Catalonia marks World AIDS Day and sets 95% viral suppression target for 2025

The Catalan government, Barcelona City Council and several other groups joined together on Wednesday to mark World AIDS Day, December 1, and condemn the inequality and stigma that people with HIV are subjected to.

Forty years on from the first diagnosis of the disease in Catalonia and Spain, a manifesto produced by the health department and signed by more than 130 different organizations highlighted the progress that has been made but warned that pandemics, such as HIV or Covid-19, demonstrate the inequalities in society.

The December 1 Committee (Comitè 1r de Desembre), an NGO that works to address HIV/AIDS in Catalonia and support people living with the illness, called for the firm implementation of the social plan – approved by the government in 2020 – to counter stigma and discrimination of people with HIV, with "adequate" budget funding to guarantee their "rights and quality of life."

At the official event at the Palau de la Generalitat, the president Pere Aragonès said that there had been a lot of progress made, both "in the field of medical research and social response," but that "there is still a long way to go."

On Wednesday morning, dignitaries and representatives from various organizations unveiled sections of a memorial tapestry commemorating the fight against AIDS. Two large patchwork quilts were unfolded from the balconies overlooking Plaça Sant Jaume in Barcelona's historic Old Town – one from the government headquarters at the Palau de la Generalitat and the other from Barcelona City Hall, the two buildings facing each other on opposite sides of the square.

2025 target: 95% undetectable viral load

After achieving the 90-90-90 targets set by the UN for 2020 – 90% of all people living with HIV know they are; 90% of all diagnosed are receiving antiretroviral therapy and 90% of those receiving antiretroviral therapy have an undetectable viral load – Catalonia is now aiming for 95-95-95 for 2025, according to the health minister, Josep Maria Argimon, and has currently reached 91-91-92.

There are currently an estimated 33,340 people living with HIV/AIDS in Catalonia.

The targets were laid out in the government's plan against HIV and other sexually transmitted infections for 2021-2030, approved on Tuesday evening.

Monitoring, prevention, care and community environment are the four central pillars of the plan, which includes more than 50 actions, such as community screening and promoting the social pact against stigma and discrimination.

Overall, the number of new HIV diagnoses per 100,000 inhabitants has shown a slight and gradual decrease over the period 2010-2020, from 11 to 4.2 cases. In 2020, new HIV diagnoses fell by 50%, a figure much higher than the average annual decline in the period 2010-2019 of 3%.

Men account for 87% of the total cases, with a rate of 7.5 cases per 100,000 inhabitants, while women have a rate of 1.06 cases per 100,000. The average age of people living with HIV is 36 years old.

Regarding the main route of transmission, more than half of new diagnoses were in men who have sex with other men (62%) and 20% were in heterosexual men and women.

An estimated 9% of people infected are not aware that they are, while the number of new diagnoses that meet late diagnosis criteria is 43%, an increase of 7% compared to 2019.

56% report discrimination

56% of people with HIV in Catalonia have suffered discrimination due to having the disease, according to a survey conducted by the December 1 Committee. This rise to 87% if all types of discrimination are taken into account.

However, 90% of those surveyed did not report the discrimination. The survey was based on 255 responses, 74% men, 22% women and 2% non-binary people.

The December 1 Committee says that the current model of HIV care is too fragmented and focused on the biomedical field and does not give enough attention to people's mental and social wellbeing.

Prevention treatment could save €93m

The widespread use in Catalonia of pre-exposure prophylaxis (PrEP) to prevent HIV would allow the public health system to save €93m over 40 years.

That is the conclusion of a cost-benefit study led by the Fight AIDS and Infectious Diseases Foundation, in collaboration with IrsiCaixa AIDS Research Institute, Germans Trias i Pujol Hospital, the Center for Research in Economics and Health (CRES) at Pompeu Fabra University, the NOMS-Hispanosida project and BCN Checkpoint.

The study estimates that annual treatment of PrEP per person costs €1,433, while the cost of antiretroviral treatment for an HIV-infected person is almost six times higher, amounting to approximately €8,500.

The authors of the study estimated that if the price of PrEP were reduced by 50%, the savings would be €152m. According to the latest available data, in Spain there are about 5,000 people using PrEP, 2,400 of whom are in Catalonia.

The latest UNAIDS report, the Joint United Nations Programme on HIV/AIDS, estimates that there are about 38 million people living globally with HIV and 1.5 million new diagnoses in 2020.