On World AIDS Day, celebrated on December 1st, awareness and education about the theme receive a vital boost with the involvement of various organizations. Among them, the SCRUFF app stands out, playing a crucial role in disseminating information and supporting the LGBTQ+ community.
The human immunodeficiency virus (HIV) was first identified in the early 1980s, marking the beginning of one of the most challenging public health crises of the 20th century. The initial period of the epidemic was marked by intense fear and stigmatization, stemming from a lack of knowledge about how the virus was transmitted and the absence of effective treatments.
In the subsequent years, the mobilization of the scientific and activist communities led to significant advances in understanding the virus, the development of detection tests, and treatment, transforming AIDS from a death sentence into a manageable chronic condition.
In Brazil, the first cases of AIDS were recorded in the early 1980s, and the country ended up becoming one of the most affected in Latin America, facing unique challenges due to its continental dimensions and socioeconomic inequalities. However, the Brazilian government took a proactive stance, standing out in the fight against the epidemic.
One of the main measures was the implementation of a policy for free distribution of antiretroviral drugs by the Unified Health System (SUS), initiated in 1996. This action was a global pioneer and contributed significantly to the reduction of mortality and HIV transmission in the country. Furthermore, Brazil invested in prevention and awareness campaigns, addressing topics such as condom use, regular testing, and combating the stigma associated with HIV and AIDS.
The date of December 1, designated as World AIDS Day, was established by the World Health Organization (WHO) in 1988 and is globally recognized. The purpose of the date is to raise awareness about the theme, promote the exchange of information and experiences, and combat the stigma and discrimination associated with HIV.
Thus, the date, which extends throughout the entire month under the title of “Red December”, it is an opportunity to remember loved ones who have passed away, support those living with HIV, and recognize the progress made in responding to the epidemic, both in terms of prevention, treatment, and care, as well as in supporting affected communities.
The 1987 Conference, mentioned in relation to this date, was a milestone in the cause. The event brought together activists, scientists, healthcare professionals, and policymakers from around the world to discuss and share strategies and advancements in the fight against the epidemic. The conference symbolized a critical moment of global recognition of the issue and the need for a coordinated and cooperative approach. The event emphasized the importance of scientific research, public education, access to treatment, and community engagement.
Moreover, the conference was crucial in giving a voice to activists, many of whom were living with HIV, and highlighting the importance of advocating for human rights and the dignity of those affected. The event not only influenced public health policies and practices but also inspired solidarity and activism that are central to World AIDS Day commemorations to this day.
Current treatments represent one of the greatest advances in modern medicine. With the development of antiretroviral therapy (ART) initiated in the 1990s, AIDS ceased to be a death sentence and became a manageable chronic condition. This transformation in treatment allows people living with HIV to maintain a high quality of life and life expectancy similar to the general population, provided they have continuous access to effective treatments.
ART works by inhibiting the replication of the virus in the body, reducing the viral load to nearly undetectable levels. This protects the patient’s immune system and prevents progression to AIDS. With the suppressed viral load, the risk of HIV transmission is also significantly reduced, which has a crucial impact on prevention.
Furthermore, advances in treatment also include the simplification of medication regimens. Initially, patients had to take multiple medications several times a day, which could lead to significant side effects and challenges in adhering to the treatment. Currently, many patients can keep the virus under control with a single daily pill that combines multiple antiretrovirals in one dose.
These advances in HIV treatment are the result of decades of intensive research and significant investment in science and technology. However, there are still challenges, especially concerning universal access to these treatments. While treatment is widely accessible in many high-income countries, in low- and middle-income countries, access is still limited, posing a significant barrier globally.
The current focus on HIV research also includes the search for a cure and effective vaccines. While there is still no cure or vaccine available, ongoing efforts in this direction keep the hope alive that, one day, HIV may be completely eradicated.
Undetectable = Untransmittable (U=U)
The concept of “undetectable = untransmittable” (U=U) represents a fundamental milestone in the understanding and management of HIV. This scientific breakthrough, substantiated by robust studies and widely accepted by the medical community, establishes that individuals living with HIV who maintain an undetectable viral load through antiretroviral therapy do not transmit the virus through sexual relations. Undetectable viral load is achieved when the amount of HIV in the blood is so low that standard laboratory tests cannot detect it.
This understanding has radically changed the approach to HIV, both from a medical and social standpoint. From a medical perspective, it reinforces the importance of early diagnosis and immediate initiation of antiretroviral therapy, not only for the individual’s health but also as an effective strategy for preventing HIV transmission.
Socially, the concept of “undetectable = untransmittable” has a significant impact on reducing the stigma associated with HIV. For a long time, the fear of transmission was a factor contributing to the discrimination and isolation of people living with HIV. With the spread of this information, there is a shift in the social perception of HIV, promoting greater acceptance and understanding towards people living with the virus.
This advancement is also crucial in empowering people living with HIV. Knowing that maintaining an undetectable viral load eliminates the risk of sexual transmission of the virus helps reduce anxiety and internalized stigma, improving the quality of life and mental health. Furthermore, it reinforces the message that HIV is a manageable condition, and individuals on effective treatment can lead a normal and healthy life.
The promotion and dissemination of this concept are vital in this cause, as they not only encourage people living with HIV to adhere to treatment but also play a crucial role in prevention and combating the stigma and discrimination associated with the disease. This evidence-based approach contributes to a more informed and inclusive society, where HIV is approached with understanding and without prejudice.
Importance of Testing
Regular HIV testing is a critical component in the fight against the epidemic. Early diagnosis of HIV is crucial not only for individual health but also for public health. When HIV is detected early, treatment can be initiated sooner, leading to better long-term health outcomes for the infected individual and significantly reducing the risk of transmission.
Initiating antiretroviral treatment soon after diagnosis helps maintain the viral load at undetectable levels, which, as discussed earlier, prevents the transmission of the virus to sexual partners. Furthermore, maintaining a low viral load protects the immune system of the infected individual, reducing the risk of developing HIV-related complications and increasing life expectancy.
In addition to direct medical benefits, regular HIV testing plays a crucial role in prevention. By raising awareness of HIV status, individuals can make more informed decisions about their sexual and health practices. This includes adopting prevention strategies such as condom use, PrEP (pre-exposure prophylaxis), or PEP (post-exposure prophylaxis) in risky situations.
Regular testing is also vital in combating the stigma associated with HIV. The normalization of testing as part of routine healthcare helps destigmatize, encouraging more people to get tested and speak openly about HIV. This is especially important in communities and population groups where stigma is a significant barrier to testing and treatment.
Finally, regular testing is an essential tool in monitoring and controlling the HIV epidemic. By identifying new cases, healthcare systems can better track the spread of the virus and allocate resources more effectively to areas and populations that require greater attention and support.
Therefore, regular HIV testing is more than an act of individual responsibility; it is a public health action that benefits society as a whole, reducing HIV transmission and contributing to the broader goal of controlling and eventually eradicating the epidemic.
PrEP and PEP
Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) are crucial innovations in HIV prevention, marking a significant advancement against the epidemic. Both strategies provide effective means to reduce the risk of HIV infection, but they work in distinct ways and are applied in different contexts.
PrEP is a preventive regimen designed for individuals who do not live with HIV but have a significantly higher risk of contracting it. It involves taking a daily pill containing antiretroviral medications. When taken as prescribed, PrEP significantly reduces the risk of contracting HIV through sexual activity or shared needle use. This preventive approach has proven highly effective, with studies demonstrating a significant reduction in the risk of HIV infection among adherent PrEP users.
On the other hand, PEP is an emergency treatment for individuals who may have been exposed to HIV. It should be initiated as soon as possible, preferably within 72 hours after potential exposure to the virus, and continued for a period of 28 days. PEP involves taking antiretroviral medications that can prevent viral replication. PEP is recommended after potential high-risk exposures, such as unprotected sexual intercourse or in cases of sexual assault or occupational accidents in healthcare settings.
Both PrEP and PEP represent proactive and evidence-based approaches. The availability of these prevention options significantly expands the arsenal of tools against HIV transmission, complementing traditional methods such as condom use.
The use of condoms is one of the most efficient and accessible tools in preventing HIV and other Sexually Transmitted Infections (STIs). This barrier method has been a fundamental pillar since the beginning of the epidemic.
Studies show that consistent and correct condom use is highly effective, as they act by preventing the virus present in bodily fluids such as semen, vaginal fluid, and blood. This physical barrier is one of the most effective ways to prevent HIV, especially when combined with other prevention strategies such as PrEP.
In addition to HIV, condoms are effective in preventing a wide range of other STIs, such as chlamydia, gonorrhea, syphilis, and HPV. This is particularly important as some STIs can increase the risk of acquiring or transmitting HIV.
To maximize the effectiveness of condoms, it is essential that people have access to education on how to use them correctly. This includes understanding the importance of using condoms in every sexual encounter, checking the integrity and expiration date of the product, and using lubricants to reduce the risk of breakage.
Furthermore, easy and affordable access to condoms is crucial. Public health programs, awareness campaigns, and initiatives for free distribution play an important role in ensuring that everyone, regardless of their economic situation or geographical location, can access condoms.
While new technologies and treatments for HIV prevention continue to evolve, condoms remain one of the simplest, accessible, and effective ways to prevent the transmission of HIV and other STIs. Their importance in global public health and the fight against the AIDS epidemic cannot be overstated.
Lubricants are important for prevention
Lubricants are an essential component in the prevention of Sexually Transmitted Infections (STIs), including HIV. They play an important role in reducing friction during sexual intercourse, which, in turn, decreases the risk of injuries and tears in the skin and mucous membranes. These injuries can serve as entry points for HIV and other STIs, making lubricants an important tool in reducing the risk of transmission.
There are various types of lubricants available, including water-based, silicone-based, and oil-based. Water-based lubricants are compatible with latex condoms and are a popular choice because they are easy to clean and less likely to cause irritation. On the other hand, silicone-based lubricants are longer-lasting and are a good choice for longer sexual activities or in water. However, it’s important to avoid oil-based lubricants when using latex condoms as they can degrade the latex and increase the risk of breakage.
During sexual intercourse, especially anal intercourse, the lack of natural lubrication can lead to microfissures and injuries. These small ruptures not only increase discomfort but also facilitate the entry of pathogens, including HIV. By reducing friction, lubricants help prevent these injuries, making sexual intercourse safer.
In addition to reducing the risk of HIV transmission, lubricants also decrease the likelihood of transmission of other STIs that can be transmitted through skin or mucous membrane injuries, such as genital herpes and syphilis.
Just like condoms, it’s important to have education on the proper use of lubricants and easy access to them. Public health campaigns and sexual education initiatives should include information about the importance of lubricants in practicing safe sex.
In other words, lubricants not only enhance the sexual experience but also play a significant role in reducing the risk of HIV and other STI transmission, protecting the integrity of the body’s physical barriers during sexual activity.
Up-to-date vaccination records are also prevention
Keeping vaccinations up-to-date is another notable strategy in preventing Sexually Transmitted Infections (STIs) which, in turn, can influence the risk of contracting or transmitting HIV. Vaccination provides effective protection against various diseases that are commonly sexually transmitted, such as hepatitis and Human Papillomavirus (HPV).
Hepatitis B and C are viral infections that affect the liver and can be sexually transmitted. Hepatitis B has an effective vaccine, widely available and recommended for most individuals, including newborns. While there is no vaccine for hepatitis C, prevention through the use of condoms is recommended. Chronic hepatitis infections can cause significant damage to the liver, and in people living with HIV, they can accelerate the progression to more severe liver diseases.
The Human Papillomavirus (HPV) is the most common sexually transmitted virus and is associated with various types of cancer, including cervical, anal, and oropharyngeal cancer. Vaccination against HPV is highly effective in preventing the strains of HPV that cause the majority of these cancers. The vaccine is recommended for pre-adolescents and young adults but is also highly recommended for people living with HIV.
While vaccines for hepatitis and HPV do not directly prevent HIV, they play an important indirect role in prevention. Infections such as hepatitis and HPV can cause lesions and inflammation, increasing the risk of contracting or transmitting HIV during sexual contact. By preventing these infections, vaccination reduces an additional risk.
In addition, people living with HIV may have a compromised immune system, making them more susceptible to infections and related complications. Vaccination provides an extra layer of protection, reducing the risk of co-infections that can complicate the management of HIV.
In conclusion, vaccination plays a crucial role in the overall strategy for preventing STIs and, by extension, preventing HIV. It not only protects against specific STIs but also contributes to overall sexual health and well-being, being an essential component of public health.
Make the difference!
On World AIDS Day, SCRUFF’s contribution reinforces the message that awareness and education are key to demystification, prevention, treatment, and, above all, clarification regarding the “Red December” universe. It is a reminder that together, we can make a difference in the lives of many.
In Brazil, access to HIV testing is widely facilitated by the Unified Health System (SUS), which provides free and confidential testing for everyone. The main locations for conducting these tests are Basic Health Units (UBS) and Testing and Counseling Centers (CTA).
All testing services provided by SUS ensure the confidentiality of results. It is important to emphasize that access to testing is universal and free, regardless of the individual’s health insurance status.
Basic Health Units (UBS)
UBS (Basic Health Units) serve as the gateway to the Brazilian healthcare system and are present in virtually every municipality in the country. At these units, it is possible to undergo HIV testing free of charge and confidentially. In addition to testing, UBS provides guidance on prevention, HIV transmission, and other STIs. In case of a positive result, UBS is also the place to initiate referral for treatment and medical follow-up. Check the list of UBS in Brazil or click here if you are in the State of São Paulo.
Testing and Counseling Centers (CTA)
The Testing and Counseling Centers (CTA) are specialized services for Sexually Transmitted Infections (STIs) and HIV/AIDS. They not only provide testing for HIV but also for other STIs such as syphilis and hepatitis B and C. In addition to testing, CTAs offer pre and post-test counseling, which is crucial in helping individuals understand the results and make decisions about care and treatment. In case of a positive diagnosis, CTAs also provide guidance on the next steps, including referrals for treatment and psychological support. To find the nearest CTA, click here.
Where to find PEP
For emergency treatment after potential high-risk exposures, such as unprotected sex or in cases of sexual assault or occupational accidents in healthcare settings, seek post-exposure prophylaxis (PEP). PEP involves taking antiretroviral medications as soon as possible, To find locations offering PEP, please visit this link.