Aids Alert International-HIV/AIDS response differs among Latin American countries
Some nations offer antiretrovirals; others cannot afford drug treatments
While the HIV epidemic has not caused as much devastation south of the U.S. border as it has in other regions of the world, it still taxes financial and health care resources among many Latin American nations, some of which have spent hundreds of millions of dollars treating those infected.
Plus, UNAIDS of Geneva, Switzerland, reports that the epidemic is picking up speed, particularly in certain southern nations, Central America, and the Caribbean. (See story on HIV in the Caribbean, p. 3.)
An estimated 1.3 million people in Latin America have HIV, and there have been more than 520,000 deaths in the region from AIDS, according to statistics from UNAIDS.
The adult HIV prevalence rate in Latin America is 0.57%, which is nearly identical to the prevalence rate in North America. Also in both regions, about 20% of HIV-positive adults are women and the chief mode of transmission is men who have sex with men, followed by injection drug use and heterosexual sex.
But the epidemic's trends differ greatly among Latin American nations. For example, in Bolivia, the disease hasn't reached epidemic proportions, with little more than 300 AIDS cases. In this nation, HIV spreads chiefly through heterosexual contact, and Bolivian officials say the rate of infection is equal between men and women, says Adriana F. Gómez Sagüéz, advisor to UNAIDS for the Andean Region. She works in Lima, Peru.
Surveillance numbers cannot accurately reflect the epidemic's spread in Ecuador, but UNAIDS officials say the disease also is chiefly a heterosexual problem in that nation, Gómez Sagüéz says.
"Economics and the political situation of this country make it very difficult to keep the surveillance work up to date," she adds.
Peru, which has more than 10,000 AIDS cases, has three times as many infected men as women, and the chief mode of transmission there is through homosexual contact.
Brazil, the largest Latin American country, has more than 530,000 HIV cases, which are believed to be chiefly due to heterosexual transmission. A recent Brazil health ministry study showed that more than three-quarters of the population had not used a condom during the previous 12 months, and nearly half of men and 32% of women had sex before reaching age 15.
In some southern nations, injection drug use plays a big role in HIV's spread. For instance, in Argentina, which has more than 16,000 AIDS cases, the number of people infected with HIV via drug use is nearly 40%. In Uruguay, drug use accounts for about 27% of AIDS cases, while heterosexual transmission accounts for about 40% of cases, says Mercedes Weissenbacher, MD, who works with HIV patients in Buenos Aires, Argentina, and who is the former inter-country program advisor for the Southern cone in South America.
Heterosexual and homosexual transmission are nearly identical in Argentina, with each accounting for 25% of cases, she adds.
"But in Chile, there mostly are homosexual cases, with more than 70% of HIV transmitted homosexually," Weissenbacher says.
Paraguay also has many cases due to men who have sex with men, with about 50%.
Prevention and treatment programs vary widely in the region. Some countries, such as Brazil, Argentina, and Chile, provide antiretroviral medications to HIV patients. Other, poorer nations, including Ecuador, have no funds for any antiretroviral drugs or for medications to treat opportunistic infections.
"In Bolivia, they provide some medications for people who are infected and who are covered by a social security plan," Gómez Sagüéz says. "In Peru, they only have medication for pregnant women to cut down the mother-to-child transmission."
On the other hand, Argentina and Uruguay each provide antiretrovirals to all people who test positive for HIV. They each receive at least three antiretroviral drugs, Weissenbacher says.
This has led to a decline of more than 40% in the number of new AIDS cases reported each year in Argentina.
Brazil spent $300 million in 1999 providing antiretroviral drugs to about 75,000 people with HIV. The Brazilian government estimates that this program has saved more than $100 million in hospital admission and treatment costs.
Paraguay had been paying for three antiretroviral drugs for each person with HIV, but due to economic constraints, the government had to cut back in 1999 to providing two drugs per person.
More problems arise in the area of prevention, testing, and counseling. Social barriers might be as big an issue as funding in some nations.
While Argentina does very well with drug assistance, the nation fares poorly in the area of prevention, Weissenbacher says.
"For example, if you ask me, prevention among injecting drug users is very low, and for men who have sex with men it is very low," she adds.
Prevention efforts are beginning to pick up, however. "I think now things are changing," Weissenbacher says. "Not very much, but some actors, movie stars, and football players are doing short TV ads about HIV prevention."
This is a notable change, considering that five years ago it was nearly impossible for anyone to mention condoms in Argentina, she adds.
The Catholic Church has played a large role in discouraging any prevention education for school children that includes discussion of condoms, Weissenbacher says.
"There are many private Catholic schools, and we were working with them on programs that talk about sexual education, drug use, and prevention of HIV, without discussing condoms," Weissenbacher explains.
Also, UNAIDS has sponsored a pilot project on HIV prevention through risk reduction among injection drug users in four countries. But while the program appears to be working, it can only reach a handful of the targeted drug users, and a broader-based government effort is needed, Weissenbacher says.
In Chile, HIV experts work with schools and through peer counseling with men who have sex with men on HIV prevention. Uruguay has many good TV prevention campaigns, and the nation provides prevention education in schools. Last year, the nation began preparing programs for men who have sex with men and for injection drug users.
In Paraguay, there are programs that work with female sex workers on how to use the female condom, and condoms were distributed for free in one project. "There has been a high acceptance of the condom by female prostitutes and their clients," Weissenbacher says.
Farther north, Bolivia is providing prevention education to sex workers, and in Peru, HIV experts are working with young people through peer education, Gómez Sagüéz says.
An international Catholic Church organization, called International CARITAS, has an agreement at the global level with UNAIDS to work in the prevention of HIV/AIDS. The program reinforces sexual responsibility and abstinence, and obviously, no condoms promotion program is planned, Gómez Sagüéz says. "You can't expect the Catholic Church to hand out condoms."
Instead, the group discusses responsibility and how HIV is transmitted, and promotes abstinence until marriage.
Prevention programs are limited chiefly because of economic difficulties, Gómez Sagüéz says. "The poor countries are not getting everything the rich countries are, which is not only information, but resources, medications, treatments, and access."
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