Catalonia has already reached one of the goals set by the international community in its commitment to end the HIV epidemic as a threat to public health in 2030. To achieve this goal, which is part of the Agenda 2030 for Sustainable Development approved by the United Nations Assembly, UNAIDS stated that this year three goals needed to be achieved: '90 -90-90', that is, 90% of the infected people know they are infected; 90% of them are being treated; and 90% of them have undetectable viral load.
 

In Catalonia, this goal has been achieved by reaching 91-90-93 figures, and it might soon be '95-95-95', which is the goal for 2030, the new challenge that concentrates much of the efforts of the world society. In addition, work is also being done to define and achieve a fourth '90' with regards to the quality of life of people infected from HIV.

The decline of new infections continues
In Catalonia, there is a decrease in HIV infections, according to data from the Centre for Epidemiological Studies of Sexually Transmitted Disease and AIDS in Catalonia (CEEISCAT), integrated in the Programme for the Prevention, Control and Care for HIV, STIs and Viral Hepatitis (PCAVIHV). The number of diagnosed cases has fallen by 23% in one year: in 2019, 471 new diagnoses were recorded, that is, 23.2% less than in 2018. The decrease is gradual since 2010: 871 new diagnoses in 2010 compared to 471 in 2019, a decrease of 45.9%.

This reduction in the number of new HIV diagnoses is explained by a drop and delay in reporting, but it is also the effect of a decreased population transmissibility due to the incorporation of universal treatments in 2015 and the preventive policies in place, with the increasing use of pre-exposure prophylaxis.

It is estimated that 33,736 people live with HIV in Catalonia. Currently, the incidence rate of infection is 6.1 cases per 100,000 inhabitants. Men account for 87% of the total cases, with a rate of 11.04 cases per 100,000 inhabitants, while women have a rate of 1.5 cases per 100,000 inhabitants. The average age of people living with HIV is 35 years old.

The main transmission route, that is, more than half of the new diagnoses occurred in homosexual men (61%) and a quarter (26%) were in heterosexual men and women.

On the other hand, 9% of infected people are still unaware of it and the number of new diagnoses meeting late diagnosis criteria (36%) has decreased by 8% compared to last year.

HIV and COVID-19
Generally speaking, it is estimated that people with HIV taking antiretroviral treatment, having a normal CD4 cell count and an undetectable viral load would not face a higher risk of developing a serious COVID-19 than the general population. However, in order to minimize any risk, the implementation of innovative mechanisms has been accelerated, such as telecare, early diagnosis systems for HIV and other STIs without having to travel to a health centre, and the adaptation of antiretroviral drug supply systems.

The response to HIV in Catalonia
 In Catalonia, we are working to guarantee universal and equitable health care, also in the case of HIV, which incorporates a gender perspective, the promotion of research and innovation.

One of the latest actions of the Ministry of Health is the implementation of the new treatment for the prevention of HIV, so-called pre-exposure prophylaxis (PrEP), which is already distributed to 21 health devices throughout Catalonia and has already benefited around 2,500 people. This treatment is a very effective public health strategy to prevent HIV in people at high risk of infection.

This treatment is one of the many actions of the PCAVIHV. The plan for prophylactic accessibility (more than 2 million distributed free of charge); the provision of informative material adapted to new technologies; syringe exchange programmes (1,121,670 syringes distributed through more than 600 agents); technical and financial support for prevention projects carried out by community organizations (€1,467,070.54 for 66 projects from 32 organizations); or the diversification of supply for HIV testing (17,439 tests performed in 12 NGOs, 2,469 tests in 127 pharmacies and more than 400,000 tests performed in the health network).

In fact, the creation of PCAVIHV shows that HIV is a priority in Catalonia. Its creation in 2017 represented a major boost and led to the creation of the Action Plan against HIV and other STIs 2016-2020, both approved by Government Agreement. The PCAVIHV is currently leading to the creation of the new Plan of Action against HIV and other STIs 2021-2025, which should enable progress towards the global goal of ending AIDS by 2030.

This Plan includes the elimination of the stigma and discrimination associated with HIV. In this sense, the Ministry of Health, together with the Ministry of Labour, Social Affairs and Family and the First Committee of December, have promoted the creation of the Social Pact on discrimination against people affected by HIV. This Pact provides the foundations of the strategy for resolving possible rights violations. The Government has also eliminated HIV infection this year as a medical cause of general exclusion in the access to public employment, in order to prevent discrimination on health grounds and guarantee the right to work.

A manifesto involving more than 130 entities
On the World AIDS Day, which is celebrated every December 1, this year 131 public and private entities have joined the manifesto promoted by the PCAVIHV of the Catalan Public Health Agency (ASPCAT). The paper entitled 'Sharing Commitments and Responses' aims to reinforce the importance of working together in the response to HIV and to appeal to a shared responsibility for a healthier society.

The latest UNAIDS report, the United Nations HIV Programme, estimates that there are 38 million HIV-positive people in the world and 1.7 million new diagnoses in 2019. In Spain, 3,244 new cases were reported in 2018 and it is estimated that 151,387 people are living with HIV.