What makes the black population more vulnerable to HIV and dying from AIDS complications

“I had to go through a process of self-acceptance and work to understand what my life would be like from that moment on.”

Two years later, Emer Conatus, an actor and art teacher, was also found to be HIV positive. Despite already following some profiles on the internet that talked about the subject, doubts regarding his own case, considering social aspects, did not fail to arise.

Both black men raised in peripheral regions — Raul in the Cariocas neighborhood, in Nova Lima, Minas Gerais, and Emer in Perus, a neighborhood in the northwest of São Paulo — the two met on the internet and realized that their trajectories had milestones in common, not only because of the same diagnosis, but because like many people, they did not have enough information about HIV before they saw themselves in the role of carriers of the virus, and race, in addition to the social context in which they lived, influenced many aspects of combating the disease. .

Black people, according to experts interviewed by BBC News Brazil, have more barriers to accessing health services in search of care for prevention and treatment.

“Often they do not have access to prevention technologies and will be diagnosed later. They are also among people with lower education, lower income, are more subject to violence, so for them the HIV diagnosis adds another difficulty to their lives. lives. And after the diagnosis, they will continue to experience stigma and prejudice, making it difficult to carry out the treatment. in HIV-related research projects.

To help others in the same position, but also to inform those who still consider HIV and AIDS as taboo, as well as those who know little about the virus and the disease, Raul and Emer created the podcast ‘Preto Positivo’, available on the streaming platform. Spotify.

“We decided to do the project because we realized that most creators of content about HIV are white, and the majority who live with the virus in Brazil and in the world are black. The intention is to bring doubts, social, family, health care… From the point of view of blackness”, says Emer.

The episodes feature personal reports, technical information and speeches from guests, among them, an infectious disease doctor, psychologist, midwife, lawyer, researchers, TV presenter, singer, poet, artists and activists for the cause. In addition, there is the voice of a character that represents the HIV virus itself, narrating, in the first episode, the first meeting with Emer and Raul.

The answer to this question has several layers — and some of them are complex — but all, in the opinion of the Acre-based infectious disease specialist Dyemison Pinheiro, have a common background: structural racism (institutional and historical practices rooted in society and constantly repeated, still that sometimes unconsciously).

“Access to information and health services is also affected by institutional racism, as this type of symbolic violence is reproduced within environments, such as in HIV and STI (Sexually Transmitted Infections) testing services. “

“Because of these barriers, the black population dies more from complications related to the virus, and sometimes this happens due to delay in diagnosis. When a patient is diagnosed earlier, even without major changes, treatment is much simpler and generates more improvement quickly”, says the infectologist.

He adds that those who discover the disease late sometimes already suffer from other opportunistic infections, as the virus causes a drop in immunity. And, without proper treatment, the person may have already developed AIDS.

This is because HIV selectively infects CD4-type lymphocytes (leukocytes), responsible for the immune response. As the virus multiplies and destroys the ‘CD4’, immunity is increasingly compromised.

“One of the criteria to define that a person has AIDS is the CD4 count. when a patient has this number below 350, he is already considered as someone who has the disease. With treatment, it is possible to improve the number, but still, some people have important qualitative flaws in the defense cells, and therefore, there are authors who advocate that, once the number was below 350, the person will always have AIDS.”

There are also, points out the doctor, other issues related to financial difficulties to access the service, regularity of visits due to more complicated routines, which affect mainly blacks, who in Brazil, as in other parts of the world, occupy historically underprivileged positions.

In addition, according to the psychologist Natalia de Souza, personal characteristics that can make the moment of diagnosis and treatment more or less difficult.

“The mental impact can vary a lot depending on what the patient already knows about HIV, if they know someone living with the virus, etc. It depends a lot on their own prejudice as well. For someone who doesn’t know what it’s like to live with HIV, for example , or someone who has issues with their sexuality, tends to be more difficult.”

In Pinheiro’s opinion, productions such as the ‘Preto Positivo’ podcast that demystify the theme are essential.

“There is a great lack of knowledge for some audiences, bringing an accessible, easy language that actually reaches everyone, especially in the case of this podcast, which is focused on the black population, is very important.”

“The content brings lightness and takes away some of that stigma, because when we talk about STIs, there is a weight, even a moral judgment, so having this content facilitates access to information. People hear about how they can test themselves and ways of prevention in general, in addition to participating in a discussion that goes beyond quality of life – which is similar to that of people without the disease – but which talks about technological discoveries, prophylaxis, injectable PrEP, and so on”, says the infectologist.

Tests that detect the presence of HIV in about 30 minutes are available free of charge to the entire population at the UBSs (Basic Health Units), Upas (Emergency Care Units) and CTA (Testing and Counseling Centers).

The SUS also offers antiretroviral drugs (formerly called cocktails), in addition to PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis), treatments indicated in specific situations and for specific periods of use.

In the opinion of infectious disease specialist Dyemison Pinheiro, in general, the Brazilian HIV/AIDS program works, but there is still room for improvement.

“We have a public system that can cover a lot, but we need to go even further into good policies. PrEP users, for example, who are just under 40,000 people, are mostly white homosexual men with higher education. It is not this public that gets infected and dies the most. It is necessary to think about how to reach the most vulnerable populations”

In an article published in the journal Global Public Health, researchers from fiocruz highlight that the Brazilian program against the disease was a reference, but has regressed in recent years. Among the causes, according to the study, is the disarticulation of institutions, both multilateral agencies such as Unaids, and the Brazilian government in relation to the demands of NGOs and patients, especially in relation to information and prevention policies.

The reality of access also tends to be different outside the capitals — where there are more diagnosed patients, but also better screening. “There is this lack of access, especially in remote areas, where information is lacking and there is also a lack of desire on the part of those who manage public health policies, both municipal and state, to make the policies more solid.”

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