The HIV/AIDS Epidemiological Challenges: Why is HIV Incidence Rising While AIDS Incidence and Mortality are Declining in Brazil?

Abstract HIV/AIDS remains a public health challenge in Latin America, and Brazil has emerged as a global reference for effective epidemiological control through its comprehensive public health response. This study investigated epidemiological trends in Brazil from 2015 to 2024, including HIV and AIDS incidence, AIDS-related mortality, time from diagnosis to antiretroviral therapy initiation, CD4 + T cell counts at diagnosis, and viral suppression. We aimed to evaluate progress in HIV/AIDS management, identify persistent gaps requiring improvement, and explore potential determinants associated with AIDS incidence and mortality to inform future policy and programmatic actions. During this period, AIDS incidence and AIDS-related death rates declined, but the HIV incidence rate increased. The percentage of people living with HIV initiating treatment within 30 days after diagnosis increased from 28 to 63%, while the proportion initiating treatment more than 6 months after diagnosis decreased substantially from 35 to 10%. Viral suppression among people living with HIV and CD4 + T cell counts at diagnosis remained relatively stable. Moreover, we observed a strong negative correlation between treatment initiation within 30 days and the AIDS incidence rate (r = -0.8147; p = 0.0075), as well as a very strong negative correlation with the AIDS-related death rate (r = -0.9564; p < 0.0001). Therefore, Brazil reduced AIDS incidence and mortality through earlier treatment initiation and sustained viral suppression. However, persistently high HIV incidence remains a challenge, requiring intensified prevention campaigns, stigma reduction, and targeted interventions in high-risk populations.