Associated Press - November 18, 2003

"HIV/AIDS in Latin American Countries: The Challenges Ahead" presents the results of a 2001 survey of health workers, governments and international organizations in 17 countries, spanning a region from Mexico to Argentina.

The authors said Latin American countries have increased efforts to prevent the spread of HIV/AIDS, but these measures are hampered by inadequate resources, underreporting of the disease, inadequate health care and social prejudices.

According to the study, 0.5% of individuals 15 to 49 years old are infected with HIV. About 130,000 adults and children were infected with HIV in 2001, and 80,000 died of AIDS.

But the researchers say underreporting is so common that the region likely has 30% more cases of AIDS and 40% more cases of HIV than existing statistics show.

"Although AIDS accounts for only a fraction of all adult deaths in most Latin American nations, those deaths occur in the most productive years of life," the study's authors wrote.

In almost all the countries in the study, infection rates are still concentrated in high-risk populations, such as prisoners, injecting drug users, commercial sex workers and men who have sex with men.

The exceptions are Honduras and southeastern Brazil, where the epidemic has reached the general population.

Nearly 2% of Honduran adults are infected with HIV. In Brazil, which has the highest number of HIV/AIDS cases in Latin America, heterosexual sex is the main mode of transmission in the southern region.

Heterosexual sex is also the primary mode of transmission in Central America, the authors said, while sex between men the is predominant means in South America. Intravenous drug use plays a significant role in the Southern Cone countries of Argentina, Uruguay, Paraguay and Chile.

Indeed, Argentina was the only country that reported injecting drug use as the leading mode of transmission, accounting for 41% of cases.

Throughout the region, people who don't fit the traditional high-risk profile are increasingly vulnerable, the authors said.

"The disease appears to be evolving from affecting only the highest risk groups...to becoming an increasingly generalized problem," the authors wrote.

Young people and women are increasingly vulnerable to HIV infection, the researchers said, and targeting of this population by educators and health workers is crucial if the disease is to be contained.

The number of men living with AIDS outweighs the number of women in all countries, the authors said, but the gender gap is closing. And behaviors associated with spread of the diseases, such as first intercourse at a young age and violence against women, are commonplace.

Inadequate or expensive health care prevents many individuals from getting tested for HIV or from receiving treatment for the disease, the study found. Nine of the countries under study, including Honduras, lack even a single anonymous testing center. Brazil is the only country in the region that provides locally produced retroviral drugs to people living with the disease, the report said.

Retroviral drugs can greatly prolong the health and life expectancy of someone living with HIV. But their high cost usually places them out of the reach of most individuals living in developing countries.

The study's authors recommended greater cooperation between non-governmental organizations, which usually have the greatest access to at-risk populations, and governments.

They also said civil organizations need to put more resources toward working with high-risk groups to prevent HIV from spreading to the general population.

According to the most recent report of the U.N. Program on HIV/AIDS, an estimated 42 million people worldwide are living with the disease. The Caribbean is the world's second most affected region, after sub-Saharan Africa.

The World Bank study was co-authored by Anabela Garcia Abreu, Isabel Noguer and Karen Cowgill and was released in Washington.
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