Both the World Health Organization, through UNAIDS, and the European Center for Disease Prevention and Control (ECDC) have issued a warning signal. The specific goal is to control the HIV and AIDS epidemic … In the world by 2030 (95% of people are diagnosed, 95% receive treatment, and 95% of those treated have an undetectable viral load), it may not be viable. There are two variables that cause this situation: Reductions in international funding for HIV prevention programs in countries with fewer resources and delayed diagnosisThis greatly reduces the chances of effective treatment and increases the risk of transmission.
According to the annual report issued by the European Center for Disease Control and Prevention on the occasion of World AIDS DayCelebrated today, December 1, 2024, 105,922 HIV diagnoses will be recorded in 53 countries in Europe and Central Asia. Although the total number decreased slightly compared to 2023, 54% of diagnoses were late.
in spain, It is estimated that there are about 3,000 new diagnoses annually About 11,000 people with HIV are undiagnosed, and who may continue to transmit the virus without knowing it.
In Spain, the main gap is in the first 95 people, with a proportion of people remaining undiagnosed or arriving late, explains Pablo Ryan, doctor at the Infanta Leonor Hospital in Madrid and president of SEISIDA. “This late diagnosis particularly affects people born in other countries, heterosexual people and older people, who tend to consider themselves out of risk and have less access to testing. Furthermore, in some autonomous regions with fewer specific offers, there are still barriers to accessing testing, pre-exposure prophylaxis (PrEP) and stigma-free services.
Despite the progress, the incidence has fallen by 70% in the last eight years, and Spain maintains around 3,000 new diagnoses per year and a “plateau” situation, comments María Velasco, president of GESIDA and specialist in infectious diseases at the Hospital Universitario Fundación Alcorcón in Madrid. “Spain joins the rest of Europe in a persistent problem: half of the diagnoses are made too late. While other European countries, especially the Nordic countries and some Central European countries, have achieved more pronounced declines, Spain still has infection rates above the continental average.
Although Spain is well placed to meet the 2030 target set by UNAIDS, we still fall short of the numbers in two criteria: people diagnosed and people on treatment with an undetectable viral load. «The main gap is in the first 95 (people who are not diagnosed or diagnosed late), and inequalities continue to sustainably suppress the virus in some vulnerable groups and regions. The 95-95-95 goal is achievable, but it requires accelerating the pace of action and reducing inequality between people. “We will have to take care to update these data to see if the downward trend is confirmed since the previous estimate (2016), where the incidence of hidden infection was 14.8%.”
For Velasco, access to pre-exposure prophylaxis is another challenge. Although oral therapy is effective and economical, it does not reach all vulnerable populations: cis and trans women, sex workers, immigrants or people living outside large cities face logistical, stigma, or time barriers to accessing the health system. “It’s not just about medicine; The specialist confirms that it is the entire software surrounding it that makes it difficult to access.
In this sense, he recognizes that the arrival of new options, such as long-acting injectable prophylaxis, opens the door to improved protection in groups with worse or less effective access with oral contraceptive pills. “However, their high cost poses challenges to large-scale implementation.”
Some companies are already talking about replacing the 95-95-95 target with the ambitious 0-0-0 – zero new infections, zero deaths, zero discrimination – by 2030. Is this realistic? “We have the tools to get closer, but we are far away. The expert warns that cost and unequal access to resources remain huge barriers. However, he defends the benefit of setting ambitious goals: “Even if they are not fully achieved, they help you go much further.”
In addition to this problem, reductions in international funding for HIV prevention programs in countries with fewer resources also have consequences in other countries.
HIV knows no borders
Ryan points out that they actually result in fewer tests and treatments Weakening key HIV prevention programmes. This puts at risk millions of people who rely on this funding to access essential treatments and services. If these cuts are not reversed, they could lead to a significant increase in new infections and preventable deaths, threatening to undo decades of progress against HIV.
Moreover, he adds, HIV knows no borders: the problem is concentrated in countries with fewer resources, but Spain and Europe remain no strangers. We live in a very interconnected world. An increase in cases in other regions could have an impact on global health.
We must not forget, remembering that the President of GESIDA highlights that “nearly half of the new diagnoses in Spain have been discovered in migrants. Therefore, the global evolution of the virus is linked to the national reality.
He explains that if the number of new diagnoses increases in other countries, given the global mobility that exists today, it is very likely that we will see more cases coming from abroad, or that vulnerable migrants will become infected here, which is one of our current gaps. «We need to better inform and protect vulnerable peopleBecause many migrants become infected within Spain,” Velasco offers.
On the one hand, there is this interconnectedness: If cases increase in one place, they will end up affecting other countries. On the other hand, he adds: “If there is not good access to antiretroviral therapy in some countries, or it is used irregularly, resistance may arise. This resistance could eventually reach other places. Importing resistance is a real possibility.”
Ryan believes that for Spain to reach the 95-95-95 target in 2030, expanding diagnostic opportunities is a priority.Including inspection and self-test—, decentralizing and facilitating access to pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) programs, and strengthening multidisciplinary teams where nursing plays a key role in education and adherence. It is also necessary to support NGOs and local communities, promote comprehensive sexual education and remove administrative barriers, especially for migrants and other vulnerable groups. With these investments, Spain can reach 95-95-95 and advance towards the “three zeros” in 2030.