It has been estimated that in Spain there are between 120,000 and 150,000 individuals with HIV infection, although almost 40% are not aware of it. About 2,900 new cases are diagnosed each year, the majority in young people, males, and men who have sex with men [MSM]. The regular presence of new cases represents 'a failure of HIV/AIDS prevention and education programmes', according to David Dalmau, President of the Spanish AIDS Interdisciplinary Society (SEISIDA), and co-chair of the XVI National Congress on AIDS, and XI International AIDS IMPACT Conference, which will gather together in Barcelona until October 2nd, more than 600 national and international experts in the field of HIV/AIDS.


The latest reports from the Health, Social Services, and Equality Ministry Monitoring System show that more than 80% of new HIV diagnoses affected males, and the most frequent age was 35 years. Dalmau believes that the reason is not 'just the economic crisis and austerity', and points out that while 'prevention, education, and information programmes have been cut in recent years', this is not a new development. In many ways, 'we have not been able to raise awareness of the adverse consequences of HIV infection amongst individuals who maintain risky behaviours'. There as been a 'loss of the culture of awareness of HIV, and the economic crisis has made things worse', and we need to recognise that 'we do not know how to control the epidemic'. Any observed gains are 'more the result of treatment rather than of prevention strategies'.



Similar views are expressed by Asier Saez Cirion, from the Pasteur Institute, who states that in western countries, were access to treatment is 'guaranteed', AIDS as stopped being a deadly disease, and has become a' type of chronic infection'.  He says that 'many now believe that nobody dies of AIDS anymore, and that taking a pill solves the problem. It is striking to note that while the epidemic is beginning to be under control in the worse affected countries, the incidence of the epidemic in France is increasing in some groups that continue to maintain risky behaviours'.



Unity is Strength

Meetings like this Barcelona conference help to clarify these issues and to explore possible solutions. 'The theme of the meeting, "Unity is Strength", highlights the need to bring together health professionals, people with HIV/AIDS, politicians, NGOs, social workers, scientists and sociologists, researchers, etc', says Jordi Blanch, co-chair of the XI AIDS IMPACT Conference, for whom 'the work of some without the collaboration of the others would be ineffective'.


HIV infection raises multiple challenges. According to Blanch, 'for doctors is important to improve treatments to reduce side-effects and improve adherence'; for people living with HIV and for NGOs,' it is important to facilitate free access to effective treatment', while politicians 'will claim there is no money', social agencies will insist that 'there are insufficient measures to prevent infection', and scientists 'will want greater research funding'.


In this context, Montserrat Pineda Lorenzo, President of the 'Comite 1er Decembre', believes that  'the challenge needs to be faced in the round and urgently. Society needs to recognise again as a challenge everything related to HIV, as the only way we can and must face this epidemic'. Pineda thinks that it is essential to 're-politicise' the epidemic at all levels.  



Furthermore, Pineda says that the main problems raised by the pandemic are related to the 'vulnerabilty' or weakening of rights at several levels. 'We should speak about the impact that HIV has on the lives of those affected not as isolated incidents or individuals, but rather as a result of specific policy decisions regarding health. To have access to prevention programmes and/or care of quality; to free health care; to adequate housing, or to access to work without discrimination, are all the result of political choices', she claims. 



Stigma and criminalization

And, faced with an economic crisis 'that increases and worsens the problems created by HIV', Pineda argues that 'we can be sure that early diagnosis will become harder, it will be more difficult to access treatment, and that discrimination and stigma, as well as criminalization of HIV will increase'.


It is clear that the economic crisis is affecting the process of managing the epidemic. Dalmau believes that current political decisions regarding health 'lack vision' and what he calls 'politicians' myopic shortermism' is leading us to 'medium and long-term problems with the epidemic', and not just in Spain, but also in many resource poor countries that have suffered a reduction in assistance.


Fortunately, HIV treatments are improving, even if there is still no cure. Nevertheless, highlights Saez Cirion, 'some individuals are able to reach remission thanks to early treatment, and although the virus remains present, it is at such low levels that there is no need for further medication to control the infection'. Some of the participants in research by Saez Cirion's group have been living for more than 10 years with the infection 'under control' after stopping treatment. We do not yet know, however, how this happens. 'A key feature of those that manage to control the virus is that when treatment is interrupted, they have very low viral load levels, very few infected cells, although we know it is not

sufficient'. Early treatment has effects at different levels: 'it not only reduces the number of infected cells, it also reduces the number of viral mutations, and it facilitates te reconstruction and preservation of immune responses. It is likely that in those that resond there is an optimal combination of these factors'. Unfortunately, we are not able to predict yet who will be able to control the infection after stopping treatment'.


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