Por: Mario Scheffer
Mario Scheffer – O Globo
There is an ongoing revolution in HIV prevention. More and more evidence proves that the correct use of antiretroviral drugs dramatically reduces the risk of HIV transmission during sex. By lowering to undetectable levels the amount of virus circulating in the blood and genital secretions, the ideal treatment, performed accurately, with patient adherence, almost eliminates the possibility of a person living with HIV/Aids to transmit HIV to another person. If all of those exposed to the risk of infection have access to HIV testing as soon as possible and if those receiving the positive result starts treatment at the right time, the spread of Aids can be dramatically slowed down. Besides individual therapeutic benefit, the treatment also represents a global prevention goal. In a study of preliminary results, with the so-called pre-exposure prophylaxis, when individuals exposed to risk took anti-HIV medication, much more protection against HIV infection was recorded.
The urgent antiretroviral treatment – That in the past was recommended only for pregnant women, rape victims and health workers exposed to the virus – is now advocated for vulnerable populations who had unprotected sex. The AIDS control will always depend on people’s behavior and social and cultural factors. Hence the importance of inclusive and human rights policies stimulating pro-prevention environments. Obviously, the priority remains the consistent use of condoms by all, during most of sex relations, and for life. But, if taken as the only alternative, unfortunately this policy results on a resounding failure. The use of antiretroviral drugs as a tool to refrain the AIDS epidemic brings along the risk that the commercial interests of the pharmaceutical industry start to guide the prevention policy. We must remember, moreover, that the simple notion that there are medicines to treat AIDS has already shown to have a dangerous side effect, to induce relaxation in the habits of safe sex. Moreover, the expansion of treatment with preventive purposes would require Brazil to increase its production capacity of generic and radicalization of the questioning of existing rules of intellectual property and patents.
In Brazil, there are more obstacles: the hegemony of those who deny the profile of a concentrated epidemic, avoinding to expose convincingly that some groups and the major centers are affected by HIV and therefore deserve special prevention policies; and the high rate of late diagnosis, with the arrival of thousands of people already sick with AIDS in the health system, since there are at least 250 000 HIV-positive that don’t even know they have HIV. It is inescapable to the Brazilian AIDS program take the combined prevention, which is to combine the universal and timely treatment, with the massification of rapid testing for HIV, behavioral methods and facilitate the use of masculin and fewminim condoms and lubricant gel, guaranteeing the free decision on the options available for prevention. To regain the “lost avant-garde”, the country needs to move the sttoped indicators, change radically in the next few years the dynamics of the AIDS epidemic, reducing the number of illnesses, deaths and new HIV infections.
Mário Scheffer, president of NGO "Pela Vidda-São Paulo" and researcher from the Preventive medicine department of the Medicine School of São PAulo University.