AIDS: In Brazil, 67.7% of pregnant women with HIV are black

Data from the Ministry of Health released this Monday, 23, show that the number of HIV cases detected in brown and black pregnant women increased year after year, evolving from 62.4% in 2011 to 67.7% in 2021 , with a higher proportion among pregnant women aged 15 to 29, who represented 69.6% of these notifications. The ministry once again published the “Black Population Health Epidemiological Bulletin”, which had not been updated since 2015.

The document is an important tool for monitoring health indicators among black people and will guide public policies to combat racism, reduce inequalities and promote health over the next few years, in another step towards racial equality in the country, a of the federal government’s priorities.

In Brazil, the notification of pregnant women, women in labor and women who have recently given birth with HIV has been mandatory since 2000, with the aim of preventing vertical transmission, that is, the passage of infection from mother to baby. Even so, the epidemiological bulletin indicates that, in 2021, the proportion of black people under 14 years of age reported with AIDS exceeds 70% (with 6.3% of black people and 64.9% of brown people). The document also points to a 12% increase in the proportion of black and brown people tested for HIV or AIDS between 2011 (50.3%) and 2021 (62.3%).

In the case of AIDS deaths, black men and women are also the biggest victims, with numbers increasing significantly each year. The rate went from 52.6% in 2011 to 60.5% in 2021. This represents almost two thirds of the total number of deaths in relation to white people (46.5% of mixed race and 14.0% of black people).

The scenario is similar to that of acquired syphilis. For this disease, the proportion of cases in black people is the majority in all age groups, with emphasis on individuals up to 14 years old, with 64.6% black, 53.4% ​​brown and 11.2% black. The lowest proportion of black people is aged 50 or over (56.1%) and individuals aged 30 to 39 (59.8%).

Throughout the period covered by the research, more than 60% of pregnant women diagnosed with syphilis were black. However, there was a small reduction in the proportion of self-declared black women, which went from 14.5% in 2011 to 12.7% in 2021. Among pregnant women diagnosed with syphilis who self-declared brown, it ranged between 51.6% in 2011 and 56. 9% in 2021.

Racism as a social determinant of health

The National Policy for Comprehensive Health for the Black Population (PNSIPN), established in 2009, marks an important advance for the Unified Health System (SUS) and social movements in combating racism. Aligned with the World Health Organization (WHO), the policy recognizes racism as a social determinant of health, which means that the largest portion of the Brazilian population is vulnerable, due to the multiple racial inequalities historically faced by these black people. and brown.

The Secretary of Health and Environmental Surveillance of the Ministry of Health, Ethel Maciel, declared that the epidemiological bulletin is a first step towards building a baseline.

“Some policies are already underway, others are in recovery. The health of the black population is a priority for the federal government, which understands the social determinants that cause many obstacles to access to health for this population,”

he said.

This scenario of inequality impacts the rates of so-called socially determined diseases, such as HIV infection and tuberculosis, which despite having free treatment through the SUS, represent the causes of a large number of deaths among black men and women in Brazil.

In this sense, the advisor for Racial Equity in Health at the Ministry of Health, Luís Batista, highlights that this special edition of the epidemiological bulletin serves to create a baseline for intersectoral actions, programs and policies, but also represents a form of dialogue with society about the problems that most affect the health of the black population. “The next step is for all identified critical nodes to form part of the strategy and indicators of the National Health Plan”, explains.

Black and brown people affected by tuberculosis

Among the risk factors for tuberculosis are the lack of access to quality food and poor housing conditions, which can be evidenced by the prevalence of cases among low-income people. Between 2010 and 2022, an average of 73 thousand new cases were reported per year, with a concentration of black people in approximately 60% of cases.

In 2022 alone, 78 thousand people were diagnosed and, among these new cases, 49,381 were brown and black, which represents 63.3% of cases. Furthermore, between 2010 and 2020, Brazil recorded an average of 4,500 deaths, with a peak of 5,072 in 2021, and a percentage of 64.4% of black people killed by the disease in the period. In this context, the predominance of dropouts in relation to preventive tuberculosis treatment among this social group also draws attention: only 60.3% of black people and 64.3% of brown people completed treatment.

Tuberculosis and co-infection with HIV

Another important factor to highlight is the expansion of testing for HIV/AIDS in new cases of tuberculosis, which increased from 62.1% in 2010 to 79.7% in 2022. This is a reflection of the guidelines issued by the Ministry of Health, which encourages HIV testing among all those diagnosed with tuberculosis, which is justified by the high rate of people infected with both diseases and the possibility of a cure through early treatment. In the historical series, 5,938 black people were diagnosed with tuberculosis-HIV co-infection.

These diseases mostly affect the black population, since their incidence is associated with limited access to indicators such as education, basic sanitation, food security, employment and income. Despite the stigma that HIV and tuberculosis still carry, the SUS offers free prevention, diagnosis and treatment.

Unprecedented rapid test in the SUS to help eliminate socially determined diseases

As another diagnostic alternative, a rapid test capable of identifying, at the same time, syphilis and HIV infections will be offered in the SUS. The Ministry of Health will invest R$27 million in the acquisition of the new technology, unprecedented in the public network, also called a duo test, resulting in 4 million units.

The expectation is that distribution to the states will occur in 2023. The initiative will enable more agile treatment for the population and is another step by the federal government to meet the goal of eliminating or controlling, by 2030, 14 diseases with high incidence in regions of greater social vulnerability, as is the case with HIV and syphilis.

The ministry also incorporated into the SUS, in September, an innovative and faster treatment for resistant tuberculosis: pretomanid. According to estimates, the medicine can reduce people’s treatment time from 18 to six months – a drop of almost 70%. Among the benefits is oral administration, which facilitates patient adherence and requires fewer follow-up visits.

The actions are part of the federal government’s strategies to eliminate diseases that affect, more intensely, populations with greater social vulnerability. This is also the case with the Interministerial Committee for the Elimination of Tuberculosis and Other Socially Determined Diseases (CIEDDS), an unprecedented initiative, which brings together nine ministries and will operate until January 2030 under the coordination of the Ministry of Health.

Data from the folder shows that, between 2017 and 2021, socially determined diseases were responsible for the deaths of more than 59 thousand people in Brazil. The initial work plan includes tackling 11 of these diseases – such as malaria, schistosomiasis, Chagas disease and viral hepatitis – in addition to the vertical transmission of syphilis, hepatitis B, HIV and HTLV. This strategy is aligned with the Sustainable Development Goals (SDGs) of the United Nations (UN).

Specifically regarding syphilis, the objective is to eliminate congenital syphilis as a public health problem. Congenital syphilis is a consequence of the transmission of syphilis during pregnancy and/or childbirth. Regarding HIV, the goal is to have 95% of people living with HIV diagnosed, of which 95% are on treatment and 95% have a controlled viral load.

The installation of CIEDDS is based on the premise that guaranteeing access to health treatment alone is not enough to achieve these goals. It is necessary to propose intersectoral public policies that are aimed at health equity and the reduction of social inequalities, a factor directly linked to the causes of the problem.

*With information from the Ministry of Health