The epidemic still exists. We can't let our guard down.
Each December, Teresina's Testing and Counseling Center renews its call to confront what has never truly receded: the HIV/AIDS epidemic. In Piauí, the virus now finds its most common host among heterosexual men under forty — a demographic shift that demands a reimagining of who prevention is for and how it must be delivered. The campaign arrives this year shadowed by pandemic disruption, which may have obscured the true scale of infection, reminding us that the distance between official statistics and lived reality is itself a public health concern.
- HIV/AIDS continues to spread actively in Piauí, with heterosexual men under forty now representing the majority of new infections — a pattern that challenges outdated assumptions about who is at risk.
- Two years of pandemic disruption suppressed testing and reporting, meaning the official reduction in cases may be a statistical illusion rather than a genuine victory.
- The CTA is offering free testing, counseling, and access to both pre- and post-exposure prophylaxis, tools that can transform infection from a death sentence into a manageable condition — but only for those who show up.
- The real obstacle is not the absence of services but the persistence of silence: convincing people to walk through a door that is already open remains the campaign's hardest work.
Every December, Teresina's Testing and Counseling Center — the CTA — reopens the conversation the rest of the year risks letting fade. This year's campaign carries added weight: two years of pandemic disruption have strained testing systems and clouded the epidemiological picture, and coordinator Cristiana Rocha is careful to name what the numbers may be hiding. A reported reduction in new infections in Piauí offers little comfort when the infrastructure for counting those infections was itself compromised.
The epidemic's current profile in Piauí is specific: most new cases are occurring among heterosexual men under forty. This demographic reality reshapes where prevention messaging must land and how it must speak. Rocha frames the challenge not as ignorance but as vigilance — the danger of letting one's guard down, of treating an ongoing epidemic as a solved problem.
The CTA's response is practical and layered. Condom use remains the foundation, but the center also provides access to post-exposure prophylaxis for those who may have already encountered risk, and pre-exposure prophylaxis for those at ongoing higher risk. These interventions exist. They are free. The center on Rua 24 de Janeiro keeps hours designed around working lives, open mornings and afternoons Monday through Friday.
What the December campaign ultimately asks is simpler and harder than any pharmaceutical protocol: that people treat knowing their status as an ordinary act of self-care rather than a confession of risk. The services are there. The question the campaign cannot answer for anyone is whether they will choose to use them.
December arrives in Teresina with a familiar reminder: the virus is still here. Every year, the month brings a national campaign focused on HIV and AIDS prevention, and this year the city's Testing and Counseling Center—known locally as the CTA—is once again opening its doors to anyone who wants to know their status. The center offers free testing and specialist consultation, services that have become more urgent as the country emerges from two years of pandemic disruption.
Cristiana Rocha, who coordinates the center, speaks about December's campaign with the tone of someone who has watched the same epidemic persist through changing circumstances. "We're always reminding people in December about prevention and confronting HIV and AIDS," she says. "It's an epidemic that still exists. We've come through two years of pandemic, and this year we're being especially careful to keep reminding the population and pushing decision-makers to understand that we all have to face the HIV epidemic that's still here." The work is not ceremonial. It is necessary.
The epidemiology tells a specific story. In Piauí state, where Teresina is located, most new infections are occurring among heterosexual men under forty years old. This fact reshapes how prevention messaging must be framed and where resources should be directed. The challenge, Rocha explains, is not awareness alone but sustained behavioral change. "The challenge today is prevention," she says. "We have to stay alert, we can't let our guard down."
The center offers three main prevention strategies. The most familiar is condom use—both male and female condoms remain foundational. Beyond that are two forms of prophylaxis: post-exposure treatment, taken after potential exposure to the virus, and pre-exposure treatment, taken before exposure by people at higher risk. These pharmaceutical interventions have transformed HIV from a certain death sentence into a manageable chronic condition, but only for those who know about them and can access them.
The latest epidemiological bulletin from the state health department shows a reported reduction in new infections. But Rocha offers an important caveat: the numbers may not tell the full story. The pandemic disrupted testing and reporting systems across the country. People who might have sought testing stayed home. Clinics operated at reduced capacity. The actual number of infections could be higher than what the official statistics reflect—a gap between what we know and what is true.
The Testing and Counseling Center operates from a straightforward address: Rua 24 de Janeiro, number 124, in the Centro-Sul neighborhood. It opens Monday through Friday, from eight in the morning until noon, then again from one in the afternoon until half past six. The hours are designed for working people. The service is free. The barrier to entry is low; the barrier to actually walking through the door remains higher.
What December's campaign attempts to do is lower that second barrier—to make the conversation normal, to make testing routine, to remind people that knowing your status is an act of care for yourself and others. The epidemic persists not because prevention is impossible but because prevention requires sustained attention, honest conversation, and access to services. Teresina's center exists to provide those things. Whether enough people use it remains an open question.
Citas Notables
The epidemic still exists. We've come through two years of pandemic, and this year we're being especially careful to keep reminding the population and pushing decision-makers to understand that we all have to face the HIV epidemic that's still here.— Cristiana Rocha, coordinator of the Testing and Counseling Center
The challenge today is prevention. We have to stay alert, we can't let our guard down.— Cristiana Rocha
La Conversación del Hearth Otra perspectiva de la historia
Why does December specifically matter for this campaign? Is it arbitrary or does something about the month make it significant?
December was chosen nationally as a moment to refocus attention on HIV prevention. It's partly symbolic—a time when people are thinking about health and new beginnings before the year turns—but it's also practical. The campaign creates a concentrated moment when media, clinics, and public health officials all speak with one voice about something that otherwise gets fragmented throughout the year.
Cristiana Rocha mentions that the pandemic disrupted things. What exactly got disrupted?
Testing dropped. People avoided clinics. Reporting systems slowed. So when the state health department released numbers showing fewer infections, it might have reflected fewer tests rather than fewer actual infections. That gap between the official count and the real count is crucial—it means the epidemic might be larger than the statistics suggest.
The data shows most new infections are among heterosexual men under forty. That's a shift from earlier in the epidemic, isn't it?
Yes. In the 1980s and 1990s, HIV in Brazil was heavily concentrated in men who have sex with men. That's changed. Now the fastest-growing group of new infections is heterosexual men in their twenties and thirties. It means prevention messaging has to change too—it can't assume the same risk profiles or the same social networks.
What does post-exposure prophylaxis actually do?
If someone has a potential exposure—a condom breaks, there's an accident—they can take medication within 72 hours that dramatically reduces the chance the virus will establish itself. It's not perfect, but it's a safety net. Pre-exposure prophylaxis is different—it's for people at ongoing high risk, taken regularly to prevent infection before it happens.
Does the center actually get people walking through the door?
That's the real question. The center exists, the services are free, the hours are reasonable. But knowing a service exists and actually using it are different things. There's still stigma, still fear, still the difficulty of admitting you want to know your status. The campaign tries to normalize it, but the work is slow.