HIV in Portugal: how national surveillance and community-based testing data compare (2016-2024)
H BarrosAbstract
Background
HIV testing can be offered through multiple strategies to reach populations with specific needs, leveraging different contexts and structures (health-care facilities, community-based organisations, self-testing). The Portuguese HIV surveillance system reports yearly notifications affected by delays, underreporting, and knowledge gaps. This analysis compares trends in national HIV case notifications and community-based reactive cases between 2016 and 2024, considering key populations.
Methods
Annual data on HIV notifications, gender, and mode of transmission were retrieved from the Portuguese Directorate-General for Health reports. Reactive HIV test results, disaggregated by key population and gender, were obtained from 47 community-based centres across Portugal. Time trends and differences by gender, mode of transmission, and key population were assessed.
Results
Between 2016 and 2024, HIV notifications declined by 43.5%(1,766 to 997 cases). Self-reported cis men accounted for most cases(72.5%); heterosexual transmission was most frequently reported(45.2%), followed by transmission among men who have sex with men(MSM)(32.5%). Over the same period, community-based reactive results increased by 104.9% (204 to 418). These were predominantly men(66.5%), most frequently MSM(53.5%), in contrast to national surveillance. Community-based services identified a higher relative contribution of transgender persons(4.0%) than national reports (0.2%).
Conclusions
National surveillance shows a continued decline in reported HIV diagnoses in Portugal, while community-based services show increasing case detection, particularly among MSM and other key populations. These trends highlight the complementary role of community-based testing in reaching populations less likely to access conventional healthcare settings, and underscore the importance of efficient record linkage and of strengthening these services to improve equitable access to HIV testing and early diagnosis.