Brazil faces an ongoing public health challenge with Human Immunodeficiency Virus (HIV). This article examines the current status of HIV in Brazil, its historical trends, affected populations, and contributing factors. It also details the country’s comprehensive response strategies.
Understanding the Current Situation
Brazil has a substantial number of people living with HIV. In 2023, the country recorded 38,000 new cases, a 4.5% increase from 2022. This rise is partly attributed to expanded diagnostic capabilities, particularly through increased access to pre-exposure prophylaxis (PrEP). The majority of these new infections, approximately 27,000, were among men.
As of 2022, an estimated one million people in Brazil were living with HIV. Of those, 90% had received a diagnosis, with 81% of diagnosed individuals undergoing antiretroviral treatment. Notably, 95% of those on antiretroviral treatment have achieved an undetectable viral load, preventing further transmission. The age group most affected by new HIV infections in 2023 was 20 to 29 years old, accounting for 37.1% of cases. The AIDS-related mortality rate in 2023 was 3.9 deaths per 100,000 inhabitants, the lowest recorded since 2013, indicating improved treatment outcomes.
Historical Trends and Affected Populations
The first recorded case of HIV in Brazil was in 1982. During the 1980s, infection rates rose significantly, prompting a World Bank prediction in 1990 of 1.2 million cases by 2000, though the actual number was considerably lower. The epidemic initially concentrated in the Southeast region, particularly in states like Rio Grande do Sul, São Paulo, and Rio de Janeiro, which still account for over 75% of infections.
Over time, the male-to-female ratio of reported cases shifted, indicating a gradual increase in heterosexual transmission. While national prevalence rates have stabilized over the past decade, certain populations remain disproportionately affected. Men who have sex with men (MSM) experience a higher prevalence, estimated at 18.3% in 2018. Transgender women also face a high burden, with prevalence rates as high as 30-34.4% in various studies.
People who inject drugs (PWID) have also been impacted, with prevalence decreasing from 52% in 1999 to 5.9% in 2018, partly due to needle exchange programs. Young people, particularly those aged 15-24, have shown an increasing trend in new HIV diagnoses, with a 138% rise in AIDS diagnoses among 15-19 year olds between 2007 and 2017.
Key Contributing Factors
Socioeconomic factors influence HIV distribution in Brazil. Disparities in healthcare access and education contribute to vulnerability, particularly for marginalized groups. Transgender women, for example, often experience unstable housing and engage in informal work, including transactional sex, which increases their exposure to HIV and limits their access to health services. Lower levels of education have also been associated with higher HIV prevalence among transgender women.
Behavioral patterns, such as unprotected sexual intercourse and substance use, also influence transmission rates. Young transgender women, for instance, have higher rates of condomless anal intercourse and drug use compared to older transgender women. While injecting drug use has declined, other psychoactive substances, including crack cocaine, remain a concern, linked to higher HIV prevalence and lower treatment adherence. Stigma and discrimination also create barriers, preventing vulnerable individuals from seeking testing and care.
Brazil’s Response to HIV
Brazil has implemented a comprehensive approach to address the HIV epidemic. A significant policy is the universal and free provision of antiretroviral drugs (ARVs) since 1996, ensuring treatment access for all people living with HIV/AIDS. This policy has significantly reduced AIDS-related morbidity and mortality. The country also invests in domestic production of ARVs and engages in discussions with pharmaceutical companies to reduce drug prices.
Prevention programs are a central part of Brazil’s response. The Ministry of Health actively distributes condoms, including millions annually during events like Carnival, to promote safe sexual practices. Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) are available, with a notable increase in PrEP users, reaching 109,000 in 2023. Brazil also emphasizes early diagnosis, expanding HIV testing services, including community-based testing initiatives for key populations.
The country’s national health care system, SUS, plays a central role in delivering these services. Efforts also include decentralizing healthcare, scaling up PrEP, reducing structural barriers for transgender people to access care, and improving data systems for better management of the response. Civil society organizations are important partners in outreach and support, particularly for affected populations.