Health Status of the Population
Human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) in the Americas
According to data from the Joint United Nations Program on HIV/AIDS (UNAIDS), an estimated 2 million people were infected with HIV in Latin America and the Caribbean (LAC) in 2015. More than 98% of them were over 15 years of age. The population of children with HIV has systematically declined in recent years, but not the absolute number of adults with HIV, which has increased in both sexes, and especially among men, rising more than 13% since 2013 and nearly 3% in the last year ().
The estimated prevalence of HIV infection among people age 15 to 49 years in LAC in 2015 (0.47–0.6%) has remained stable over the last decade. The Caribbean is especially affected, with 1% prevalence. In Latin America, the epidemic has mainly affected men, who represent 68% of people with HIV. In the Caribbean, however, 52% of people with HIV are women ().
For the countries, the highest prevalence reported is for the male population of the Bahamas (4.2%), followed by women in the Bahamas (2.3%), men in Barbados (2.1%), women in Haiti (2.1%), and men in Jamaica (2.0%). These are the only groups that surpass 2% prevalence.
Men who have sex with other men (MSM), sex workers, transgender women, drug users (especially users of injectable drugs), and some indigenous populations are among the groups disproportionately affected by the epidemic in the Americas (Figure 1). According to the data for 2015 reported by 21 countries in the Region, the average prevalence of HIV infection in MSM is around 15%, ranging from 1.3% in Saint Kitts and Nevis to 32.1% in Jamaica. It is estimated that more than half of MSM in LAC do not know their serological status with regard to HIV. Condom use is low (37%) and more than a third of MSM report not having used a condom the last time they had anal sex, both for those under and over 25 years of age (). A third of new infections in LAC occur among MSM (). In 2015, the average prevalence of HIV infection among sex workers was 3.7%, and it was much higher among transgender women (19.9%) than other women (1.3%). However, reported condom use is high among this population (85–90%). Limited data are available on transgender women, but in the countries that report on this group to the World Health Organization (WHO) and UNAIDS, the prevalence of HIV infection ranges from 8.4% in Guyana to 23.1% in Guatemala ().
Source: UNAIDS, AIDS info [online database] ().
There were an estimated 102,500 new HIV infections (between 86,000 and 121,000) in LAC in 2015 (Figure 2). Of these, 90% occurred in Latin America and 10% in the Caribbean. Four Caribbean countries (Cuba, the Dominican Republic, Haiti, and Jamaica) and four others in Latin America (Brazil, Colombia, Mexico, and Venezuela) account for three out of every four new cases of HIV infection in their respective regions. The new infection figures for 2015 show a reduction from 2000 and 2005 levels (23% and 10%, respectively). Since 2010, the number of new infections has stabilized, although with a small uptick in 2015 compared to 2013 and 2014 ().
Figure 2.Latin America and the Caribbean
Source: UNAIDS, AIDS info [online database] ().
Among children under 14, new infections dropped by 55% between 2010 and 2015 (). Among people over age 15 in LAC, new infections in men account for more than 70% of all new infections in adults. In the Caribbean—except in Haiti, the only country where the inverse is true—new infections among adult men (over 15 years of age) also surpass the number of new infections in women ().
More than one-third (35%) of new infections in adults are found in the young adult population (15–24 years); two-thirds of these are in young men (63%). By population groups, an estimated 30% of new infections occur in MSM, 23% in clients of sex workers and other sexual partners of key populations, and 6% in sex workers ().
It is estimated that 50,000 people died in LAC in 2015 as a result of HIV. There has been a continuous downward trend in annual deaths since a peak in 2005 (74,000 deaths), with a stable rate of decline (around 5% a year) since 2012 ().
In the last 5 years (2010–2015), the greatest declines in mortality (above 25%) have been registered in Uruguay (52.3%), Colombia (50.0%), Haiti (44.1%), the Dominican Republic (36.2%), Nicaragua (32.8%), Honduras (31.6%), and Chile (28.5%). During that period, two patterns were identified in the percent change in annual mortality: countries such as the Dominican Republic, Honduras, Nicaragua, Mexico, and Uruguay registered year-to-year declines in mortality (also Argentina, Bolivia, Chile, Colombia, Haiti, and Trinidad and Tobago, but only in the last 3 years), while countries such as Barbados and Venezuela saw continuous increases in mortality from one year to the next.
The pace of decline in annual mortality was greatest in 2015 in the Caribbean countries, with declines of more than 20% in the Bahamas and Suriname. By contrast, the biggest increases in annual mortality were seen in Guatemala (+28.4%), Peru (+19.7%), Cuba (+9.3%), and El Salvador (+9.1%) ().
Children under age 15 accounted for 3.6% of total deaths. This figure marks a new low, considering that it stood at over 10% two decades ago. The youth subgroup (15—24 years old) accounted for 4.5% of deaths ().
In LAC, 2.5 deaths per 100 people living with HIV were registered in 2015. The countries with the highest figures were Haiti (6 deaths per 100 infected people), Honduras (5.2 deaths), Dominican Republic (4.6 deaths), and Jamaica, Paraguay, and Bolivia (>4 deaths per 100 infected people). In the same year, 27% of new HIV infections were diagnosed in advanced stages of the disease (less than 200 CD4 cells) ().
In summary, improvements have been observed in the control of the HIV epidemic in the Region, with reductions in the number of new infections and deaths, but with differences among countries, some of which show continuous increases in both indicators. The number of people with HIV infection continues to rise along with the increase in life expectancy, since antiretroviral therapy is provided earlier. The presented data show that HIV continues to be an important public health problem in the Region, with a significant burden of morbidity and mortality that especially affects vulnerable and stigmatized populations.
Every year there are an estimated 64 million new cases of curable sexually transmitted infections (STIs) (Chlamydia trachomatis, Neisseria gonorrhoeae, syphilis, and Trichomonas vaginalis) in people 15 to 49 years of age (). Certain population groups present higher levels of STIs, such as sex workers, MSM, and transgender women. Syphilis outbreaks have recently been documented in populations of MSM in high-income countries, including the United States (). Human papillomavirus (HPV) infection is the most common viral infection of the genital tract. The estimated prevalence of HPV in LAC is 16.1% (95% CI: 15.8–16.4%) (). In 2014, an estimated 11.6 (7.1–16.6) million women were vaccinated in the Region, covering 19% of women and girls between ages 10 and 20 years ().
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