2030 Goals: GAT identifies structural challenges in the national response to HIV

The Treatment Activists Group (GAT), in partnership with the AIDS Healthcare Foundation (AHF), held this Wednesday, at HF Fénix Lisboa, the Meeting to Update the Status of HIV in Portugal, with the participation of the Director of the National Program for Sexually Transmitted Infections and HIV (PNISTVIH), Bárbara Flor de Lima, and GAT leaders Luís Mendão and Ricardo Fernandes.

During the Meeting on the Current Status of HIV in Portugal, structural challenges that continue to compromise the national response to HIV and Portugal's ability to meet international targets for 2030 were discussed.

Prevention remains below what is necessary in PrEP

GAT warns that most new infections continue to be concentrated among young men between the ages of 20 and 29, especially men who have sex with men (MSM). According to Luís Mendão, Director-General of GAT, “For a country the size of Portugal, we should have at least 20,000 people on PrEP. We are far behind international projections.”

The current prescription and dispensing model also raises concerns: the state subsidy for each package of PrEP is €27.72, which is considered high when compared to the cost of hospital dispensing, which would be more economical and allow for greater rationalization of public resources.

Delays in reporting create bias in epidemiological data

One of the problems identified is the delay in reporting new diagnoses, which causes a significant distortion in the official figures. Luís Mendão emphasized that “We cannot plan public policies with figures that arrive a year late. This creates bias and prevents decisions based on real data.”

The Director of PNISTVIH, Bárbara Flor de Lima, committed to making efforts to improve this situation by 2026, reducing the gap for the coming years.

Resources should be allocated according to incidence

GAT argued that resources should be concentrated where HIV incidence is highest. The example given was HIV Counseling and Testing Centers (CAD), whose geographical distribution does not always correspond to epidemiological needs. The same reasoning applies to Primary Health Care (PHC).

Ricardo Fernandes stressed that “It is not effective to have the same resources in regions with very different incidence rates. The response must be proportional to the real needs of the country.”

Importance of community organizations

GAT argues that around 30% of the response to HIV should be provided by community-based organizations, with rigor, evaluation, and defined objectives. This distribution would make it possible to prioritize the most affected regions, strengthen combined prevention, and improve early diagnosis, especially in areas where the lack of family doctors hinders access to healthcare.

The priorities identified by GAT for the coming years include:

• Significantly increasing PrEP coverage;
• Strengthening combination prevention (condoms, lubricant gel, PrEP);
• Improving secondary prevention through timely diagnosis and treatment;
• Implementing opt-out strategies in CSPs in areas of higher incidence;
• Ensuring that community screening covers at least 30% of newly diagnosed infections.

Luís Mendão, a long-standing HIV activist, believes that without structural reforms and the strengthening of combined prevention, Portugal will continue to fall short of its 2030 targets. The country has the tools and technical knowledge to reverse this trajectory, but quick decisions and consistent investments are needed for Portugal to meet the international targets set for 2030.