The HIV/AIDS Epidemic in Minas Gerais, Brazil, 2009–2022: An Analysis of Geographic, Demographic, and Temporal Factors of Health Macroregions

This study assessed the geographic, demographic, and temporal factors underlying the evolution of the HIV/AIDS epidemic across the health macroregions of Minas Gerais, Brazil, comparing the periods before (2009–2014) and after (2015–2022) the implementation of universal HIV notification and immediate antiretroviral therapy (ART). An ecological study was conducted using statewide surveillance and clinical monitoring databases. Epidemiological indicators, including HIV detection, AIDS incidence, AIDS-related mortality, ART coverage, and sustained viral suppression (SVS), were analyzed according to sex and health macroregion using generalized linear models with negative binomial regression and spatial analysis. HIV detection increased markedly following the expansion of mandatory notification, while ART coverage and SVS also increased significantly. In contrast, AIDS incidence and AIDS-related mortality declined during the later period. Substantial heterogeneity was observed across macroregions, with important differences in epidemiological indicators and HIV care cascade performance. These findings demonstrate that the benefits of expanded HIV detection and universal ART have not been distributed uniformly across the state. Regional disparities in access to diagnosis, treatment, and long-term care remain important barriers to HIV control, highlighting the need for targeted, region-specific public health strategies to reduce territorial inequalities and strengthen the HIV care cascade.