HIV AND AIDS IN THE AMERICAS: DIVERSITY OF EPIDEMIC IS ADDITIONAL RISK FACTOR, NEW REPORT SAYS

Washington, June 21, 2001 (PAHO) - The HIV epidemic is so varied in the Americas that its very diversity makes more likely its further spread, according to a new report by Pan American Health Organization experts, "HIV and AIDS in the Americas: An epidemic with many faces."

"Nowhere is the HIV epidemic more diverse than in the Americas, especially in Latin America and the Caribbean, where the levels, patterns of spread and responses to the epidemic are probably more varied than in any other geographical region of the world," said Dr. Fernando Zacarías, who heads the Pan American Health Organization's program on AIDS and Sexually Transmitted Infections.

The new report, prepared ahead of the United Nations General Assembly on AIDS that starts next week, says that as the HIV epidemic enters its third decade, "the challenges it poses to families, to societies, to governments and to science continue to grow. The more we learn about HIV and the behaviors that spread it, the more we are forced to recognize the diversity of the global pandemic." The UN meeting "is an opportunity for governments to address this issue in a significant way," according to Dr. Zacarías.

Because of the great diversity of behaviors that help transmit HIV in the Americas, widely varying population groups, and combinations of these, are exposed to the virus, and governments need better information to understand the patterns of spread and design appropriate responses, Dr. Zacarías said. All forms of transmission--sexual, blood, and maternal to child -- coexist in the Americas and affect population groups. Different prevention programs for each group are required, but for these to be effective, Dr. Zacarías said, a "second generation" surveillance system that includes more behavioral information is essential to prevent HIV/AIDS.

Available information on the spread of the epidemic is not systematic or comprehensive, relying on blood tests of pregnant women, sporadic surveys of sex workers, and reports of sexually transmitted infections. In many countries in Latin America and the Caribbean, there is very little information "about infection levels or risk behaviors in sub-populations especially vulnerable to HIV infection," the PAHO report said. These populations with the highest HIV infections rates include men who have sex with other men, men and women who inject drugs, prisoners, street children and other marginalized groups, including some ethnic minorities, and youths, who are also considered to be at higher than average risk of HIV infection.

The lack of information "is unlikely to be because such risk behavior does not exist. It is, rather, because it has been overlooked, deliberately or otherwise. Homosexual behavior is illegal in many countries of the Region and injecting drug use is illegal in all of them. Besides being illegal, these behaviors are widely frowned on and frequently denied, sometimes even by the people who engage in them. Because members of sub-populations with high risk behavior are also part of the wider population, the behaviors that expose them to HIV infection may also eventually expose the men and women with whom they interact, even when those men and women do not share the risk behavior," according to the report.

Although the HIV epidemic in the Americas has grown more slowly than in other areas, the report estimates that one person in 200 in North America and Latin America is infected with HIV and one in 50 is infected in the Caribbean. "The epidemic has not blown up to African levels, but the risk factors are present, and diversity is definitely one of these factors, " Dr. Zacarías said.

Around 1.3 million people in Latin America and another 360,000 in the Caribbean are now living with HIV. Since the epidemic began two decades ago, some 557,000 people have already died of AIDS in the Region.

Every day some 567 people are newly infected with HIV in Latin America and the Caribbean. In the United States and Canada widespread access to antiretroviral therapy has dramatically decreased AIDS mortality but new infections have not decreased appreciably and HIV prevalence has increased with approximately 900,000 persons now living with HIV, the report said.

The report was prepared by PAHO and UNAIDS experts and reviewed by members of the Monitoring the AIDS Pandemic Network and the Latin American and Caribbean Epidemiology Network for HIV/AIDS. It is available on the PAHO web site at http://www.paho.org/English/HCP/HCA/faces_final.pdf.