AIDS in Latin America: Epidemic stable, but still deadly

HAVANA, Cuba — Major gains have been made in the fight against the spread of HIV and AIDS in Latin America and the Caribbean, where the infection rate has held stable over the past decade.

But some of the highest rates of HIV/AIDS prevalence outside sub-Saharan Africa persist in several countries in the region, and experts warn that the disease continues to spread among certain at-risk populations. In addition, nearly one-third of those infected in Latin America are still not getting treated, they say.

While the global spread of AIDS has stabilized, in Latin America “stabilization of the epidemic is not a success,” said Cesar Nunez, the director of UNAIDS in the region.

“It reflects slow and fragile progress with modest gains,” said Nunez in an interview with GlobalPost. “There are still approximately 227 new infections every day in Latin America,” he added.

That infection rate still represents a significant decline from a decade ago. There were 92,000 new infections in 2009, the most recent year for which data were available, down from 99,000 in 2001, according to UNAIDS figures.

Overall, the HIV prevalence rate in the region was 0.4 percent, unchanged over the past decade. But the disease has wide variations, from a high of 3.1 cases per 100 residents in The Bahamas — which tops Latin America and the Caribbean — to just 0.1 per 100 in Cuba, one of the world’s lowest rates.

In 2009, some 58,000 died in Latin America of AIDS-related causes, according to UNAIDS data, up from 53,000 in 2001.  

“In most of Latin America and the Caribbean, the HIV/AIDS epidemic is concentrated in certain key populations, including men who have sex with men, sex workers, drug users and transgender women,” said Drew Bailey, a spokesman for USAID.

A USAID report cited one study that found that men who have sex with men in South and Central America “were 33 times more likely to be infected with HIV than the general population.”  Latin America’s economic, cultural and ethnic divisions produce vastly uneven infection rates, according regional UNAIDS director Nunez.

“Stigma and discrimination towards key populations most affected by the epidemic is the main obstacle limiting access to crucial HIV-related treatment, prevention, care and support services,” he said.

Efforts to reach those populations are showing promising results. Nunez singled out prevention efforts that have targeted sex workers — one of the populations most affected by the epidemic — as especially successful. Ninety-two percent of sex workers in the region report using a condom with their most recent client, he added.

Still, he cautioned that “prevention efforts need to be expanded to target other groups with the highest prevalence rates, in particular men who have sex with men and transgender women.”

Now a challenge for the region will be caring for the growing number of HIV- positive Latin Americans who are living with the disease and dependent on public health programs for treatment.

Most countries in Latin America and the Caribbean fund their own HIV response programs. Domestic sources accounted for 93.6 percent of overall spending, according to a report last year published by National Institutes of Health. Their growing economies have helped fund big increases in health care spending.

Though antiretroviral coverage increased from 10 percent in 2004 to 50 percent in 2009, governments in the region continue to pay some of the highest rates in the world, the report found.  

The boost in the availability of antiretroviral therapy has led to an increase in the number of people living with AIDS in the region, from 1.1 million to 1.4 million.

Another major success cited by experts has been the sharp decrease in mother- to-child transmission as a result of much-improved access to testing, services and treatment.

According to the USAID study, the number of children acquiring the disease in Latin America and the Caribbean declined by 45 percent between 2001 and 2010, from 9,200 to 5,100 cases. Child deaths from AIDS dropped from 6,300 to 3,700 during that same period.

“If these achievements can be scaled up quickly and effectively throughout the region, Latin America could become one of the first regions in the world to achieve the vision of zero babies born with HIV,” said Nunez.