Miami Herald - November 23, 2005
Jacob Goldstein, jgoldstein@herald.com

The number of people living with HIV and the number of people dying from AIDS is holding steady in the region, even as caseloads increase in every other part of the developing world. The news is particularly heartening because the Caribbean has long had the highest rate of HIV and AIDS outside sub-Saharan Africa.

Perhaps most encouraging are long-term declines in Haiti, the hemisphere's hardest-hit country.

"This is tremendous," said Dr. Jean William Pape, who has treated AIDS in Haiti for more than 20 years. "We have everything -- bad political situation, terrible economic conditions, high risk of sexually transmitted disease . . . If you put it all together, the fact that this was reversed is remarkable."

HIV cases and AIDS deaths increased in Latin America, though rates there remained far lower than in the Caribbean.

Several factors have driven the decline in Haiti, including widespread education programs, new clinics, an infusion of international aid, and an early recognition that a commercial blood bank was distributing tainted blood.

The nation's infection rate remains high -- about 3 percent of the adult population has HIV, five times the rate in the United States. But that is down from roughly 5 percent in the 1990s, according to an estimate by Eric Gaillard, a Port-au-Prince researcher funded by USAID.

AIDS remains the leading killer of young adults in the Caribbean. The region's overall infection rate is 1.6 percent, but rates vary widely from country to country.

A PARTIAL BREAKDOWN

The new report, released Monday by the United Nations and the World Health Organization, does not give a full country-by-country breakdown. But it does say HIV rates are over 1 percent in Barbados, the Dominican Republic and Jamaica, and over 2 percent in the Bahamas, Guyana, and Trinidad and Tobago.

In Cuba, by contrast, the rate remains below 0.2 percent, by far the lowest in the region. A UN assessment credited the nation's long-standing treatment, education, testing and research programs. But the country has been criticized for forcing AIDS patients to leave their homes and live in isolation.

But the rate of new HIV infections in Cuba, though still low, is rising, possibly as a result of a growing sex industry, according to the report.

Elsewhere in the region, several factors appear to be slowing the spread of HIV. Among the shifts singled out in the report: better care for HIV-positive pregnant women in the Bahamas, more voluntary counseling and testing services in Barbados, and widespread condom use among prostitutes in Santo Domingo.

Dr. Michel Dodard, a Haitian-born UM physician who helps run a medical center in Cap-Haitien, said broad cultural shifts have helped fuel declines in Haiti.

"There is clearly a better educational effort that's being made, better acceptance of things like use of condoms," he said. "You can see, even when you drive in the country, advertisements for condoms, which at one time was not culturally acceptable."

The stigma of being HIV positive is also declining, Dodard said.

"The ostracism is not completely gone, but you find more and more people willing to talk about it and going for testing," he said.

Two decades ago, in the earliest days of the AIDS epidemic, the United States Centers for Disease Control and Prevention identified four groups at high risk: gay men, intravenous drug users, hemophiliacs and Haitians.

The designation "created a real blow to national pride," Pape said. But it also led to the formation of institutions to study and treat the disease.

"It created a national reaction against what appeared to be discrimination," he said.

These institutions persisted after the CDC took Haitians off the high-risk list, and they have survived the country's instability.

"For my country, the fact that we can stand up and fight against this disease has been extremely important," Pape said. "I can tell you for sure, we will control AIDS here."

ON THE CONTINENT

In Central and South America, according to the report, the infection rate is 0.6 percent, comparable to the rate in North America.

Within the region, the epidemic is most intense in Belize, Guatemala and Honduras, all of which have infection rates of 1 percent.

In raw numbers, Brazil, Argentina, and Colombia have the largest share of the region's 1.8 million HIV cases.

In Brazil surveys suggest teenagers are having sex at earlier ages and with more partners, the report said. One survey of 15-24-year-olds found that only 62 percent knew how HIV is transmitted.

In Argentina, most new infections are coming from unprotected sex between men and women, with women bearing a growing share of the burden. In 1988, women accounted for one in 16 AIDS cases; in 2004, they accounted for one in four.

Increasing numbers of women are being infected in Colombia, as well, particularly along the Caribbean coast and Northeast.

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