sustainable development 20 years on from the ... - José Eli da Veiga

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Thanks to the improvements in water supply and sanitation services noted earlier, the level of
mortality from intestinal infectious diseases has fallen considerably among the population in general.
Proportionally speaking, this cause of death fell from number 24 in 1997 (0.99% of all deaths) to number
33 in <strong>20</strong>07 (0.62% of all deaths). Among children aged 1 to 4 <strong>years</strong>, however, it was the second largest
cause of death in 1997 and the third largest in <strong>20</strong>07, accounting for 8.8% of deaths in that age group in
both <strong>years</strong> (PAHO, <strong>20</strong>11a). Overall, risk of death from intestinal infectious diseases in the region came
down from 6.8 per 100,000 inhabitants in 1997 to 3.4 per 100,000 in <strong>20</strong>07, but with major variations
—from 1.17 to 29.4 per 100,000 between countries (PAHO, <strong>20</strong>11b).
(b)
Control of communicable diseases
The incidence of malaria fell by 53% in the region between 1992 and <strong>20</strong>09 (PAHO, <strong>20</strong>08a).
Some examples of what are known as neglected tropical diseases have also been successfully reduced. Of
the 13 original foci of onchocerciasis (river blindness) in six countries (WHO, <strong>20</strong>10a), eight have been
eradicated. Endemic transmission of lymphatic filariasis has been reduced from seven to four countries
(WHO, <strong>20</strong>10b). The transmission of schistosomiasis, too, has been reduced (Amaral and others, <strong>20</strong>06)
and the transmission of Chagas’ disease in the household environment was also eradicated in several
countries in the region during this period (PAHO, <strong>20</strong>10a).
More efficient and timely early warning systems are needed, as demonstrated by the emergence
of rapid-spread communicable diseases such as influenza A (H1N1), the recurrence of outbreaks of
leptospirosis, yellow fever and other viral haemorrhagic fevers and the resurgence of cholera in Haiti.
Dengue is an unresolved challenge: the number of cases has risen constantly. What is needed is a
thoroughgoing revision of preventive and control measures based on better-integrated ecosystemic and
public health strategies. 6 As the efficiency of intervention measures and strategies becomes better
understood, a greater effort is needed to broaden and strengthen prevention and control of neglected
tropical diseases. Efforts need to be focused on eradicating the last remaining pockets of trachoma,
onchocerciasis, leprosy and other diseases (PAHO, <strong>20</strong>09b).
The prevalence of HIV/AIDS has remained relatively stable in Latin America and the Caribbean
in the past two decades, at between 0.4% and 0.5% of the general population. This is undoubtedly an
achievement, although the epidemic continues to seriously affect certain key groups which have long
suffered institutional discrimination and neglect. Rates of HIV infection as high as 34% have been
reported among the transsexual population, for example. Among men who have sexual relations with
men, HIV prevalence is over 5% in all the countries of the region and as much as <strong>20</strong>.3% in some. The
highest HIV infection rate reported among sex workers in the Latin American countries is 4.9% in Brazil.
But among male sex workers HIV prevalence in the countries with data available is as high as 22.8%.
Among intravenous drug users, the rate is over 5% (UNAIDS, <strong>20</strong>11a). The proportion of men infected in
relation to women has dropped drastically since the 1980s, yet the number of infections among men has not
fallen. Instead, a higher number of infections has been reported among women, In Latin America, more than
one third of adults (36%) living with HIV in <strong>20</strong>10 were women (UNAIDS, <strong>20</strong>11b).
In the Caribbean, the epidemic has slowed considerably since the mid-1990s. Since <strong>20</strong>01, new
HIV infections slowed by close to 25% in the Dominican Republic and Jamaica and by close to 12% in
Haiti. AIDS-related deaths were reduced by 50% between <strong>20</strong>01 and <strong>20</strong>10. Greater access to HIV-
6
Pan American Health Organization/World Health Organization (PAHO/WHO), “Dengue Regional Information:
Number of cases”, [online] http://new.paho.org/hq/index.php?option=com_content&task=view&id=264&
Itemid=363&lang=en.