InterPress News Service (IPS) - Monday, December 1, 1997
Daniel Gatti

MONTEVIDEO, Dec 1 (IPS - Latin American Desk) - Inadequate prevention policies and the high cost of treatment mark the future outlook for AIDS in Latin America, said experts from several countries in the region on the occasion of World AIDS Day Monday.

Studies by the Pan-American Health Organisation (PAHO) indicate that close to 785,500 cases of full-blown Acquired Immuno Deficiency Syndrome (AIDS) have been reported in the American continent since 1986, 461,500 of whom have died.

In 1995, there were 55.5 AIDS victims per million inhabitants in Latin America, 215.2 in North America and 247.1 in the Caribbean.

Some 30 million people currently live with the AIDS-causing Human Immuno Deficiency Virus (HIV) today, the immense majority - 90 percent - of whom are in the developing world, primarily Africa and Asia.

"While AIDS prevalence in Latin America is lower than in other parts of the Third World, we must not sit back and do nothing," said Dr. Pedro Cahn, president of the Argentine AIDS Association.

Overly frequent reports on the industrialised world's success in lowering sero-positivity levels and ameliorating the virulence of the disease do not contribute to prevention, he added.

Watchfulness and resistance to "lowering the guard" must be even higher in areas of the world where the state lacks the means of providing adequate care for AIDS victims, said Jorge Peries, an Argentine expert living in Paris.

In Nicaragua, which presently has the lowest AIDS prevalence in Central America, the government predicts a major rise due to both increasing poverty and social marginalisation and to improved reporting and monitoring.

A large number of people in Nicaragua and other Central American countries are even unaware of how to avoid infection.

"In the past four years, the number of AIDS - rather than HIV- positive cases - has risen fivefold," stresses a Nicaraguan Ministry of Health report, which forecasts a total of 24,600 HIV- positive individuals by the year 2000, compared to the 227 cases detected from 1987 to late 1995.

Latin America "lacks adequate prevention policies, and medication - especially combination treatments - is not within everyone's reach," said Cahn.

"Due to the inability to finish a course of treatment once it has been started, because the patient cannot obtain the drugs with the required frequency from the state, nor purchase them because they are extremely expensive, strains that are more resistant to the medicine begin to emerge," said the physician.

What seems to be the most effective therapy for curbing the onset of AIDS, the triple combination anti-retroviral treatment, costs around 10,000 dollars a year per person in Latin America, according to a PAHO report.

Administered since 1995, the triple combination treatment, which combines three drugs, keeps up with the multiplication of the AIDS virus, eliminating as many infected cells as are reproduced daily in HIV-positive individuals, its inventor Martin Markovitz explained last week in Montevideo.

Health Minister Raul Bustos of Uruguay, where treatment of HIV patients is compulsory in all health centres, stressed that the application of the triple combination treatment cut the number of deaths caused by AIDS in half in one year.

Since 1985, 2,411 HIV-positive individuals have been officially reported in Uruguay, although experts put the real number at around 7,200. Of the total 979 patients who developed full-blown AIDS, 519 have died.

Markovitz stressed that the triple combination treatment inhibits the development of AIDS but does not cure it. He told the Montevideo daily 'El Observador' that "in one or two years" he would be testing a vaccine. But other researchers are more pessimistic, predicting that it will be many years before a vaccine capable of defeating the deadly disease is discovered.

"The high cost of the combination 'cocktails' is without a doubt one of the most pressing problems for infected people in the Third World," commented a member of a support group for HIV- positive people in Brazil.

Meeting in November in the Uruguayan city of Piriapolis, the health ministers of the Mercosur trade bloc - comprised of Argentina, Brazil, Paraguay and Uruguay, plus associates Bolivia and Chile - decided to join together to make joint purchases of the medicines used in combination therapy, aiming to cut the cost of the treatment by up to 50 percent.

In Venezuela, a court decision obliged the social security system to provide medication and treatment for HIV-positive individuals. But that does not occur in practice, due to the collapse of that system, say support groups for persons living with HIV.

In Venezuela, where 7,024 AIDS victims have been officially registered since 1982 - 4,081 of whom have died - a network of social organisations providing assistance to HIV-positive patients has arisen to make up for the insufficient state- provided care.

World Health Organisation documents indicate that in many poor countries, especially in Africa and Asia but also in Latin America - Bolivia, El Salvador, Guatemala and Nicaragua, for example - the great majority of the population lacks access even to AIDS tests. (END/IPS/TRA-SO/DG/JC/SW/97)

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