“Waiting lists for the anti-AIDS pill condemn people to infection”

  • The director of BCN Checkpoint and the NGO Projecte dels Noms explains in EL PERIÓDICO his history as an activist in the fight against AIDS and what are the most promising treatments

Ferran Pujol (Reus, 1959) runs BCN Checkpoint, which was opened in 2006 to more quickly diagnose HIV infections. In 2017, this center began to dispense pre-exposure prophylaxis (Prep, the anti-AIDS pill) that until 2019 was not funded by Health. Pujol is also the director of the NGO Projecte dels Noms, whose goal in the 1990s was to put a face to those affected by HIV. On the occasion of World AIDS Day, Pujol reflects in EL PERIÓDICO on an epidemic that, in Spain, causes some 3,000 new infections a year (there are about 150,000 patients in total). In low- and middle-income countries, some 690,000 people continue to die each year.

When did you start activism in the fight against AIDS?

I found out that I had been infected with HIV in 1986. In 1993 I created the NGO Projecte dels Noms-Hispanosida. I understood that people with HIV had to associate because, until then, associations were ‘for’ people with HIV, not ‘for’ people with HIV. It was a very paternalistic concept. Okay, we had a fatal disease, but we also had full powers: we wanted to express what we needed, not to be told what to do. From 86 to 93 I lived a whole personal struggle, for survival; I went through a depression. And in 1993 I began to react by creating the NGO. I wanted to make what was happening visible.

How?

The vision that was given then was a very punitive one with people addicted to drugs and with homosexuals. We homosexuals were under the law of social dangerousness, that is, we were mentally ill. Imagine the panorama: the authorities were very uncomfortable talking about all this, about AIDS. The Parliament of Catalonia did not open its mouth. But in Catalonia there were 8,000 people affected, a lot of deaths, and nothing was said. Televisions were alerting a bit to the so-called “gay disease.” With Projecte dels Noms we bring reality to the streets, the reality of hospitals, the dead. And we saw that this did not generate rejection, but tenderness, even sadness, solidarity. This was the first step: making the pandemic visible. Projecte dels Noms had a pioneering program: we helped people to do the treatments. Many people abandoned them because they were so tough.

With HIV, it is the same as with covid-19. Even if you are infected, if your viral load is undetectable, you are not contagious even if you do not use a condom

But later the treatment became sophisticated.

Yes. From the mid-1990s on, mortality plummeted in rich countries. We go from 15 or 20 pills a day to just one. And other needs arose: for example, to promote early diagnosis. In 2019, the ‘Partner’ study confirmed what we already knew: that people with HIV who were on treatment could not infect others. In 2014, I had already said this in EL PERIÓDICO. That day a nurse from the Hospital Clínic called me to tell me that the doctors, with THE NEWSPAPER in hand, were scandalized. “People will drop the condom, infections will go up & mldr;”. I said what was already coming and what the study confirmed. And this is where the concept of “undetectable viral load equals untransmittable” comes from. It is the same as with covid-19: if you do not have a viral load, you are not contagious. And we already knew this, but the necessary studies had not been done.

And if you already knew this, what had to be done to avoid the disease?

We thought that if we quickly diagnosed people, we would cut the chains of transmission. We saw that the person, by becoming aware of their infection, was already avoiding infecting others. New infections fell more than 50% when people were aware of their status. In addition, as soon as it was known, drugs could be started so that it would not go to more. For this reason BCN Checkpoint opened in 2006. We saw that there was a very important diagnosis in homosexual men. And we changed the paradigm of when a person should be tested: instead of doing it every time they had risky practices, we started doing it every three months.

And what happened?

In 2006 we reduced late diagnosis by more than 30% in Barcelona. And between 2009 and 2017 the incidence of HIV in our cohort – men who have relationships with other men, which is the largest cohort in Europe – fell by 60%, also in Barcelona. They are data from the Barcelona Public Health Agency (Aspb). We were the first center in Europe to include the rapid test. Before, testing involved analytics, waiting for results & mldr; In our case it was to come, make a puncture and in 15 minutes you had the result. Today, we are the first diagnostic center in Catalonia: we have 8,000 users every year. We follow up on most of these users. We have many people who come in for HIV testing periodically and we can see what percentage is infected.

In November 2019, Healthcare included pre-exposure prophylaxis (Prep), the anti-AIDS pill, in the portfolio of services. It was a very important step because taking it before having risky practices prevents infection. What remains to be done?

In Spain there are 9,000 people taking Prep, 5,000 of which in Catalonia. And, of these, 2,000 are in our center, BCN Prep-point -which supplied the Prep before it was financed by Health, through clinical trials-. These figures give you an idea of ​​the great territorial inequality. There are also many people on the waiting list. We 700 people right now to access the Prep. This is especially serious and needs to be fixed. We are trying to relocate these people to some hospitals, even though they are far away. Making people who are asking you for Prep wait is, in some cases, condemning them to become infected with HIV, and that will be irreversible.

The next innovative treatment will be a subcutaneous implant that will replace taking the daily drug

There are those who criticize the use of Prep.

I have advocated Prep for many years, even before there were studies to demonstrate its high efficacy. I advocate for biomedical prevention, something highly criticized because prevention, years ago, was based on the use of condoms and on “changing people’s behavior.” I was very irritated by this expression because people do not have to change their behavior, since it may pose a risk at one point in history, but not so much at another. If AIDS did not exist, we would not be talking about all this. People with HIV do not have a vaccine because it is a virus that changes a lot. But, instead, there is one thing that prevents the virus and whose effectiveness is even higher: the Prep.

What is the biggest challenge in the field of HIV right now?

Continue diagnosing as early as possible. At Checkpoint, more than 60% of diagnoses are infections less than three months old. On the other hand, we must ensure that people have less latent HIV reservoir; For this, it is necessary to act faster therapeutically. By making people undetectable, the infection is stopped. With this we have come a long way, and this is what explains that in Catalonia, and specifically in Barcelona, ​​we have been seeing a decrease in HIV cases in recent years.

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And what are the most innovative treatments?

For infected people, the ‘long acting’: alternatives to the single pill consisting of subcutaneous implants. They are tubes that are implanted under the skin and that release the drug over two months. Of course, you have to change it. It is like a pill that you take and whose effect lasts for two months. They are not yet commercialized, but they are about to arrive and have been shown to be fully effective. They could be available in the next six months, but there is another factor: they are developed by pharmaceutical companies that will price them very high. So what can delay their arrival is whether governments approve them or not.

Reference-www.elperiodico.com

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