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—from Epidemiological Bulletin, Vol. 21 No. 3, September 2000— Update on HIV/AIDS Surveillance in the AmericasThe WHO/PAHO/UNAIDS Working Group on AIDS estimates that there are about 2.6 million people living with HIV in the Region: 1.3 million in Latin America, 360,000 in the Caribbean and close to one million in North America. The epidemic in the Americas is growing steadily. In 1997, our report on HIV/AIDS surveillance in the Region* mentioned a cumulative total of about 750,000 AIDS cases and 440,000 deaths since the inception of PAHO’s surveillance system in 1986 (view previous report). As of May 2000, a cumulative total of 1,088,053 cases were reported in the Americas (see table 1), representing an increase of more than one third in the three-year period. At the same time, pediatric cases (less than 15 years of age) increased from 13,119 to 19,321, remaining at about 1.8 percent of all cases. A total of 513,522 deaths have been reported since 1986, but it is estimated that the number may be higher since data is incomplete for 1998-1999. The latest report* provided AIDS incidence rates for 1994 in Latin America of 58.2 per million population, 202.8 in the Caribbean and 236.3 in North America. By 1997, the incidence rate in Latin America had increased 34% to 77.7, and decreased 5% in the Caribbean to 191.9 and by 30% in North America to 165.8 per million population. Over the period 1994 to 1997, the male:female ratio of notified cases went from 3.5 to 2.6 in Latin America, 1.9 to 1.6 in the Caribbean and 4.4 to 3.3 in North America, showing a narrowing trend in these regions as the epidemic progresses. The HIV epidemic in the Americas is very diverse. The Andean countries are apparently among those least affected by HIV infection in contrast to several Caribbean states that have been severely hit by the epidemic. At the end of 1999, over 5% of adults between 15 and 49 were HIV positive in Haiti, and in the Bahamas, the adult prevalence rate was over 4%. The primary mode of HIV transmission in Central America and the Caribbean continues to be heterosexual. As of May 2000, exposure to the HIV virus through heterosexual contacts was responsible for 72.8% of all AIDS cases reported in Central America, 61.8% in the English-speaking Caribbean and 44.9% in the Latin Caribbean. In Guatemala and Belize, the heterosexual epidemic is growing fast, with HIV prevalence rates among adults in the general population between 1 and 2%. This is also reflected in the level of infection among pregnant women. The available data shows that in 1994 in Belize District for example, less than 1% of pregnant women using antenatal services tested positive for HIV, while the prevalence had risen to 2.5% in 1997. In other countries of Central America such as Costa Rica and Mexico, HIV is transmitted mainly during unprotected sex between men. As of May 2000, homo/bisexual transmission was responsible for 35.1% of the cumulative total of AIDS cases in Mexico, 42.3% in the Andean Region, 28.7% in Brazil and 49% in North America. In this case, the low prevalence of HIV infection among heterosexuals is reflected in a relatively low prevalence rate among pregnant women. In 1999 in Colombia, nowhere was the rate greater than 1 in 250 in this group. Transmission attributed to intravenous drug use is dominant in the Southern Cone, where 33.4% of AIDS cases reported as of May 2000 are due to exposure to the HIV virus through injection drug use, but also frequent in North America (33.2%) and Brazil (19.3%). One of the important aspects of the epidemic in Latin America is that several countries, including Argentina, Brazil and Mexico, are providing antiretroviral therapy for people infected with HIV. Coverage still varies widely - access to antiretroviral therapy is more limited in Central America and Caribbean states for example - but these efforts are nevertheless having a definite impact. Although treatment is expensive, savings in the direct and indirect costs of illness and the improvement in both the length and quality of people’s lives support the use of antiretroviral drugs that slow down the progression of the disease. The provision of therapy is complicating the task of HIV and AIDS surveillance and increasing the proportion of people living with HIV. The weakness of some surveillance systems also make it difficult to determine trends over time. Other factors such as under diagnosis, under and delayed reporting affect the completeness and quality of the information for analysis and planning. PAHO and its Member States are working continuously to improve the quality and completeness of the data. To improve the collection of information, PAHO is currently implementing second generation HIV surveillance, which concentrates resources where they will yield information that is most useful in reducing the spread of HIV and providing care for those affected. These efforts are carried out in part through the use of networks of AIDS epidemiologists such as LAC EpiNet. All the relevant epidemiological information about each country in the American Region is presented in the Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections prepared by PAHO and the WHO/PAHO/UNAIDS Working Groups on Global HIV/AIDS and STI Surveillance. These notes can be accessed through the PAHO Web site: WWW.PAHO.ORG (access the fact sheets).
References: Source: PAHO. Division of Disease Prevention and Control, Program on AIDS and Sexually Transmitted Infections (HCP/HCA)
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