Acquired Immune Deficiency Syndrome (AIDS)

Diagnoses of acquired immune deficiency syndrome and the human immunodeficiency virus that causes it (hereto jointly referred to as HIV/AIDS) began surfacing in Latin America and the Caribbean in the 1970s. The first case was in the Caribbean, and larger countries such as Brazil and Mexico followed in the early 1980s. In 2005 the prevalence rate was 0.57 percent, an increase from previous years. Though the HIV/AIDS epidemic in the region has not reached the same proportions as those seen in sub-Saharan Africa, it continues to be a significant public-health problem throughout the region. One challenge has been the difficulty of collecting accurate data; this results in a high degree of underestimation. Outdated surveillance mechanisms, varying country stand-ards, and limited testing access contribute to the underreporting of HIV/AIDS cases in Latin America and the Caribbean (UNAIDS 2006; World Bank 2001).

Several demographic groups that are categorized as having a higher risk for HIV/AIDS are used as indicators of the intensity of the epidemic in a country. They include men who have sex with men, sexually transmitted infection patients, and commercial sex workers. The epidemic is generally concentrated in these high-risk groups in Latin America, with some exceptions (García Abreu 2003). In Latin America the first and third groups are particularly important to understanding the disease's evolution. Both men who have sex with men and the clients of commercial sex workers often maintain relationships with other women, spreading the infection when they contract it, and contributing to the rise in the number of women with HIV/AIDS in the region (UNAIDS 2006). Though the majority of infections in the region are in males, the recent trend of feminization of the HIV/AIDS epidemic in Latin America is apparent. The male-to-female ratio has been decreasing, and the infection rate has been increasing in pregnant women and children (García Abreu 2003; World Bank 2001).

SUBREGIONAL VARIATION

Central American countries have some of the highest infection rates in the Spanish-speaking Americas; the three countries with the highest rates are Honduras, Guatemala, and Panama. In contrast, Nicaragua has comparatively low infection rates. In Honduras, the country with the highest infection rate, the prevalence rate among Garífunas living on the Caribbean coast is six times higher than the national average. Central America is one of the few regions where the disease is transmitted almost exclusively through heterosexual intercourse, with the exception of Costa Rica, where men who have sex with men have the highest infection rates. Additionally, the epidemic in Central America is highly concentrated in urban areas (García Abreu 2003).

In Mexico the prevalence of HIV/AIDS has leveled off. Traditionally, the primary means of transmission was sex between men, but Mexico has seen an increasing number of women being infected. Additionally, there has been an increase in the number of rural infections in Mexico, due in part to migration patterns (García Abreu 2003).

New cases of HIV/AIDS have leveled off in Brazil, although the percentage of the population living with HIV/AIDS has continued to rise due to a government program providing affordable antiretroviral medicine, which has decreased the death rate of HIV/AIDS patients. Brazil is unique in the breath of the epidemic's impact; the disease is transmitted through a variety of means. HIV/AIDS is concentrated in the southeast, with the highest rates in Rio de Janeiro and São Paulo, but it is beginning to spread to the northeast (García Abreu 2003). There has also been an increase in the number of Brazilian women affected by HIV/AIDS (UNAIDS 2006).

Data reporting for the Andean region is particularly bad, contributing to underreporting and a lack of understanding about the nature of the epidemic in this area. Sex between men is a significant mode of transmission, with heterosexual intercourse contributing in certain areas, such as the Atlantic Coast of Colombia, parts of Peru, and Bolivia. Evidence also suggests that high levels of risky sexual behavior (measured by the prevalence of other sexually transmitted infections) are contributing to the spread the disease in the region (García Abreu 2003).

In the Southern Cone, injection drug use has been the most significant factor in the transmission of HIV/AIDS, especially in Argentina and Uruguay. In Paraguay, transmission is most often via heterosexual sex or sex between men. Argentina also had a high rate of infection among pregnant women, especially in urban areas (García Abreu 2003).

The Caribbean has the worst HIV/AIDS epidemic in the world outside of sub-Saharan Africa, and Haiti is the country with the highest prevalence outside of sub-Saharan Africa. Transmission is most often through heterosexual sex, followed closely by sex between men. Since the 1990s there has been a significant increase in the number of women infected compared to the number of men, representing the most extreme manifestation of the overarching regional trend (World Bank 2001). Commercial sex workers in the Caribbean have extremely high rates of infection, some above 20 percent (UNAIDS 2006).

TREATMENT AND PREVENTION

Most of the prevention measures implemented in Latin America involve mass-media campaigns and education. Some campaigns—mostly those in Brazil, Mexico, and Central America—have been broadly based to reach the general public. Most education and public-outreach efforts do not place significant emphasis on consistent and proper condom usage, though Brazil's and Costa Rica's are major exceptions (García Abreu 2003). In addition, in addressing the HIV/AIDS epidemic, Latin American and Caribbean nations have not targeted their preventative measures at high-risk groups with high incidences of infection (García Abreu 2003; UNAIDS 2006).

Brazil and Costa Rica lead the region in providing antiretroviral therapy to afflicted patients, and some other Latin American nations are close behind. The United Nations estimated that 73 percent of Latin Americans in need of treatment were receiving it in 2005. However, poorer countries in Central America, the Caribbean, and the Andes have a harder time providing treatment to their citizens. Caribbean nations fare the worst, with less than one in four of those in need of antiretroviral therapy receiving treatment (UNAIDS 2006).

See alsoDiseases; Public Health.

BIBLIOGRAPHY

García Abreu, Anabela; Isabel Noguer; and Karen Cowgil. HIV/AIDS in Latin American Countries: The Challenges Ahead. Washington, DC: World Bank, 2003.

Smallman, Shawn C. The AIDS Pandemic in Latin America. Chapel Hill: University of North Carolina Press, 2007.

UNAIDS. Report on the Global AIDS Epidemic 2006. Geneva, Switzerland: Author, 2006. Available from http://www.unaids.org/en/HIV_data/2006GlobalReport/default.asp.

World Bank. HIV/AIDS in the Caribbean: Issues and Options. Washington, DC: Author, 2001.

World Bank. World Development Indicators 2007. Washington, DC: Author, 2007. Available from http://web.worldbank.org/WBSITE/EXTERNAL/DATASTATISTICS/0,,contentMDK:21298138?pagePK:64133150?piPK:64133175?theSitePK:239419,00.html.

                                Angela M. Granum