There are fewer cases, but late diagnosis remains.

Ministry of Health and National Epidemiological Center of the Carlos III Institute of Health published a report that shows a downward trend in the number of new HIV diagnoses in Spain between 2013 and 2023. However, it also highlights the persistence of late diagnosis, especially in women and the elderly.

According to a report published by ISCIII, there were 3,196 new HIV diagnoses recorded in 2023, however, 48.7% of these diagnoses were recorded when patients were already suffering from the disease at an advanced stage;

Regarding the mode of transmission, the predominant route remains sexual (80.7%), with the highest incidence rate among men who have sex with men (MSM), accounting for 55%. Heterosexual relationships account for 25.7% of cases, and infection through injection drug use accounts for 1.7%.

However. The report itself states that these cases show a rate of 6.65 cases per 100,000 residents, but this is a figure that has not yet been corrected due to notification delays. After adjusting for this lag, the rate is projected to actually be 7.38 cases per 100,000 residents in 2023, when notification of all diagnoses made that year is completed.

Transmission by age and sex

By age, 33.5% of new diagnoses are in the group from 25 to 34 years old.. 11.5% were aged 15 to 24 years and 18.3% were aged 50 years or older. The highest age indicator was observed in the age group of 30-34 years.

Between 2013 and 2023, there is a downward trend in overall rates and by gender. Depending on the mode of transmission, declines in PID rates can be observed worldwide and among both sexes. Cases of heterosexual transmission also showed a significant downward trend worldwide during the study period, with differences between sexes: while for heterosexual men the trend decreased significantly between 2013 and 2023, for heterosexual women the trend stabilized between 2013 and 2017 year. decreases significantly between 2017 and 2023. Rates of new diagnoses among MSM show a downward trend between 2017-2023. By origin, a significant decrease is observed among Spanish MSM between 2016 and 2023, while among MSM from other countries there is an increase between 2013 and 2018, followed by a stabilization between 2018 and 2023.

Late diagnosis: a persistent problem

Almost half (48.7%) of people diagnosed with HIV in 2023 were diagnosed late, meaning the infection was already well advanced..

Late diagnosis of HIV increases with age. If among people under 25 years of age late diagnosis occurred in 33.4% of cases, then among people over 50 years of age this figure increases to 61.5%.

Regarding the mode of transmission, the heterosexual route has the highest rates of late diagnosis: 57.8% in men and 53.5% in women. On the other hand, 42.1% of men who have sex with men (MSM) receive a late diagnosis.

The report also shows inequalities in access to diagnostics. 49.8% of new diagnoses correspond to people born outside Spain, predominantly from Latin America. For women, this figure increases to 61.6%..

Given the data presented, it is necessary to continue the implementation of the Strategic Plan for the Prevention and Control of HIV and other STIs in Spain in order to accelerate the reduction in the rate of new HIV diagnoses and late diagnosis of infection.

AIDS cases

HIV and AIDS are related, but they are not the same thing. HIV is a human immunodeficiency virus. It damages your immune system by destroying a type of white blood cell that helps the body fight infections. This puts you at risk of contracting other infections and diseases.

AIDS stands for acquired immunodeficiency syndrome. This is the final stage of HIV infection. This occurs when the body’s immune system is severely damaged by the virus. Not all people with HIV develop AIDS.

The report data indicates that there were 337 cases of the disease in 2023, which is 0.83 per 100,000 inhabitants.. 80.7% of these cases were middle-aged men and were diagnosed at approximately 44 years of age.

Since the beginning of the epidemic in Spain until 30 June 2024, a total of 90,275 cases of AIDS have been reported. The proportion of AIDS cases among people whose country of origin is not Spain has increased gradually since 1998, reaching 45.1% in 2023.

During the period 2014-2023. the most common AIDS-defining disease was Pneumocystis pneumonia (33.2%), followed by tuberculosis of any site (15.7%).

Report findings

In conclusion, The report shows that the rate of new HIV diagnoses is similar to that of other Western European countries, although higher than the European Union average.. Sexual transmission is the main mode of transmission of new HIV diagnoses, with HIV transmission between homosexual men accounting for the majority of cases. On the other hand, people from other countries of origin account for a significant proportion of new diagnoses.

Although the trend of new HIV diagnoses during the analyzed period is decreasing, late diagnosis, as we noted earlier, is very high.

On the other hand, with regard to AIDS, the downward trend in the number of new cases that began with the introduction of highly active antiretroviral drugs in the mid-1990s has also continued.

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