It has been forty years since the first patient in the Netherlands was diagnosed with HIV, the virus that causes AIDS. In 2022, HIV care in the Netherlands will look completely different than in the 1980s. Contracting the virus is no longer a death sentence and it is easy to live with medication. But the fight against HIV is not over and the stigmas surrounding the virus are persistent.
According to Mark van der Valk, internist-infectiologist and head of the HIV outpatient clinic at Amsterdam UMC, the Netherlands currently has about 24,000 people with HIV. ‘Of these, 22,500 people are currently in care, and 1 in 24 in treatment centers. If you look at the composition of those people, 63 percent are men who have sex with men, 28 percent are other men and women, and we don’t know how they got HIV from 8 percent.’
Diagnoses
The number of HIV diagnoses in the Netherlands has fallen sharply in recent years, to 427 diagnoses in 2021. This year also shows an effect for the first time from the roll-out of PrEP, pills that people take preventively to avoid contracting the virus. ‘We see that the proportion of men who have sex with men with an early diagnosis is falling sharply, by 9 percent,’ says Van der Valk. ‘That means that that group of men, who were already concerned about STI and HIV screening, now protect themselves with PrEP.’
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In 2010, more than 1,000 people were still diagnosed with HIV. The Netherlands is one of the few countries where the number of estimated infections has fallen by more than 75 percent in the past ten years. According to Van der Valk, this is because Dutch HIV care is particularly well organised. There are 24 treatment centers where specialist care providers work. The GGDs and general practitioners test for STIs and HIV. As a result, the Netherlands has the most intricate HIV approach in the world.
Leading
From the early years, the Netherlands has been a leader in the HIV field, explains Van der Valk. ‘There is very good cooperation between all stakeholders in HIV care: public health, the GGDs, the community, clinical science and basic science. The Netherlands also started very early with long-term monitoring of groups of people, to look at risk factors and what does and does not work in terms of prevention. In the 1990s we played an important role in conducting drug research with new medicines, being one of the countries where most innovation came from. To this day we are very high on the lists when it comes to HIV research.’
The prejudices surrounding the virus are persistent. For example, there are still countries where you are not allowed to enter if you have HIV. Many people also still think that HIV is something that only happens to gay people, but that is incorrect: everyone who has unprotected sex is at risk. Van der Valk: ‘In a monogamous relationship, the chance of contracting HIV is small. Unfortunately, it doesn’t always work that way in the real world.’ However, vulnerable people in society generally run a greater risk of contracting the virus. Homelessness, drug use, sex work, and social and economic deprivation are all risk factors. For example, transgender women have an increased risk of contracting HIV, but so do refugees.
Signals
According to Van der Valk, the most important thing in the fight against HIV is to be alert to signals. Because the sooner you detect it, the less likely you are to transfer it. ‘If you have been at risk for HIV, so you have had unprotected sex and you get a serious flu a week or two or three later, then you have to test for HIV. After that acute phase you have virtually no complaints for a period, but there are a number of diseases that occur much more often in people with HIV, such as certain STIs, shingles and severe pneumonia. Then it is effective to do an HIV test, and we know from research that general practitioners and medical specialists do this far too little.’
