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December 2008 Edition

Communicable Diseases
Region Makes Progress, Faces Challenges on HIV

Efforts to fight HIV/AIDS in the Americas have yielded mixed results, the Pan American Health Organization's (PAHO) top AIDS expert said on World AIDS Day, Dec. 1.

"We do see progress in our region, but there is still an unacceptable number of new infections, and mortality has not decreased as expected," said PAHO's senior advisor on HIV, Gottfried Hirnschall, during a panel discussion at PAHO headquarters marking World AIDS Day.

Some 3 million people are living with HIV in the Americas today, up from 2.7 million at the start of the decade, he said. This represents a "leveling off" of the epidemic. But in 2007, the latest year for which data are available, some 100,000 people died of AIDS. "That number should be lower, given the availability of treatment," he said.


Courtesy Ministry of Health of Brazil

In 2007, some 214,000 people contracted HIV in the Americas, or about 586 per day. Access to antiretroviral treatment (ART) in Latin America and the Caribbean has expanded to 62 percent of people who need it, said Hirnschall. However, that regional average masks much lower rates of coverage in many countries. Only Brazil approaches coverage of 100 percent.

Similarly, testing for HIV in pregnant women is about 50 percent regionwide but is even lower in many countries. Only 36 percent of pregnant women living with HIV receive ART, said Hirnschall. "This is really an unacceptable situation."

The proportion of women versus men with HIV has increased over the years, but this trend also is leveling off, said Hirnschall. In the Caribbean, half of people with HIV are women; in Latin America, there are three men for every woman with HIV.

Hirnschall said that without a strong focus on prevention, "the number of new people infected with HIV will always exceed the number who are getting treatment."

He also noted that stigma against people with HIV and vulnerable groups remains a major problem, contributing to suffering and also impeding prevention and treatment efforts.

Special efforts should be focused on high risk groups, Hirnschall said.

"In Latin America and the Caribbean, we should speak of epidemics, not one epidemic. In the vast majority of countries, there are concentrated epidemics in specific populations rather than a generalized epidemic." These most-affected population groups include men who have sex with men, transgender individuals, sex workers, injecting drug users, incarcerated populations, vulnerable children and youths, and ethnic minorities.

The major challenges for HIV efforts in the Americas today, Hirnschall said, include:

  • Scaling up and targeting prevention efforts at specific groups in which transmission is occurring.
  • Strengthening health systems and mainstreaming HIV efforts into them.
  • Mobilizing other sectors, such as education, to build a multisectoral response.
  • Improving resource mobilization in Latin America and the Caribbean, for example, from the Global Fund for AIDS, Tuberculosis and Malaria.
  • Improving coordination among United Nations agencies and increasing civil society participation in HIV efforts.
  • Translating new evidence into policy and program action.

Also as part of its observance of World AIDS Day, PAHO highlighted new approaches to communication for HIV prevention with an exhibit of artworks from the 1st International HIV/AIDS Cartoon Exhibition, an initiative of  the Ministry of Health of Brazil and the Memorial Institute of Graphic Arts of Brazil. The PAHO exhibit, "Drawing it Out," featured 60 of 300 cartoons selected from among 1,200 entries from 50 countries illustrating humor as an opening for discussion of HIV.

PAHO also exhibited 200 television spots from its "VIHdeo America" collection of HIV prevention public service announcements from 24 countries.

 
 
 

PAHO briefs OAS rights commission

Pan American Health Organization (PAHO) staff briefed members of the Inter-American Commission on Human Rights (IACHR) on HIV in Central America, at the Organization of American States (OAS) inWashington, D.C., in October.

PAHO human rights specialist Javier Vásquez and HIV expert Monica Alonso described the scope and nature of the HIV epidemic in Central America and analyzed human rights aspects of the epidemic in the context of the "right to health" and resolutions passed by PAHO Member States.

They noted that Central America has among the highest rates of HIV in Latin America, but fewer than half of those with HIV have access to treatment. Many suffer from stigma and discrimination as a result of their HIV status. Vásquez noted that PAHO/OAS member countries are, in general terms, obliged by their constitutions and international treaties to guarantee their citizens' human rights in these and other areas related to public health.

The IACHR requested the PAHO briefing to support its efforts to monitor and defend human rights and fundamental freedoms—including those of people with HIV—throughout the hemisphere.

 

 
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