Continuous and mandatory training in human rights, sexual health, and ongoing updates for all healthcare personnel is needed. Avoid all forms of discrimination. Evaluate social determinants of health in cases of non-adherence. Eliminate bureaucratic barriers and guarantee a permanent supply of medications. Public policies that diversify the approach: specific programs for women and adolescents, with corresponding research and budgets. Political leadership that prioritizes people's well-being. Invest in mental health. Bye-bye to health prices. See you soon… This article, along with reports, exclusive interviews, videos, podcasts, and more, can be found in our next special digital edition of 'Select Topics on HIV' on VIH.lat by LaSalud.mx, The Journal of the Medical Community. Visit some of our special editions at https://issuu.com/grupo-mundodehoy
Training is sporadic, when it exists, because 'people don't want to learn,' and the lack of continuous updating results in the perception of healthcare services as violent and unsafe, and, as users and everyone in general rightly say, an 'ugly, ugly, ugly' environment. Improving the structure, hiring trained personnel, offering dignified salaries, and, above all, educating ourselves in human rights is imperative. Secondary gains happen everywhere in the system, with some direct and indirect benefits for politicians, researchers, doctors, activists, and even patients' families. The need for a policy focused on women has been urgent for decades; it is necessary to improve processes and research to increase adherence in groups where added vulnerabilities are a reality. Misunderstood austerity aggravates everything. It is obvious and necessary to say, for the 300th time, that simplifying processes, guaranteeing stable supplies, and prioritizing public health over formalities is fundamental so that no one's life is threatened by bureaucratic procedures. Isn't it idiotic to have to present three forms of identification? I live on the street, what proof of address can I give? It is important to talk about 'free-riders'; those individuals who benefit from a public good or service without paying for it or contributing to the collective effort. (Yes, we need injectables for PrEP, PEP, and treatment, because more options are better). Public policies also fail when they do not prioritize mandatory training in human rights and scientific updates for all healthcare personnel. Only then will HIV cease to be a public threat and a business for the free-riders. It is time to confront these free-riders and the internal enemy without fear. Identifying these free-riders will help improve procedures and create a better environment. And we all know several free-riders… (The politician who cuts the budget for prevention, treatment, research, and structure [because we need more budget], the researcher who only wants samples and recognition, the 'It's not my job' types, the psychologist who harasses patients and invites them to dinner, the nurse who doesn't work, the social worker who complicates access, the activist who economically profits from community models, the journalist aligned with the regime, and so many more parasites who profit by doing things wrong [pulling water to their own mill…])
Today, the idea is that through health and sex education, it can be understood that HIV is a controlled chronic condition that allows a person to develop in all areas of life with the aim of being happy or at least achieving a certain fulfillment. Politicians who implement these measures behave as direct enemies of patients and doctors. It is time to confront this internal enemy with courage. It has many names and is diffuse, but here they are: corruption, ineptitude, ignorance, stigma, and, in its crudest form, the wickedness of screwing over the other for the pleasure of doing so and, above all, for personal gain. It generates a chronic supply shortage, endless paperwork, a lack of decentralization, and undignified salaries that drive away trained personnel. Regarding patients, there is a group of individuals who internalize this fatality and live from it like a flame that gives them existence; that is, a victimhood with secondary gains. Bureaucracy represents one of the most insidious and avoidable obstacles in the fight against HIV, as it creates administrative barriers that disrupt timely access to antiretroviral medications and seriously compromise treatment adherence. Because cutting budgets stops research, quality care, and something very important that raises complaints every day: the supply. The truth is that we need more budget and more research to facilitate access to health. Criticism of the health system is inevitable. We need health systems that supply treatments to all users, in addition to continuous education, comprehensive care that includes mental health, reproductive rights, elimination of bureaucratic barriers, and political leadership that places the end of stigma as an absolute priority, focused on the population and its well-being (the real one that improves the health of individuals). One hope lies in injectables, but for that we need budget (money, loot, marmaja and/or cash), political will, and, above all, to get out of redundant speeches focused on one population (because there are many chavos). Another important aspect that damages the entire health system is the poor understanding of the concept of austerity. Cutting budgets is not efficiency; it is sabotage. This internal enemy is among us and seriously harms our community. Despite decades of scientific evidence, many healthcare professionals maintain condemning attitudes, violate confidentiality, postpone procedures, or use stigmatizing language. This group is overshadowed by activists, politicians, researchers, and doctors who focus on men who have sex with men and have no intention of changing the approach to other key populations, both in program development and public policy. Those of us who work with HIV have identified for years a social pathogen that inhabits our institutions, researchers, politicians, some healthcare providers, and, unfortunately, within the community itself. The system, in all its areas, has been 'rotten' for decades. All of us who work directly or indirectly in this pandemic are standing on the shoulders of giants, compiling data and developing procedures and techniques to bring health to populations, individuals, and communities that previously did not have access. Long-acting injectables promise greater adherence. We are, in theory, on the threshold of the end of the pandemic. That is 'very cool.' But the reality is different, 'babies of health.' Because as long as the health system discriminates, the virus will continue to find allies where it should least: among those who swore 'first, do no harm.' Treating through mental health would give us answers and many more questions about this futile perception, which in the long term would generate specific interventions for a better quality of life. Currently, the real victims who suffer from a system designed to fail them and the truly forgotten in HIV are women (cis and trans), as well as adolescents living with HIV. In terms of prevention, campaigns shine with their absence. And we don't even talk about adolescents; their life expectancy is reduced by the lack of specialized care. Making the discourse redundant and, above all, misogynistic for decades. Migrants, women, trans people, sex workers, adolescents, people living on the street, and incarcerated populations suffer due to absurd and unnecessary procedures that reduce their life expectancy. Today, a person with guaranteed access to antiretroviral treatment lives a long, healthy life, and, most revolutionary, with an undetectable viral load, so they do not transmit, pass on, and/or spread the virus, giving us the scientific success of: (U=U). 'It is time to burn a sofa in front of their homes, institutions, and offices and to bother them a little.' By: Lirio Pepenador del Bosque
For decades, HIV is no longer the death sentence it was in the 80s and 90s; goodbye to the idea of a 'Terrible Disease.' Thanks to science—and a necessary deep recognition of researchers, activists, doctors, and health politicians who have genuinely driven change—today it is a controllable chronic condition. The real enemy is not the virus; that 'bastard' is tamed with pills and injections. That is to say, internalized (and externalized) stigma is basically 'a self-imposed shame' that is precisely fed by these experiences in the health system, perpetuating the epidemic. Stigma continues to be the fuel and catalyst of this vicious cycle. In health, anyone dedicated to assistance, the development of procedures, techniques, etc., knows well these 'bloodsuckers' found at all levels.
