wide and free access to prevention therapies are pointed out by specialists as the reasons that made São Paulo an example in the country in the fight against HIV.
Young people aged 19 to 24, however, are still the most vulnerable part of the population to contamination by the disease.
“In addition to young people having a more active sex life, this public considers itself invulnerable, they think that nothing will reach them, it is a characteristic of young people”, says Álvaro Furtado Costa, infectologist at the Hospital das Clínicas in São Paulo.
There were 4,167 new cases among this public in the city of São Paulo between 2016 and 2021. It was the age group in which the highest number of infections was recorded.
“Not all young people have space to talk about sex and sexuality openly or autonomy to obtain prevention inputs. This puts this population in a more vulnerable situation”, says Adriano Queiroz, prevention coordinator of the STI/AIDS Coordination of the SMS .
The good news is that the reduction of new cases in this public between 2016 and 2021, of 44.3%, was even stronger than in the general population.
This was the age group with the second biggest drop, behind only the group between 15 and 19 years old, in which notifications dropped by 55.7%.
Costa also assesses that the pandemic may have contributed doubly to the drop in notifications.
“During this period, people stayed at home more, reducing contagion, and also sought less health services. So, it may be that there are cases that have not yet been notified.”
‘It’s not because I have HIV that I transmit the virus’
Adriano Queiroz says that the city of São Paulo has achieved important advances in the diagnosis and treatment of HIV.
He explains that, in 2016, a person diagnosed with HIV took around 180 days to start antiretroviral therapy. Today, it starts in three days.
“We take this service closer to the population, in subway stations, buses, at extended hours and also on Saturdays and Sundays. Today, it is possible to do a quick test in these places, and the result comes out in 20 minutes”, says Queiroz.
“If the result is positive, the person is already forwarded to health services for treatment.”
Costa adds that another relevant factor for the drop registered was the new drugs, with fewer side effects.
“With more effective and less bureaucratic treatments, patients tend to abandon treatment less often, contributing to the reduction in transmissibility of this patient”, says the infectologist.
Medications can be withdrawn for free from the municipal health network. Only a medical prescription is required.
People with HIV who take treatment correctly and have an undetectable viral load for more than six months, without other sexually transmitted infections, do not transmit the virus, according to experts.
This is the case of personal trainer Diego Alberti Moi, 40, who discovered the infection in October 2019.
At the time, he had been in a stable relationship for two years and didn’t know he was vulnerable to the virus, but his girlfriend was HIV positive. Diego only discovered the disease when he was hospitalized.
“I started having symptoms like itching, allergies and a drop in the immune system, but I took a medicine and got better. At the time, I was very focused on work, living in an abusive relationship and I didn’t seek medical attention”, he says.
After spending two weeks in bed, with a high fever and difficulty breathing, he decided to go to an emergency room. He says he was in the hospital for 15 days and lost about 25 kilos.
“I did several tests and then the doctors gave me the diagnosis. It was a shock, but I tried to inform myself and focus on how I would live well with the virus”, he says.
Since the diagnosis, Diego has been regularly monitored by a doctor, takes the prescribed medication and maintains a healthy diet combined with physical activity. For three years, he has been non-transferable.
“Today, I’m married, I have a three-month-old daughter and I lead a normal life. I do all the exams every six months and I’m very methodical with health care. My wife and daughter don’t have the virus”, he says.
“It is necessary to demystify HIV, it is possible to live with the virus and have a normal life. I, for example, take less medication than my father with diabetes and high blood pressure.”
Prevention with PrEP and PEP
This downward trend was not the reality in the city of São Paulo until the middle of the last decade.
Since 2012, cases have been increasing, but in 2016, with the arrival of new drugs that prevent infection by the virus, there was a turning point in the HIV Pandemic in the city.
Pre-exposure (PrEP) and post-exposure (PEP) prophylaxis, preventive methods that prevent HIV contamination even if there is contact with the virus, have contributed to the reduction in the numbers of new people infected with the disease.
PrEP must be taken regularly to avoid contagion in risky situations.
PEP should be started no later than 72 hours after exposure, if possible within the first few hours, and treatment lasts 28 days.
Prophylaxis is not a new method. They were approved in 2012 by the World Health Organization, but were initially obtained only in the private network in Brazil.
That year, a box of the drug cost around R$ 2,000. The value gradually dropped and, today, it can be found in pharmacies for R$ 50.
Five years ago, it also started to be offered free of charge by the Unified Health System and can be found in municipal health units.
Currently, around 30,000 people already use PrEP in São Paulo, according to SMS.
Álvaro Costa assesses that the offer of PrEP in the public network contributed to the great reduction of new cases among people aged 20 to 24 years.
“It is an audience that is more familiar with the use of PrEP than other age groups, such as 30 years old, for example, and it has been the group that seeks this medicine”, says the infectologist.
Adriano Queiroz adds that these prophylaxis in general have proven to be valuable allies in controlling HIV in the general population.
“We believe that, with them, we will be able to put an end to the horizontal transmission of the virus”, says Queiroz.
Horizontal transmission is the one that happens due to contact between an infected person and one who does not have the virus. In the case of HIV, it occurs mainly through sexual intercourse.
To facilitate access to these medicines in São Paulo, the City Hall created SPrEP, a digital medical consultation service.
After treatment, the patient receives a prescription and can pick up the medication at health centers and other locations.
Hairdresser and digital influencer Dennis Sloboda, 32, has been using PrEP for five months.
“I informed myself about the pros and cons and saw that it is very effective and decided to use it. It is a safe form of prevention”, he says.
Dennis says that prophylaxis is very similar to using a contraceptive: just one pill a day, every day.
“We need to end prejudice and taboo.”
This text was originally published here.