HIV/AIDS in Latin America

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Science  25 Jul 2008:
Vol. 321, Issue 5888, pp. 465
DOI: 10.1126/science.1162896
CREDIT: GABRIEL GONZALEZ

Sixteen International Aids Conferences were held before the HIV/AIDS community looked to Latin America and the Caribbean. Finally, next month, the world will pay long-overdue attention to this region when the XVII International AIDS Conference (AIDS 2008) is held in Mexico City. Given that so many in Latin America and the Caribbean have died from HIV/AIDS and have fought this disease with the same enthusiasm and passion as in any part of Africa and Asia, there seems no justification for this lack of attention.

Although no country in Latin America and the Caribbean has the double-digit HIV prevalence seen in sub-Saharan Africa, there are an estimated 2 million people living with HIV/AIDS in the region, with about 120,000 new cases and 70,000 deaths in 2007. The cumulative estimate for 2015 is nearly 3.5 million HIV/AIDS cases and 1.5 million deaths from the disease.

CREDIT: MALCOLM LINTON

There are issues in Latin America and the Caribbean that make epidemic conditions unique to the region. Many people still do not understand that HIV/AIDS is a viral, not a moral, infection. Widespread stigma and discrimination hamper efforts to achieve universal access to HIV prevention, treatment, and care. HIV transmission continues to occur among populations at higher risk, including sex workers, males that have sex with males (but increasing among heterosexuals), injecting drug users, and migrants. Prevention efforts, including education campaigns, are disorganized and poorly supported because budgets are mainly devoted to treatment.

As far as treatment is concerned, for the past 5 to 10 years, most governments in Latin America and the Caribbean have been trying to provide antiretroviral drugs to all in need. This strategy is thought to be the most cost-effective, as well as the most visible, and is therefore the primary goal of most countries in the region. However, some countries that implement wide access to treatment have forgotten that universal access to expert care, prevention, and the monitoring of laboratories are as important as access to drugs. The education of more physicians to treat the disease has become a major challenge because many specialists do not want to treat HIV-infected individuals because of stigma and the fear of contracting AIDS themselves. Providing adequate care is even more complicated because tests that monitor response to treatment are not always given by the health care systems. Even when such tests are available, they are performed every 6 or more months apart (rather than every 3 to 4 months). This lack of monitoring allows more patients to develop viral resistance to drugs, and this can lead to a decrease in the efficacy of subsequent antiretroviral treatments, which are more expensive. The problem is compounded by the fact that infected people usually don't seek treatment until they have symptoms and/or low T cell counts. Together, these factors have decreased the impact of treatment on mortality reduction. As a consequence, HIV/AIDS is taking its toll on health expenditures in the region and on lives. These are not unlike problems experienced elsewhere, so there are opportunities to help countries in Latin America and the Caribbean avert the projected devastating effects the disease will have during the next decade.

But not all is bad. At the AIDS 2008 conference, Latin America and the Caribbean will showcase good examples of how to provide universal antiretroviral treatment with and without generic drugs, and highlight extraordinary activism among communities, governments, religious organizations, and researchers. These groups are working together to thwart the epidemic through new programs, including group-specific education campaigns and efforts to reach migrants as well as rural populations that sometimes speak local dialects.

The theme of AIDS 2008 is Universal Action Now, implying that immediate actions are needed in all regions of the world suffering from HIV/AIDS. By understanding the common and different issues across countries that are related to overcoming the disease, we can hopefully promote the most effective actions possible for each region, for each country, and for each human being.

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