Despite decades of advancements in treatment, HIV remains a significant public health concern, and experts are warning of a worrying trend in Spain.Recent presentations at the “HIV Through Time: science, Society and Public Health” conference revealed that half of new HIV diagnoses in the contry are occurring at a late stage, indicating potential gaps in prevention and testing efforts. This finding underscores the ongoing need for increased awareness, reduced stigma, and improved access to care, even as the global community strives toward ending the HIV epidemic by 2030.
Spain is facing a concerning challenge with HIV diagnoses, as half are occurring at a late stage, highlighting an urgent need to improve early detection and prevention efforts. This was a key takeaway from the “HIV Through Time: Science, Society and Public Health” conference organized by the Fundación Jiménez Díaz, where experts including doctors Miguel Górgolas and Alfonso Cabello, heads of the hospital’s Infectious Diseases Department, emphasized the importance of expanding information and awareness campaigns.
One factor contributing to delayed diagnoses is a decreasing perception of risk, with some populations believing HIV is a problem of the past or associated with other groups. “This leads to a relaxation in the use of preventative methods, which remain crucial,” explained Dr. Beatriz Álvarez, a specialist in the same department and co-organizer of the conference. She added that many people don’t consider the possibility of having HIV because the infection often presents no initial symptoms. This underscores the importance of routinely including HIV testing as part of standard healthcare, as anyone could be unknowingly exposed.
While HIV is now managed as a chronic condition thanks to highly effective treatments, evolving sexual health trends present new hurdles. Dr. Irene Carrillo, also from the Fundación Jiménez Díaz’s Infectious Diseases Department, noted a resurgence in sexually transmitted infections in many countries, driven by decreased condom use. There have been significant increases in syphilis, gonorrhea, and chlamydia, particularly among young people and those at higher risk. This trend highlights the need for continued vigilance in sexual health practices.
Experts also point to the role of drug use in increasing transmission risk. According to Dr. Górgolas, “the consumption of drugs that enhance sexual activity and are used intravenously – often referred to as ‘slamming’ – can facilitate the spread of HIV and other infections transmitted through shared needles.” Raising awareness about the risks associated with these practices is therefore critical.
Shifting Public Perception of HIV
Therapeutic advancements have dramatically changed the outlook and quality of life for people living with HIV. “Thanks to the wide variety, high efficacy, and maximum safety of treatments, which allow for individualized therapy, these individuals can lead lives similar to the general population, maintaining viral control with treatment and requiring regular check-ups, much like other chronic health conditions,” said Dr. Cabello, also highlighting the benefits of pharmacological prevention.
Today, people with HIV have a life expectancy comparable to that of the general population, can maintain a healthy sex life, and have children without risk of transmission, enabling them to plan for the future without fear. The concept of “undetectability” has been a major factor in changing public perception. “Maintaining an undetectable viral load not only improves individual health but also prevents transmission to others, bringing the end of the pandemic within reach for the first time,” stated Dr. Álvarez, noting that this is one of the goals included in the United Nations’ Sustainable Development Goals adopted in 2015.
Current Challenges
The greatest achievement of the 21st century regarding HIV has been improving prognosis and enabling those affected to live normal, high-quality lives. However, Dr. Álvarez believes that addressing the social, cultural, and emotional aspects of the disease is still necessary, as these are integral to overall health. She argues that one of the biggest challenges is the stigma that persists in social and family relationships, the workplace, and mental health. “Misinformation about the infection continues to generate fear, social alarm, and maintain social and structural barriers, which can lead to low self-esteem, difficulties with self-acceptance, and fear of social rejection,” she explained.
Despite significant therapeutic and preventative advances, research continues to face challenges. These include simplifying treatment regimens by extending dosing intervals, exploring therapies that “teach” the immune system to control the infection without antiretroviral treatment (known as functional cure), and finding a way to eliminate the viral reservoir, as well as developing an effective vaccine, according to Dr. Cabello. Continued research is vital to further improve outcomes and potentially find a cure.
“Antiretroviral treatment has also evolved as a preventative tool, with drugs that can prevent infection through a semi-annual injection, with potential for annual administration in the future, offering significant advantages in countries where the infection continues to take a toll,” Dr. Cabello added.
Improving Access to Treatment
Inequalities in access to diagnosis, prophylaxis, and treatment remain major challenges in the fight against HIV. Despite progress, many people still present to healthcare systems at a late stage, and key populations face legal and social barriers. These issues are compounded by a gradual reduction in international funding. Addressing these disparities is crucial for achieving global HIV control.
To address this, experts are promoting more comprehensive prevention and care strategies, including increased use of oral and injectable pre-exposure prophylaxis (PrEP), strengthened systematic screening, and the incorporation of long-acting antiretrovirals as an alternative to daily medication, according to Dr. Carrillo. These strategies aim to reach more people and improve treatment adherence.
The healthcare sector is also moving towards more accessible and integrated care models that address HIV, STIs, and hepatitis together, with rapid testing and programs designed to reduce stigma and build a more equitable and sustainable health system, the experts concluded.
