No epidemic is controlled through silence.
In Chile, a virus that never left has nonetheless disappeared from public life. With more than 91,000 people living with HIV and over 4,300 new infections recorded each year, the country's health system continues to provide treatment—but has quietly abandoned the sustained prevention work that keeps epidemics from growing. Specialists warn that silence is not neutrality; it is a choice with consequences, and the consequences are already visible in the gaps between diagnosis, care, and viral suppression.
- HIV has not been defeated in Chile—it has simply stopped being discussed, and specialists say that distinction is costing lives.
- The country meets only the first of three international targets: people may know their status, but nearly a third of those diagnosed are not receiving treatment, and almost a third of those on treatment have not achieved viral suppression.
- Prevention tools—rapid tests, self-tests, PrEP, long-acting injectable therapies—exist and are proven, yet remain dramatically underused in the public system, particularly for the most vulnerable.
- Experts are pressing the new health authorities for a concrete, phased action plan, warning that goodwill and awareness days are not substitutes for sustained public health strategy.
- The silence around HIV is not uniquely Chilean—Latin America, Eastern Europe, and North Africa are all stalling on their 2030 targets—but Chile's comparatively high infection rate relative to its population size suggests the problem is more urgent than official narratives imply.
Chile's health system is occupied with visible crises—long waiting lists, cancer programs, infrastructure gaps. But specialists warn that this busyness has allowed a quieter emergency to go unaddressed: HIV has nearly vanished from public conversation, even as the virus continues spreading at a rate of more than 4,300 new infections per year among a population of 91,000 living with the disease.
The government has not abandoned treatment. Antiretroviral drugs remain available. What has eroded is everything upstream—the testing campaigns, the public messaging, the sustained prevention infrastructure that stops new infections before they happen. Pharmaceutical chemist Fernando Bernal put it directly at a health conference last December: no epidemic is controlled through silence.
Chile falls well short of the UNAIDS 95-95-95 targets. While roughly 95 percent of people with HIV know their status, only 71 percent of those diagnosed are receiving antiretroviral therapy, and just 68 percent of those on treatment have achieved viral suppression—the threshold at which the virus becomes undetectable and untransmittable. These are not abstract statistics; they describe real people falling through the gaps between diagnosis and sustained care.
Immunologist Alejandro Afani, who directs the HIV Center at the University of Chile's teaching hospital, describes the country's prevention campaigns as historically precarious—concentrated around awareness days rather than embedded in ongoing public health strategy. He stops short of blaming the current administration, which is newly in office, but is unambiguous about what must come next: a concrete plan with short, medium, and long-term measures.
The tools are available. PrEP is offered free through parts of the public system but remains vastly underutilized. Long-acting injectable therapies—given every few months rather than daily—could transform adherence for people facing poverty, housing instability, or the stigma of visible daily medication. These innovations exist; they are simply not being deployed at scale.
Health Minister May Chomali has reportedly shown genuine interest when briefed on these concerns. But specialists are clear that interest must become strategy, and soon. The virus does not pause for institutional processes. Every month of silence is a month of undetected infections, untreated cases, and preventable transmission—a slow accumulation of harm that no single awareness day can undo.
Chile's health system is busy with other things. The waiting lists are long. Cancer programs need strengthening. But beneath the noise of those priorities, a quieter crisis is unfolding: HIV has nearly vanished from public conversation, and the people who treat it are alarmed.
There is no formal abandonment of HIV treatment policy. The government still provides antiretroviral drugs. What has disappeared is something harder to measure and harder to fix—the sustained campaigns, the testing strategies, the constant public reminder that this virus still matters. In 2024, Chile recorded more than 4,300 new HIV infections. Roughly 91,000 people in the country are living with the virus right now. Yet outside of World AIDS Day and the occasional international headline, the disease has become nearly invisible in the national conversation.
Fernando Bernal, a pharmaceutical chemist, said it plainly during a health systems conference last December: "HIV left the political and health agenda." He added something harder to argue with: "No epidemic is controlled through silence." The concern is not that treatment has stopped, but that prevention has. The testing campaigns have withered. The public discussion has gone quiet. And in that silence, new infections continue.
Chile is far from meeting the international targets set by UNAIDS, known as the 95-95-95 goals. The first target—that 95 percent of people with HIV know their status—Chile has essentially reached. But only 71 percent of those diagnosed are receiving antiretroviral therapy. And only 68 percent of people on treatment have achieved viral suppression, the state where the virus becomes undetectable and untransmittable. Those gaps matter. They mean people are falling through the system between diagnosis and care.
Alejandro Afani, an immunologist who directs the HIV Center at the University of Chile's teaching hospital, has watched this unfold. He describes Chile's prevention campaigns as "historically precarious," existing mainly in bursts around awareness days rather than as sustained public health strategy. He is careful not to blame the current administration directly—the new health authorities have only recently taken office—but he is clear about what needs to happen next: a concrete plan, with short, medium, and long-term measures. "That's what I would expect first," he says.
The real challenge now is not treatment access, where Chile has made genuine progress, but prevention and early diagnosis. Afani emphasizes the need for expanded rapid testing campaigns, wider use of self-tests, and much greater uptake of PrEP—pre-exposure prophylaxis, a preventive medication available free through parts of the public system but vastly underutilized. These tools exist. They work. They are simply not being deployed at scale.
There is also the matter of newer treatments. Chile has access to long-acting injectable therapies, medications given by injection rather than daily pills. For people living in poverty, facing violence, or struggling with housing instability, the difference between taking a daily pill and receiving an injection every few months can mean the difference between maintaining viral control and losing it. The stigma around daily medication, the practical barriers, the fear—these dissolve when treatment becomes simpler. Yet these newer options remain limited in the public system.
The worry extends beyond Chile's borders. Europe is not on track to meet its HIV targets by 2030. Eastern Europe, North Africa, and Latin America are all seeing stagnation or increases in new cases. Afani notes that Argentina, with nearly three times Chile's population, records roughly the same number of new infections annually—a comparison that suggests Chile's apparent progress may be less impressive than the numbers alone suggest. The virus is not retreating. The conversation about it simply has.
Health Minister May Chomali has shown interest when presented with these concerns, according to Afani. But interest is not the same as action, and the specialists are clear that time is not abundant. The virus does not wait for bureaucratic processes to complete. Every month of silence is a month when people go undiagnosed, untested, and at risk of transmitting infection to others. The question now is whether Chile's health system will move from acknowledgment to strategy, or whether HIV will remain what it has become: a problem everyone knows exists but no one is talking about.
Notable Quotes
HIV left the political and health agenda. No epidemic is controlled through silence.— Fernando Bernal, pharmaceutical chemist
Prevention campaigns in Chile have been historically precarious. There is no sustained public health strategy, only bursts around awareness days.— Alejandro Afani, immunologist and director of the HIV Center at the University of Chile's teaching hospital
The Hearth Conversation Another angle on the story
Why does it matter that HIV disappeared from the headlines if the treatment is still available?
Because people can't get treatment if they don't know they have the virus. Right now, 29 percent of people diagnosed aren't even on medication. That gap exists partly because we stopped telling people to get tested.
But Chile has made progress on treatment access, hasn't it?
Yes, and that's real. But it created a false sense that the problem was solved. The hard part was never just handing out pills—it was finding people, keeping them in care, and preventing new infections. We stopped doing the second part.
What's the difference between a campaign and just having the service available?
A campaign reaches people who don't know they're at risk. It normalizes testing. It removes shame. Without it, only people who already suspect they're infected seek help. Everyone else stays invisible.
You mentioned Argentina has the same number of new cases as Chile despite having three times the population. What does that tell you?
That we're not actually doing better. We're just comparing ourselves to our own past instead of to countries that are actually controlling the epidemic. It's a way of avoiding the real question: why are we still seeing 4,300 new infections a year?
What would change if the government approved those injectable therapies?
For someone living on the street or in a violent home, taking a pill every day is almost impossible. An injection every few months is manageable. It's not magic, but it's the difference between staying in care and dropping out. And when people drop out, they transmit the virus.
So this is really about visibility and resources, not about whether treatment exists?
Exactly. The tools are there. PrEP is free. Testing is available. Newer drugs exist. But without campaigns, without public conversation, without resources dedicated to finding people—they might as well not exist.