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Latin America: Aids Epidemic under Control but Prevention Still a Challenge

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WASHINGTON, 1 December 2009.- As the world commemorates today the struggles to defeat the HIV/Aids epidemic, Latin America’s own plight reminds us that it is still a region engaged in a fierce battle against time to defeat a disease that has inflicted great havoc on its population.

As the world commemorates today the struggles to defeat the HIV/Aids epidemic, Latin America’s own plight reminds us that it is still a region engaged in a fierce battle against time to defeat a disease that has inflicted great havoc on its population.

"We’ve made progress with respect to treatment, reducing the mortality rate and delaying the onset of the disease in infected persons, but we must increase our focus on prevention among sexual workers, homosexuals and drug addicts," says World Bank Latin American health specialist, Joana Godinho.

Statistics are on Godinho’s side. According to the 2009 United Nations’ AIDS Report (UNAIDS), there are two million people living with HIV/AIDS in Latin America, while 170,000 new cases and 77,000 deaths linked to the epidemic have been reported. In the Caribbean, meanwhile, 240,000 people are living with the disease, with 20,000 new cases and 12,000 deaths reported. Unprotected sexual relations between men, sex workers and injecting drug users are the main focus of new infections, according to the report. For example, in Peru the number of male AIDS cases reported in 2008 was nearly three times higher than the number among females, “although this 3:1 differential represents a considerable decline from 1990, when the male:female ratio of AIDS cases approached 12:1”, says the UN study.

This continuing source of fresh cases is fueled both by a shortage of clear-cut prevention policies for high risk groups and by institutional prejudice, which in some countries still penalize homosexuality and prostitution, making the educational effort needed to stop HIV transmission even harder.

Challenging regulations

Although prevention programs in Latin America have tripled since 2005, more than 40% of the region’s countries still have laws, regulations or policies that hinder treatment for high risk population groups. In the Caribbean, more than 20% of countries have these regulations.

In spite of this somber scenario, however, there still seems to be reason for cautious optimism.
Take Brazil, where the government and the World Bank maintain a healthy partnership through various projects aimed at combating the spread of the epidemic.

After two decades of joint efforts and a US$400 million investment, the results are clear: 620,000 Brazilians are infected with HIV/AIDS today, half of the 1.2 million expected to have become infected by 2000. Approximately 180,000 people are on antiretroviral drug treatments. As a result, AIDS mortality has declined by 50 percent in Brazil, preventing an estimated 90,000 deaths.

Progress can be attributed to a transparent government prevention policy, which has enabled it to focus on high risk groups, and also to innovative World Bank-supported programs aimed at improving the governance of AIDS projects, fully integrating disease treatment in public health systems and overall strengthening of health systems.

Although prevention is still a great challenge –50% of new cases have their origin in high risk groups- the Brazilian government has taken control of the situation and “is making progress in this area too”, according to Godinho.

As the AIDS epidemic turns 30, Brazil’s experience in reducing the transmission rate can be a good lesson for the entire region, according to Keith Hansen, World Bank regional manager for health issues.

“The goal is not to stabilize HIV, an easily preventable but difficult virus, but to drive it back and get rates as low as possible,” he added.

Central America at a crossroads

AIDS does not measure everyone with the same yardstick, and despite standardized regional statistics, transmission and infection rates vary across the region.

One of the most troublesome areas is Central America, where the constant migration to and from the United States contributes to the spread of the disease and hinders any effective prevention and control policy.

Since journeys tend to last several weeks and migrants travel without their families, this area has struggled with this disease more than others, according to Marcelo Bortman, World Bank program leader for Central America.

As a consequence –warns Bortman- “hidden [HIV/AIDS] epidemics” have been detected in the area which in addition to regional interdependence and similarity of circumstances, call for the implementation of a joint regional strategy. Such strategy, financed by the World Bank through a US$ 8 million donation, includes a sophisticated diagnostic laboratory and an advanced monitoring system for migrant populations, among other measures.

“We believe that the best option is to look at this problem regionally because there is a lot of horizontal migration, and also because in that way we achieve economies of scale”, Bortman said.

The Caribbean looking stable

In the Caribbean region, meanwhile, the epidemic seems to have stabilized and the number of people dying because of AIDS – as well as the number of new cases – is going down, largely due to the availability of free antiretroviral medicines, according to specialists.

Furthermore, a greater number of people in the region now have access to antiretroviral therapy and many are turning up for treatment during the early phases of the disease, said Carmen Carpio, health specialist at the World Bank.

“This is a positive development but it questions the sustainability of further treatments, especially costlier second- and third-line drugs,” Carpio maintained.

In light of recent evidence, Caribbean countries need to prioritize young people as a critical high risk group. There are approximately 11,000 children under 15 years of age living with HIV/AIDS in the Caribbean, making them the group most affected by the epidemic, the expert said.

The World Bank has provided US$ 150 million in resources and funding for a wide variety of initiatives against AIDS in the Caribbean, including scientific research and laboratories, prevention programs and support for direct treatment.

It has recently approved two new projects for Jamaica, worth US$ 10 million, and Barbados, worth US$35 million, to reinforce those countries’ prevention strategies and contribute to slowing down the infection rate, according to experts.

“The epidemic has stabilized, and even though there’s still a great prevalence among high risk groups, it’s not growing at the rate we feared”, Carpio added.

All these initiatives have done their bit in the global and regional struggle against the Aids scourge and have had relative success in what is really important: saving lives. Looking forward, though, the developing world will have to deal with the increasing costs of combating the epidemic, estimated to reach US$ 35 billion – three times the current figure – by 2031 if the status quo is maintained.

That’s why Godinho, and many experts like her, insist on refocusing current prevention efforts on policies that have a greater impact on prevention and effective treatment, which could slash costs by half. They also recommend investing in new prevention tools and targeted initiatives to change behavior patterns that can result in further progress against this illness.

“We should not lose sight that the final objective, and our greatest satisfaction, is to save human lives”, Godinho concluded.