Care and support for people living with HIV/AIDS

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AIDS in a new millennium: a grim picture with glimmers of hopeIn Brazil as elsewhere, men are more likely to use condoms in their more risky partnershipsthan with their wives or long-term partners. Among 16–25-year-old men,87% said they consistently used condoms with their casual sex partners – an impressivelyhigh figure corroborated by a massive rise in sales of commercial condoms,from 70 million a year in 1993 to 320 million a year in 1999.A low prevalence of HIV infection among heterosexuals is the norm in the Andeanregion, at least in the countries for which data are available. In Colombia, HIV infectionis more common in coastal than in mountainous regions, but nowhere is the rate greaterthan 1 in 250 among pregnant women. Even among sex workers, the figure is below2%. Similar rates are recorded in Peru and Bolivia. In these countries, the prevalence ofHIV infection among men who have sex with men is similar to that in Mexico. Argentinahas typically high rates of HIV infection among injecting drug users and men who havesex with men, but a relatively low average prevalence of 0.4% among pregnant women.One of the defining features of the Latin American epidemic is that several populous countries,including Argentina, Brazil and Mexico, are attempting to provide antiretroviral therapyfor all people infected with HIV. Coverage still varies widely (see page 90), but theseefforts are having a definite impact. While they are improving both the length and the qualityof people’s lives, they are also increasing the proportion of people living with HIV.HIV in the Caribbean: small islands, large epidemicHIV is ravaging the populations of several Caribbean island states. Indeed, some haveworse epidemics than any other country in the world outside of sub-Saharan Africa. InHaiti, over 5% of adults are living with HIV, and in the Bahamas the adult prevalence rateis over 4%. In the Dominican Republic, 1 adult in 40 is HIV-infected, while in Trinidadand Tobago the rate exceeds 1 adult in 100. At the other end of the spectrum lie SaintLucia, the Cayman Islands and the British Virgin Islands, where fewer than 1 pregnantwoman in 500 tested positive for HIV in recent surveillance studies. In most of theworst-affected countries of the Caribbean, the spread of HIV infection is driven byunprotected sex between men and women, although infections associated with injectingdrug use are common in some places, such as Puerto Rico. High rates have alsobeen recorded among small populations of men who have sex with men in a number ofislands, including Haiti and Jamaica.Haiti, where the spread of HIV may well have been fuelled by decades of poor governanceand conflict, is the worst-affected nation in the region. In some areas, 13% ofanonymously tested pregnant women were found to be HIV-positive in 1996. Overall,around 8% of adults in urban areas and 4% in rural areas are infected. HIV transmissionin Haiti is overwhelmingly heterosexual, and both infection and death are concentratedin young adults. It is estimated that nearly 75 000 Haitian children had lost theirmothers to AIDS by the end of 1999.17
Report on the global HIV/AIDS epidemic – June 2000The Dominican Republic, which has conducted systematic HIV surveillance amongpregnant women, sex workers and patients with sexually transmitted infections everyyear since 1991, also has a substantial heterosexual epidemic. The HIV prevalence rateamong new mothers in the capital, Santo Domingo, more than doubled over the sevenyearperiod for which surveillance results are available, reaching 1.9% in 1997, while theaverage rate in sex workers and patients with sexually transmitted infections wasaround 6–8%.The heterosexual epidemics of HIV infection in the Caribbean are driven by the deadlycombination of early sexual activity and frequent partner exchange by young people. InSaint Vincent and the Grenadines, where the prevalence of sexually transmitted infectionssuch as syphilis is high for the region, a quarter of men and women in a recentnational survey said they had started having sex before the age of 14, and half of bothmen and women were sexually active at the age of 16. In a large survey of men andwomen in their teens and early twenties in Trinidad and Tobago, fewer than a fifth of thesexually active respondents said they always used condoms, and two-thirds did not usecondoms at all. A mixing of ages – which has contributed to pushing the HIV rates inyoung African women to such high levels – is common in this population too: while mostyoung men had sex with women of their age or younger, over 28% of young girls saidthey had sex with older men. As a result, HIV rates are five times higher in girls than boysaged 15–19 in Trinidad and Tobago, and at one surveillance centre for pregnant womenin Jamaica, girls in their late teens had almost twice the prevalence rate of older women.Eastern Europe and Central Asia: drug injecting is still themain riskIn the countries of the former Soviet Union, the HIV epidemic continues to be concentratedheavily in injecting drug users. The absolute number of cases has remained smallin many countries so far, but overall the growth has been rapid.In Ukraine, the number of diagnosed HIV infections jumped from virtually zero before1995 to around 20 000 a year from 1996 onwards, about 80% of them in injecting drugusers. Around a third of these cases have been seen by a special public health doctor,after which they are included in the official HIV case registry. While no country’s HIV surveillancesystem can ever be sure of capturing all infections, the data on HIV diagnosesshown in Figure 5 may well represent the true trend of the epidemic in Ukraine. As HIVspreads and new infections occur, the total number of people living with HIV continuesto grow, reaching an estimated 240 000 at the end of 1999, compared with 110 000 twoyears earlier.In any country with unsafe drug-injecting practices, a fresh outbreak of HIV is liable tooccur at any time. This is especially true of the countries in Eastern Europe where theHIV epidemics are still young and have so far spared some cities and sub-populations.In the Russian Federation, a new outbreak of HIV among injecting drug users in theMoscow region in 1999 resulted in the reporting of more than three times as many new18
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Prevention: daunting challenges ahe
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Opening new doors with counselling
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Care and support for people living
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National responses to the epidemic:
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Annex 1.How reliable are estimates
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Annex 2. HIV/AIDS estimates and dat
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Table of country-specific HIV/AIDS
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Care and support for people living with HIV/AIDS

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