The better the treatment, the less threatening the disease appears
Young Chileans aged 25-29 have the nation's highest HIV rate at 59.2 cases per 100,000 inhabitants, driven by behavioral factors rather than biological ones. Only 49% of young men use condoms; successful HIV treatment paradoxically reduced fear and preventive behavior, while other STI rates simultaneously rose.
- 4,000-5,000 new HIV cases annually in Chile for the past decade
- Ages 25-29 have the highest rate: 59.2 cases per 100,000 inhabitants
- Only 49.2% of young men use condoms; 26.1% of young women
- Antiretroviral therapy cases doubled from 28,000 (2015) to 64,000 (2023)
- 87% of new diagnoses are in young men; sexual transmission is primary route
Chile reports 4,000-5,000 annual HIV cases with young adults aged 25-29 most affected. Experts attribute the 35% increase over a decade to diminished risk perception as improved antiretroviral therapy transformed HIV into a manageable chronic condition.
Chile has been recording between four and five thousand new HIV cases every year for the past decade, and the pattern has barely shifted: young people aged twenty to twenty-nine account for the bulk of them, with those between twenty-five and twenty-nine carrying the heaviest burden. The Ministry of Health data shows this youngest group registering fifty-nine point two cases per one hundred thousand inhabitants—the highest rate in the country. What makes this stubborn statistic worth examining is that it has nothing to do with biology. It is entirely behavioral. Researchers have settled on a phrase to describe what they are seeing: low risk perception.
Leandro Carreño, an immunologist at the Millennium Institute of Immunology and Immunotherapy, has been studying this gap between the actual danger and what young people believe the danger to be. Over the last decade, the number of Chileans on antiretroviral therapy has doubled, climbing from twenty-eight thousand in 2015 to sixty-four thousand in 2023. That expansion has saved lives. But it has also produced something unexpected: as the fear has evaporated, so has the willingness to get tested. When a disease stops looking like a death sentence and starts looking like something you can live with indefinitely, the urgency to know your status fades. People can carry the virus asymptomatically, unaware they are infected, continuing to transmit it to others.
The transformation happened gradually. In the nineteen-eighties and nineties, an HIV diagnosis felt like a countdown to death. Young people born after that era have no such memory. They have grown up in a world where HIV is treatable—where, as Carreño points out, the prognosis is actually better than it is for high blood pressure or heart disease. That medical success has created a paradox: the better the treatment, the less threatening the disease appears, and the fewer precautions people take.
The numbers bear this out. Eighty-seven percent of new diagnoses are in young men, and sexual transmission is the primary route. Only forty-nine point two percent of young men use condoms, according to UNAIDS data. Among young women, the figure drops to twenty-six point one percent. The erosion of caution around HIV has coincided with a resurgence of other sexually transmitted infections—chlamydia and gonorrhea cases that had largely disappeared from the clinical conversation are now reappearing. These are infections that can leave permanent marks on a person's life.
Testing itself is not the barrier. The system is extensive: community health centers, clinics, and outreach programs distribute rapid tests that deliver results in fifteen to twenty minutes, accompanied by professional counseling. The tests are free. And yet resistance persists. Carreño describes a peculiar psychological resistance—people still harbor a fear of knowing, even though knowing is precisely what allows treatment to begin. The logic seems inverted: the thing that should feel like relief feels like a threat.
Ricardo Soto-Rifo, a researcher at the same institute and part of the HIV and AIDS working group at the University of Chile's medical school, has been advocating for a different approach: bringing testing to where young people already gather—university campuses, cultural events, places where they are comfortable. The idea is to remove friction, to make the test as ordinary as any other health check. Whether that will shift the underlying perception of risk remains to be seen. For now, Chile continues to record its steady toll, year after year, concentrated among those who believe it cannot happen to them.
Citações Notáveis
When risk perception disappears and infection can pass without symptoms, people may be infected without knowing it. Diagnosis is crucial for effective treatment.— Leandro Carreño, immunologist at the Millennium Institute of Immunology and Immunotherapy
HIV now has a better prognosis than hypertension or coronary disease, yet this success produces a paradoxical effect: better treatment leads to lower perception of threat.— Leandro Carreño
A Conversa do Hearth Outra perspectiva sobre a história
Why would better treatment actually make people less careful? That seems backwards.
Because fear is what drives prevention. When HIV was a death sentence, people were terrified. Now it's a chronic condition you manage with pills. The threat feels abstract, especially if you've never known anyone who died from it.
So the young people getting infected now—they don't remember the eighties and nineties?
Exactly. They've only ever known HIV as something treatable. There's no collective memory of what it used to mean. That absence changes everything about how they perceive risk.
The condom numbers are striking. Forty-nine percent of young men, twenty-six percent of young women. Why the gap?
That's a different conversation, but part of it is power dynamics in sexual relationships. Women often have less say in whether protection is used. But the broader point is that both numbers are too low when you're looking at a preventable infection.
If testing is free and takes twenty minutes, what's actually stopping people?
Carreño calls it a fear of knowing. People would rather not have the information than have to deal with what it means. It's psychological, not logistical.
And the other STIs coming back—that's a direct result of this shift?
Yes. When people stop thinking about HIV risk, they stop thinking about sexual health risk in general. The caution disappears across the board.
What would actually change this?
That's the question. Moving testing to places young people already are—campuses, events—might help. But you're fighting against a generation that has never experienced the disease as dangerous.