Latin American countries have stepped up efforts to prevent the spread of HIV/AIDS, but there is still need for better use of resources, stronger HIV/AIDS surveillance and broader civil society participation, a new comprehensive study by the World Bank says.
HIV/AIDS in Latin American Countries: The Challenges Ahead, presents the results of a detailed examination conducted in the 17 countries that span the region from Mexico to Argentina. The 301-page report is based on information supplied by government, physicians, and civil society organizations with large experience in HIV/AIDS prevention and treatment activities, as well as data drawn fro national statistics, international organizations and from studies undertaken in the region.
"Latin America has the organizational infrastructure and the community of professionals for sustained programs to counter the disease," said Anabela Abreu,the report's principal author and current World Bank Health Sector Manager for the South Asia region after many years of extensive work in Latin America. "If the warning signs are heeded, and appropriate prevention measures taken in the very near future, Latin America has the opportunity to avoid the sad outcomes seen in other regions."
The report, co-authored by Anabela Abreu, Isabel Noguer and Karen Cowgill, says that if the epidemic is not kept in check, HIV/AIDS will continue to inflict a costly impact on countries in the region, putting health systems under serious pressure, and causing significant economic losses. As a result, the costs of investing in multi-sectoral interventions now to reduce and mitigate the risk of an HIV/AIDS epidemic are significantly lower than the costs incurred later by a full-blown epidemic
According to the study, the prevalence of HIV among 15-to-49-year-olds is at 0.5 percent throughout the region. Some 130,000 adults and children were newly infected with HIV during 2001, and 80,000 died. But under-reporting is so common that researchers calculate that Latin America is likely to have 30 percent more cases of AIDS and 40 percent more cases of HIV than existing statistics show.
One of the report's key conclusions is that civil society, including Non-Governmental Organizations (NGOs), must be mobilized in greater strength because they have stronger links to high-risk groups. In the terminology of HIV/AIDS experts, high-risk groups include Men who have Sex with Men (MSMs), Commercial Sex Workers (CSWs), Injecting Drug Users (IDUs), and people with Sexually Transmitted Infections (STIs) and multiple partners. Focusing attention on these groups can help prevent HIV/AIDS from spreading into the population at large.
Already, HIV/AIDS has leapt from high-risk groups into the general population in two countries, Honduras, where an estimated 1.9 percent of the adult population is infected; and Brazil, where heterosexual sex has become the dominant mode of transmission in the country's southern region.
Latin America-wide statistics mask wide disparities in the extent HIV penetration and in the level and quality of response.
"Not every country has anonymous testing centers for high-risk populations," said Evangeline Javier, the World Bank's Health Sector Manager for Latin America and the Caribbean. "Availability of anonymous testing is crucial for diagnosis and prevention."
Other facets of anti-HIV/AIDS campaigns at the country level include:
In Mexico, a high proportion of men returning from work in the U.S. infect their partners. As early as 1994, 25 percent of rural AIDS patients had worked in the U.S., as opposed to 6 percent of urban cases.
Argentina is the only country reporting injecting drug use as the number-one mode of transmission, with 41 percentof cases occurring through that channel.
In Brazil, injecting drug use is the number-two means of transmission, accounting for 27 percent of cases.
"This epidemic is not only a matter of health statistics but of socioeconomic well-being, and the overall condition of the community in general," said Ana María Arriagada, World Bank Director for Human Development in Latin America and the Caribbean. "Control and prevention require the participation and coordination of governments and civil society joining in a common effort."
By September 2003, the Bank had approved over $550 million in loans to help finance the implementation of HIV/AIDS prevention and control programs in Argentina, Barbados, Brazil the Dominican Republic, El Salvador, Grenada, Haiti, Honduras, Jamaica, Mexico, Trinidad and Tobago, St. Kitts and Nevis, and Venezuela. The Bank's longest involvement has been in Brazil, where the institution has financed three large projects, and the major focus of support is the Caribbean, which has the largest epidemic outside of Sub-Saharan Africa.
According to the most recent report of the United Nations Program on HIVAIDS (UNAIDS), an estimated 42 million people worldwide are living with HIV/AIDS. The Caribbean is the world's second most affected region. New estimates, due to be released soon, will likely indicate an increase in the number of people living with HIV/AIDS in many areas.