by Late diagnoses of HIV/AIDS in the Algarve have been increasing, especially in the 30 to 39 age group. The situation is also “worrisome” in other Sexually Transmitted Infections (STIs).
Helena Ferreira, doctor in charge of the CAD – Center for Counseling and Early Detection of HIV/AIDS Infection in Faro, is concerned.
The region registered 84 new cases of HIV/AIDS in the last two years [2020 e 2021]which corresponds to a diagnosis rate of 9.7 cases per 10,000 inhabitants, according to data from the latest annual report by the Instituto Nacional de Saúde Dr. Ricardo Jorge (INSA) and the General Directorate of Health (DGS).
The medical reality «the fact that about 40% of diagnoses are decided at a late stage, which means that these people have already transmitted the disease to many others». Diagnosing someone late, “is much worse. Every year, we have many people who die with the first diagnosis because they are hospitalized at a very advanced stage of the disease. In the first hospitalization they were so serious that they no longer participated that they left the hospital. This is something you need to be aware of», he warns.
Something that still happens in the Algarve “a lot”, according to Paula Proença, an infectologist at the Faro unit of the Centro Hospitalar e Universitário do Algarve (CHUA). Incidentally, another factor that has left both doctors on the alert is the fact that the virus seems to be more resistant to medication. “We are receiving young people who, in principle, will have an infection for a short time, but who already have an immune system as degraded and low as if they have been infected for seven or 10 years. But not. They tell us they took the test last year or two years ago and it was negative. That is, there is greater virulence of the new strains. Either they are stronger, or else there is greater weakness in the population », she justifies.
In the Algarve, the number of deaths from HIV has increased in the last two years. «We have a big problem in the elderly population, but it also happens to a little bit with everyone, who ends up having a greater tendency to neoplasms [tumores]. Therefore, we have recorded a higher mortality lately. I don’t have exact numbers, but we have that notion. Neoplasms increased a lot in our consultations. We see the same in the population, in people who have the most fragile system», says Paula Proença. The public health colleague also draws attention to the fact that there is also “an increase in cases of hospitalization for serious situations of younger people with AIDS, something we have not seen for a few years”.
One of the reasons for this to happen may be related to the COVID-19 pandemic. “There has been a decrease in access to early detection and prevention and now we are feeling the effects. These are people who have not done early detection. It could even have been infected before the pandemic, but afterwards they were not prevented. For example, CAD terminated. Although other institutions continued to operate, such as the Association for Family Planning (APF) and MAPS – Movement to Support Social Problems, their activity was very limited. Health centers have closed and this is having consequences», notes the public health doctor.
This reason led to training sessions being held in all the Groupings of Health Centers (ACES) in the Algarve, “to raise awareness of the early detection of HIV”, adds Helena Ferreira.
Tourist regions are more at risk
On how the virus has been transmitted and who has affected it the most in the Algarve in the last two years, there are no numbers, since the centralized disease declaration programs have not been working at Hospital de Faro since the pandemic, as far as Barlavento has found .
However, doctors talk about trends. “Men are more affectionate than women, despite having experienced a slight increase in female cases due to sexual transmission. There are more heterosexuals getting infected. But, on the other hand, in injecting drug users there are already few cases. The latter is a very different situation from a few years ago, when HIV transmission predominated in these drug users», points out Helena Ferreira. Even so, the Algarve has always remained between the second and third region with a higher rate of new HIV cases. For Helena Ferreira, this high average may have to do with «our very specific mobility characteristics for people, tourism and temporary workers. Tourist regions are always those where there are more cases of Sexually Transmitted Infections (STIs) and HIV », she points out.
PrEP, or how to prevent AIDS
Most STIs are curable, with the exception of HIV infection, hence the «great importance of reducing their incidence», assures Paula Proença. Still, what many people still don’t know is that there is a pre-exposure treatment of the infection. It is a medicine called PrEP (Pre-Exposure Prophylaxis of HIV infection), which can be taken by anyone who is not infected and wants to prevent future contact with risk. The pill is given free of charge at CHUA and, to gain access, simply book a PrEP Consultation, a response that has existed in public hospitals in the Algarve since the beginning of 2018, much later than in other European countries, but which has been having an “excellent” adherence. «The consultation takes place every three months so that the person can have an analysis and be sure that it is negative. The medication is very well tolerated, does not have many side effects and has had spectacular adherence in Faro. We had a consultation period, now we have two and we are going to have to open a third because there are more and more interested parties. There are more than 200 to take PrEP. In Portimão, the numbers are also good», reveals an infectologist. In his opinion, «this is one of the best prevention programs to be implemented», not least because, with a daily dose of the pill, from the seventh day, the protection is 100 percent. It is also important to make it clear that “the consultations are for all people who think they are at risk of being infected with HIV. Having a great adherence on the part of men who have sex with other men, but the consultation is made for all: women, heterosexuals, young people, university students, sex workers, people who are on vacation and may have risky behavior with alcohol in excess», explained Paula Proença.
Gonorrhea and syphilis on the rise
“The data for our region is not good. In relation to other STIs, they increased a lot», Paula Proença tells us. Helena Ferreira points to a “worrying” situation in the case of gonorrhea and syphilis. According to the doctors, this situation can be denoted due to the existence of the PrEP Consultation. «It is a population that did not have so much access. People who are taking PrEP are healthy and don’t come to the hospital to be treated for this type of infection. Went to the family doctor. Maybe he treated it much later and when he already had more severe symptoms. Now, they have the opportunity to come to us at the consultation. There are days when I make four diagnoses of syphilis, when a few years ago it wasn’t like that, I diagnosed one a day», explained an infectious disease specialist. Something that doesn’t necessarily have to be negative. “People think it’s bad, but it’s spectacular that we are identifying cases as soon as they arise. We’re preventing a chain of transmission. In reality, we are diagnosing more, but we are also treating more», justifies the doctor. Like HIV infection, gonorrhea too, «is becoming more resistant to therapy and more difficult to treat», warns Paula Proença.
LGBT community is the most “conscious”
In general, and according to Paula Proença, an infectologist at Hospital de Faro do Centro Hospitalar e Universitário do Algarve (CHUA), the LGBT community seems to be more aware and aware of the risks of a Sexually Transmitted Infection (STI), although these can affect anyone, regardless of their sexuality. « At the PrEP consultation [profilaxia pré-exposição da infeção por Vírus da Imunodeficiência Humana (VIH)] we, above all, homosexuals, which is the population that is most aware of protection. The LGBT community, perhaps, is more aware and better protected than other people who think that HIV no longer exists and that it is an infection that will never reach them. Incidentally, we see this in university students who are completely careless and then show up for the appointment infected and don’t know how they got it. There is little information currently and maybe the LGBT community is even sunnier than the others».
Diseases without symptoms initials
The Human Immunodeficiency Virus (HIV), for example, if it is in an early stage, may not show symptoms. «There are many infections that do not show signs and then we have others that can start by not even affecting the sexual part. A fever and/or pimples appear on the body. This is one of the signs that we have an HIV infection. In syphilis, for example, an ulcer may appear at the site of sexual contact and a week later there are pimples all over the body. Already in gonorrhea we have other signs, for example, pus in the morning urine. This infection is often painless. You can’t feel anything, but it’s there and needs to be treated quickly», explains Paula Proença, an infectious diseases specialist at the Hospital de Faro do Centro Hospitalar e Universitário do Algarve (CHUA).
Consultations available
The Counseling and Early Detection Center for HIV/AIDS Infection (CAD) in Faro is located at Rua Brites de Almeida, nº 6, 3rd left and is open every day between 9.30 am and 4.30 pm, without interruption for lunch. The service is anonymous, free and confidential. It is possible to perform quick tests. He can be contacted by telephone (289 812 528). The PrEP Consultation is available at CHUA in Faro and Portimão. The first works on the 1st floor of the Immunodeficiency Unit (UDIM), open on weekdays between 8:00 am and 12:00 pm and 2:00 pm and 4:00 pm. She can be contacted by phone (289891234) or email (cbrites@chalgarve.min-saude.pt). In Barlavento, it takes place on Floor 0, next to the External Consultation at the Internal Medicine Day Hospital, every working day between 08:30 and 18:00. It can be booked by phone (925665038) or email (enfdiamed@chalgarve.min-saude.pt).
