In HIV, we go for biological control, quality of life and eliminate discrimination

We need quality of life to be at the center of the discussion and for clinicians who care for people with HIV to have the same level of skills whether in the center of the city or in a remote place, and for the quality of care to be similar in question of knowledge and resources.

Andrés Costilla, director of friends from San Luis Potosí in the fight against AIDS, AC

HIV control in terms of reducing mortality has been a success, today life expectancy is similar to what people had before acquiring the virus thanks to treatments, however this achievement has not been complete.

It is estimated that at the end of 2021 there were 38.4 million people living with HIV in the world, more than two thirds (25.6 million) in the African region, according to WHO data. In Mexico, according to the epidemiological surveillance system, there are currently 201,439 cases of HIV registered. In the last year, a total of 11,869 new cases were registered; being the states with the highest rate of diagnosed Quintana Roo (40.26%), Colima (22.29%), Campeche (21.66%), Tabasco (20%) and Yucatán (19.22%).

Although it is still an infection that for the moment is not curable, today there should be no deaths from AIDS, say the specialists, “because in theory there is already universal access to treatment and long-term biological suppression,” explains Andrés Costilla. , director of Amigos Potosinos in the fight against AIDS, AC . This December 1st we will be commemorating the World Day of the Fight against AIDS under the slogan ‘Equality Now’, which means that all patients should have access to retrovirals and comprehensive care, in addition to people at risk being able to have equal care throughout the territory with prevention strategies.

However, according to Censida data, close to 208,000 people are living with HIV, of which 7 out of 10 have been diagnosed, 6 out of 10 are on antiretroviral treatment (ART) and 5 out of 10 are in viral suppression. Antiretrovirals have become the cornerstone of HIV treatment, managing to lower the viral load enough to be undetectable and not transmit the virus.

The problem is that they are not the only factors to attend to when we talk about the disease. “Stigma, discrimination and late access to diagnoses continue to be structural barriers that do not allow control of the disease,” says Costilla.

Today, 55 people are infected with HIV every day and from 2010 to 2020 an increase of 33% in the number of new infections is estimated, “this is an alarm that probably continues to speak of misinformation and fear,” said the doctor, Armando Calderón, a physician specialist in infectious diseases at the ABC Medical Center.

structural barriers

Today we have the challenge of achieving retrovirals for all and access to scientific and technological advances, because although care is announced for the majority of patients, the reality is that not all have their treatment on time and migrate to other institutions, the Geographical and ideological barriers are also present.

Patients who have achieved virological suppression do not transmit the virus to their sexual partner and the number of cases is reduced. That is why antiretroviral treatment is important, this is not a widespread idea, but now it must permeate society, specialists say.

On the other hand, Costilla points out that a barrier to overcome is excessive bureaucracy in health systems; For example, when a person with HIV is referred to a health system, their care model is to go through the family doctor, be referred to epidemiology, then come tests, and finally go to the specialist doctor at the second or third level, as appropriate. the case, “that period can be up to five months to receive care.”

These times and long processes undoubtedly make people move away from the health systems and stay in the process of a diagnosis, but by the time they return they are already advanced diseases.

Furthermore, it is not only about access to medicines but also about new technologies, which is why Costilla assured that it is important that the public sector also acquire the latest treatment and long-acting alternatives that help increase people’s quality of life.

People on antiretroviral treatment take a combination of 3 or 4 drugs, that can hinder their quality of life due to co-morbidities, but with current long-acting alternatives it can be reduced to one dose or even with the newer to six injections a day. year. In the medium term, this will have an impact on an investment with a cost benefit for our health systems. “Reducing the number of medications also reduces the cost of chronic complications associated with drug toxicity or adverse effects such as cholesterol, triglycerides, or elevated glucose,” explains Marco Banda, an infectious disease doctor.

Another point to highlight is that in Mexico few people open their diagnosis; It is not the same to have HIV in Mexico City, than in other entities. For example, although in Mexico we have a federal law to prevent discrimination and there are state laws, not all states have institutes that are in charge of patient care, “a fundamental issue that affects people living with this condition is the loss of their labor rights, for example, and there is no one to defend them. It seems that having HIV takes away cognitive abilities or skills, a person with HIV can develop like any other, however behind it is stigma and discrimination”, says Costilla.

He assures that the quality of life must be at the center of the discussion and as a measure of success. For example, even with treatment, a person with a depressive condition will not overcome the disease and will not have quality of life, nor will they adhere to her medication. Comprehensive care is more than medication. The problem is that public health institutions attend exclusively to the medical part. UNAIDS has proposed not only treating patients with drugs, today quality of life is also a metric, which, although it is difficult to establish due to the needs of each person, is considered a standard for public actions.

nelly.toche@eleconomista.mx