AIDS in Latin America: assessing the current status of the epidemic and the ongoing response
1 Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil.
2 Unit for Health, Sexuality and Human Development, Cayetano Heredia University, Lima, Peru.
3 International Planned Parenthood Federation Western Hemisphere Region, NYC, NY, USA.
4 Departamento de Medicina Social, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil.
5 Departmento de Medicina Preventiva, Escola de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
* Corresponding author. Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil. E-mail: Francisco.inacio.bastos{at}hotmail.com
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Abstract |
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Background This article provides a summary of the current status of the HIV/AIDS epidemic in Latin America, as well as an outline of the diverse responses to it.
Methods A search of international databases (Pubmed and ISI-Web of Science), regional databases (Scielo and Lilacs), regional and national documents and UNAIDS reports. Data are presented according to subregion.
Results In Mexico HIV remains concentrated among urban men who have sex with men (MSM), and has been growing among injecting drug users (IDU) and in rural areas in relation to migration. An increasing proportion of women among those affected is observed in all countries in Central America, the most affected region, as well as increasing the impact on other vulnerable groups, such as indigenous populations. The Andean Countries have urban epidemics concentrated among MSM. In Peru, non-traditional vulnerable populations were identified. In the Southern Cone heterosexual transmission became more relevant, probably in connection with IDU epidemics and is increasingly affecting lower income groups. Incidence rates have been declining since 2002 in Brazil, the first country to guarantee free, universal access to antiretrovirals, where one-third of drug-naïve patients are still initiating treatment at an advanced stage. Generally, access to treatment has improved as a result of support from the Global Fund and other initiatives, but there are concerns regarding coverage, equity and sustainability.
Conclusions HIV is still concentrated among MSM in Latin America. Non-traditional vulnerable groups such as migrants and lower income populations, usually considered part of the general population, deserve attention. Programmes confronting sexual exclusion are still needed. Access to treatment has improved over time, but inequalities persist.
Keywords HIV, AIDS, Latin America, men who have sex with men (MSM), Injecting drug users (IDU), access to treatment, highly active antiretroviral therapy (HAART), gender inequality, social inequality, vulnerable populations
Accepted 2 June 2008