Objective: To estimate life expectancy of people with HIV (PWH) and describe causes of death. Design: Antiretroviral therapy (ART)-naive adults from the CoRIS cohort starting ART in 2004–2019. Methods: We calculated life expectancy at age 40 for men and women according to their ART initiation period, and stratified by transmission category, CD4 + cell count and AIDS diagnosis. We estimated life expectancy in 10-year age bands using life tables constructed from mortality rates, estimated through Poisson models. Results: Life expectancy increased from 65.8 [95% confidence interval (CI) 65.0–66.6] in 2004–2008 to 72.9 (72.2–73.7) in 2014–2019 in men [general population comparators (GPC): 79.1 and 81.2 years, respectively] and from 65.8 (65.0–66.6) to 72.5 (71.8–73.3) in women (GPC: 84.9 and 86.4, respectively). Non-AIDS-related deaths accounted for 68% of deaths among men and 78% among women. Life expectancy was longer when starting ART with higher CD4 + cell counts and without AIDS. For men acquiring HIV through sex with men, starting ART in 2014–2019 without AIDS, life expectancy was 75.0 (74.2–75.7) with CD4 + cell count less than 200 cells/μl, rising to 78.1 (77.5–78.8) with CD4 + cell count at least 350 cells/μl. Corresponding figures were 70.1 (69.4–70.9) and 76.0 (75.3–76.7) for men acquiring HIV heterosexually (HTX) and 61.5 (60.7–62.3) and 69.0 (68.2–69.8) for those acquiring HIV through injection drug use (IDU). For women starting ART from 2014 without AIDS, life expectancy increased from 71.7 (71.0–72.4) to 77.3 (76.7–77.9) among HTX and from 63.7 (62.9–64.5) to 70.7 (70.0–71.5) among IDU. Conclusion: Our findings confirm the progressive improvement of life expectancy in PWH in Spain over the last decades, supporting the insurability of PWH on suppressive ART in our current setting and time.

According to Sustainable Development Goals 10.2 and 10.3, it is imperative to promote the elimination of discriminatory laws, as as implement policies and practices for the inclusion of vulnerable social groups on the social, economic and political fronts. In regard, HIV-related discrimination and stigma remain unaddressed in many European Union countries. Fighting HIV-related stigma has been one of the main priorities of the Spanish Presidency of the Council of the European Union. This commitment was reflected in the High Level Meeting entitled HIV and Human Rights. Political action to achieve ZERO stigma. This meeting provided an opportunity to discuss a variety of strategies and agreements for eradicating stigma and discrimination associated with HIV in a variety of social, political, and institutional contexts.

According to Sustainable Development Goals 10.2 and 10.3, it is imperative to promote the elimination of discriminatory laws, as well as implement policies and practices for the inclusion of vulnerable social groups on the social, economic and political fronts. In this regard, HIV-related discrimination and stigma remain unaddressed in many European Union countries. Fighting HIV-related stigma has been one of the main priorities of the Spanish Presidency of the Council of the European Union. This commitment was reflected in the High Level Meeting entitled HIV and Human Rights. Political action to achieve ZERO stigma. This meeting provided an opportunity to discuss a variety of strategies and agreements for eradicating stigma and discrimination associated with HIV in a variety of social, political, and institutional contexts.

The Agreement of the Council of Ministers of November 30, 2018 approving instructions to eli-minate certain medical causes of exclusion in ac-cess to public employment, such as HIV, diabetes, celiac disease and psoriasis, has meant an impor-tant advance in the protection of the labor rights of people in these conditions. Since then, the tables of medical exclusions have been revised and modified for the National Police, National Police, the Civil Guard, the Customs Surveillance Corps, the Corps of Penitentiary Institutions Assistants, the Military Training Centers, the Training Centers, for the in -corporation to the Troops and Marines scales and the National School of Police. In addition, the re-peal of the Orders of the National Police (Order of January 11, 1988) and the regulatory modification of the Civil Guard (Order PCI/155/2019) guaran-tee that the diagnosis of HIV, diabetes, celiac disea-se and psoriasis, will continue without being an im-pediment for access to the National Police and the Civil Guard in the calls for the next exercises. So, that the mere diagnosis of a disease such as HIV, dia-betes, celiac disease and psoriasis will not be a gene-ric cause for exclusion from public employment, but will take into account medical advances and existing scientific evidence, as well as the health situation of each person.

Advances in treatment and care have improved the life expectancy and quality of life for people living with HIV. However, those infected with HIV remain exposed to the social stigma that continues to be associated with this condition and sometimes experience discriminatory treatment in areas such as health, education, the judiciary or the workplace, and in access to benefits and insurance. There is a lot of evidence that the discrimination and stigma associated with HIV alienate people from prevention, diagnosis, treatment and quality of life services. This situation is exacerbated by social, economic and cultural status, as social and structural inequity facilitates increased discrimination and unfair treatment in the daily lives of people living with HIV. In response to this situation arises the need to establish a Social Pact for Non-Discrimination and Equal Treatment Associated with HIV, agreed and signed by social and institutional agents key in the response to HIV. Its aim is to eliminate the stigma and discrimination associated with HIV and AIDS, ensuring equal treatment and opportunities, non-discrimination, respect for fundamental rights and diversity of those affected. Reducing discrimination against people living with HIV is one of the priority objectives of the Ministry of Health, Consumer Affairs and Social Welfare's Strategic Plan for the Prevention and Control of HIV and other STIs, currently extended to 2020. It is aligned with the UNAIDS cross-cutting objective of zero discrimination and with the fourth objective of the 90-90-90-90 strategy, which should ensure that 90% of people with HIV and viral load suppression have a good health-related quality of life.

RESUMEN Los avances en nuevos tratamientos y en la atencion sanitaria han mejorado la esperanza y la calidad de vida de las personas con el VIH. Sin embargo, quienes tienen esta infeccion siguen expuestos al estigma social que sigue asociandose a esta condicion, experimentando en ocasiones un trato discriminatorio en ambitos como el sanitario, el educativo, el judicial o el laboral, asi como en el acceso a prestaciones y seguros. Existen numerosos datos que muestran que la discriminacion y el estigma asociados al VIH alejan a las personas de los servicios de prevencion, diagnostico, tratamiento y calidad de vida. Esta situacion se acentua segun la posicion social, economica y cultural, ya que la inequidad social y estructural facilita el aumento de la discriminacion y del trato injusto en la vida diaria de las personas con el VIH. Como respuesta a esta situacion surge la necesidad de establecer un Pacto Social por la No Discriminacion y la Igualdad de Trato Asociada al VIH, consensuado y suscrito por los agentes sociales e institucionales claves en la respuesta frente al VIH. Su objetivo es eliminar el estigma y la discriminacion asociados al VIH y al Sida, garantizando la igualdad de trato y de oportunidades, la no discriminacion, el respeto de los derechos fundamentales y la diversidad de las personas afectadas. Disminuir la discriminacion hacia las personas con el VIH es uno de los objetivos prioritarios del Plan Estrategico de Prevencion y Control del VIH y otras ITS, del Ministerio de Sanidad, Consumo y Bienestar Social, actualmente prorrogado hasta 2020. Esta alineado con el objetivo transversal de cero discriminacion de ONUSIDA y con el cuarto objetivo de la estrategia 90-90-90-90, en el que se deberia de asegurar que el 90% de las personas con el VIH y supresion de carga viral tengan una buena calidad de vida relacionada con la salud.