The HIV rate has decreased, but the indicators of all other sexually transmitted infections (STIs) in the Community of Madrid have skyrocketed, as revealed by the 2023 Population Health Status Report. Although the increase occurs Also in Spain, the region's rates are well above those of the national average. For example, the incidence rate of gonorrhea per 100,000 inhabitants in Spain for 2022 was 49 cases, in the Madrid region it almost reached 60. And if we compare the rate with 2018, the pre-pandemic year, this infection Bacterial infection, which attacks the urethra, rectum or throat, has increased by 40% in the autonomous community. That Madrid registers these figures is explained by the growing use of drugs to have more intense sex – better known as
chemsex
–,
a decrease in condom use and a high diagnostic capacity, according to experts and the Ministry of Health. For this reason, the Community of Madrid will approve a new STI prevention and care plan in the third quarter of 2024, as part of a package of measures to stop this public health problem.
It is not only gonorrhea that worries doctors and health authorities. Syphilis, for example, has doubled its rate between 2018 and 2022, going from 11.99% to 24.72% incidence. The rate of Chlamydia has increased 75% in the last five years and that of Hepatitis B has returned to pre-pandemic levels. In all cases, the rates are above the national average. Although, according to data from the Epidemiological Surveillance of STIs in Spain report, published earlier this year, the gap between the Community of Madrid and Spain will close very slightly in 2022, compared to previous years.
Of course, the Community of Madrid is not the only one with alarming rates of STIs. The national report also reveals high incidence rates of gonococcal infections in Catalonia (121.8%) and the Basque Country (63%), syphilis in the Canary Islands (33%) and Chlamydia in Navarra (111.3%). Dr. María Velasco, SEIMC spokesperson and GeSIDA researcher, warns that “it is not prudent” to compare the figures between communities because not all of them report cases with the same methodology. But she recognizes that “the trend in Madrid, like that of Spain, is to take measures.” Of course, the only good news that the Report figures provide is that HIV has decreased in the region. As of 2021, the rate is 9.1%, the lowest since 2007.
One of the explanations for the low rate of HIV in Madrid is the preventive treatment of pre-exposure prophylaxis (PrEP) that is given to people who are more vulnerable to the virus. According to Mar Vera, president of the STI study group of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), at the Sandoval Center, a specialized care center for STIs, more than 4,000 patients have been included. that not only are they given antiretrovirals, but they also undergo quarterly or semiannual check-ups. “It has caught our attention that, in contrast, other STIs have increased,” says Dr. Vera, who works in the healthcare area of the Sandoval Center. “Although with PrEP we reduce the risk of HIV, we often see that there is a relaxation, a decrease in condom use in our patients.” Dr. María Velasco adds that some STIs are also either highly contagious or very symptomatic, making it easier for the patient to realize that something is wrong and go get a test.
Switching from condoms, however, is not something exclusive to this sector. The Ministry of Health has detected this behavior generally in urban areas. Dr. Velasco explains that large cities encourage people not to know each other and, some, “have more uninhibited behavior.” This ranges from not using condoms to the practice of
chemsex
, which the two experts and the Ministry point out as a key factor in the increase in infections. “It is a hidden epidemic parallel to STIs,” says Velasco and recognizes that although the Community of Madrid has some specific care center for this, “it is still insufficient for the needs that exist.” In 2023, the Community of Madrid activated a multidisciplinary program to respond to
chemsex
in the region with 20 lines of action that will be implemented until 2026. Scientific societies, LGTBI entities and rapid STI testing technicians will also participate in this project. Furthermore, in the third quarter of 2024, the new Action Plan for the Prevention and Control of HIV and other STIs will be approved, which will run until 2030. “The first phase, consisting of analyzing the state of the situation and the actions underway, It has already been completed and will be published in the coming weeks,” the Ministry of Health has confirmed.
The Minister of Health, Fátima Matute, has precisely pointed out the high diagnostic capacity of Madrid as one of the factors that explain why the region has higher rates than the national average. “We measure everything. This increase is because we put centers like Sandoval so that anyone who wants to go can go without any type of fear or restriction,” Matute said during the presentation of the State of Health study at the beginning of March. The Sandoval Center, according to Health, carries out more than 40,000 consultations and 72,000 tests a year, which allows around 6,000 infections to be detected annually. Dr. Vera, who works at Sandoval, adds that the center also serves without a scheduled appointment and even without the need for a health card so that the migrant population and vulnerable population – such as sex workers – can attend. In addition, the region has HIV and STI prevention and diagnosis service networks with rapid tests in 14 health centers and 18 municipal devices. The goal now is to open two more centers like Sandoval in the Chamberí district before the end of the year and in the municipality of Alcorcón in 2025. However, at least in the 2024 general budget, they have not been included.
Other measures are on the way. The Ministry of Health, for example, is studying the possibility of making condoms free for “those young people with lower purchasing power” and who are a population vulnerable to STIs. Dr. Velasco, however, warns that this must be accompanied by campaigns and pedagogy because it will be of little use to distribute them if the tendency of not using them continues due to a feeling of “greater freedom” and “greater pleasure.” From the SEIMC, on the other hand, they ask Madrid to consider the use of doxycycline to prevent bacterial infections. “Evidence has emerged from clinical trials and it has been detected that STIs decrease, especially syphilis and chlamydia,” describes Velasco.
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