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

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prevention services for pregnant women led to a significant reduction in the number of children
contracting HIV and in AIDS-related child deaths. Notwithstanding the progress achieved, the Caribbean
is second only to Sub-Saharan Africa in terms of HIV prevalence (0.9%). Indeed, it is the only region,
apart from Sub-Saharan Africa where there are more women than men infected with HIV. In <strong>20</strong>10,
approximately 53% of adults living with HIV were women (a percentage that has remained stable since
the late 1990s). This reflects the pattern of infection in Haiti (which has the worst epidemic in the region),
Bahamas, Belize and the Dominican Republic. In most of the other countries of the region, more men
than women are HIV-positive (WHO, UNAIDS, UNICEF, <strong>20</strong>11).
In order to halt and considerably reduce the epidemic by <strong>20</strong>15, best practices in public health and
disease control recommend targeting the HIV response on key groups and carefully compiling
information and analyses to match policy action to the dynamics of the epidemic in affected communities,
in partnership and based on a human rights approach (UNAIDS, <strong>20</strong>11a, UNAIDS, <strong>20</strong>11b).
Major advances have been achieved in Latin America and the Caribbean in terms of coverage
(50% of the region) of antiretroviral treatments for those living with HIV, but this progress has been
constantly undermined by poverty, food insecurity and undernourishment (WHO, UNAIDS, UNICEF,
<strong>20</strong>11). Undernourishment worsens the effects of HIV and hastens the onset and progress of AIDS-related
conditions (WFP, <strong>20</strong>10). Rising food prices, the economic crisis and the downturn in remittances have all
added to food and nutrition insecurity for those living with HIV, who continue to be one of the region’s
most vulnerable groups (WHO, UNAIDS, UNICEF <strong>20</strong>10).
(c)
Protecting disadvantaged groups
Several countries in the region have implemented targeted health-care programmes for the
extremely poor, children, women and pregnant women, older persons and victims of violence, among
others. Schemes that have been successful in this regard include Bolsa Familia in Brazil (Lindert, <strong>20</strong>05)
and Oportunidades in Mexico (SEDESOL, <strong>20</strong>08).
However, groups that are already disadvantaged are coming under new pressures from emerging
challenges, such as increased drug consumption, changes in eating habits, climate change, the destruction
of ecosystems, water shortages and land-use change.
(d)
Urban health
Urbanization may have a positive impact on health owing to the greater ease of supplying basic
services such as water and sanitation. It also entails many risks, however. For example, tuberculosis is
closely associated with social determinants of health and occurs mainly in urban areas. Nevertheless,
tuberculosis-related deaths in the region fell from 8 per 100,000 inhabitants in 1990 to 2.1 in 1990
(WHO, <strong>20</strong>10c).
Major inequalities remain, however, between both countries and cities within countries (PAHO,
<strong>20</strong>07). A study conducted in Buenos Aires found that child mortality was 6.5 per 1,000 live births in
one central district, but as high as 16 per 1,000 live births in another part of Greater Buenos Aires
(Bernardini, <strong>20</strong>09).