Care and support for people living with HIV/AIDS

Report on the global HIV/AIDS epidemic – June 2000the rate in one health centre, in Port Loyola, hitting 4.8%. In the Honduran city of SanPedro Sula, the rate of HIV infection among pregnant women has fluctuatedbetween 2% and 5% for several years. Much of the problem is concentrated inteenagers, suggesting that the worst is still to come. Between one-fifth and onetenthof sex workers are infected in various cities in Honduras. In some ethnic subgroups,principally on the Caribbean coast, the prevalence in 15–49-year-old menand women exceeds 8%, and the rates in men and women in their 20s are twice ashigh. In Guatemala, HIV infection follows a similar pattern, with higher infection ratesamong pregnant women and sex workers in coastal cities and the capital than inhighland cities.Heterosexual transmission of HIV is rarer in other countries of Central America. InCosta Rica, for example, HIV is transmitted mainly during unprotected sex betweenmen. In this country, as in many other parts of Latin America, there is little systematicsurveillance for HIV among groups with high-risk behaviour, but studies amongmen who have sex with men in Costa Rica showed infection rates of 10–16% aslong ago as 1993.In Mexico, too, HIV has affected mainly men who have sex with men, more than 14% ofwhom are currently infected. HIV rates among pregnant women, however, are extremelylow. Data from a programme to reduce the transmission of HIV from mothers to infantssuggest that fewer than 1 in every 1000 women of childbearing age is infected. Evenamong female sex workers in Mexico, the prevalence rate is well under 1%.Box 3. A measure of success: young Brazilians increasingly rejectunprotected sexIn Brazil, where over half a million adults are living with HIV, the Government hastaken an active lead in HIV prevention, care and protection of the rights of peopleaffected by the epidemic. Perhaps the most visible commitment is the Government’sundertaking to provide free antiretroviral therapy to all those who need it (see page101). Alongside this, the Government has committed considerable resources tofighting HIV through information campaigns and prevention services. To help ensurethat these services reach not just the general population but also marginalizedgroups, whose members make up an increasing proportion of those infected withHIV, the Government has forged active partnerships with nongovernmental organizationsand others.A survey of the sexual behaviour of 3500 adults shows that young Brazilians are moreable and willing to negotiate condom use with their partners than ever before. Whilein 1986 less than 5% of young men reported using a condom the first time they hadsex, the figure in 1999 was close to 50% – a tenfold increase. Among men withhigher educational levels, over 70% surveyed in 1999 said they used a condom fortheir first act of intercourse.–––>16