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HIV & AIDS in Latin America
At the end of 2012 there were around 1.5 million people living with HIV in Latin America, equating to 0.4 percent of the population. There were 86,000 new HIV infections during 2012, and 52,000 deaths from AIDS-related illnesses. 1
Countries in Latin American have been affected by HIV and AIDS in different ways, and to different extents. Despite many differences between the epidemics of individual countries, high levels of poverty, migration, homophobia and HIV-related discrimination are apparent throughout the region, and these factors present common barriers to overcoming the epidemic. 2
In this page, we use the term Latin America to refer to the countries of Central America and South America, excluding Suriname, Guyana, French Guyana and the Caribbean islands, which we discuss on our HIV & AIDS in the Caribbean page. In Spanish, HIV is known as VIH, and AIDS known as SIDA.
The HIV epidemic in Latin America
Although HIV prevalence in Latin American countries is relatively low compared to many parts of sub-Saharan Africa, the number of people affected is still substantial. The epidemic has remained stable for a number of years. 3 4
The countries with the largest numbers of people living with HIV are: Brazil (between 530,000 - 660,000), Mexico (170,000), Colombia (150,000), Venezuela (110,000) and Argentina (98,000). However, due to the large population of some of these countries, the HIV prevalence appears very low. For example 0.4-0.5 percent of people in Brazil are living with HIV. 5
The most severe epidemics are found in smaller countries such as Belize, which has an HIV prevalence of 1.4 percent. 6 All other Latin American countries have an HIV prevalence of less than 1 percent, but the prevalence among specific groups, such as men who have sex with men and sex workers, is often much higher.
Key affected groups
Men who have sex with men
Men who have sex with men (MSM) account for more than half of new HIV infections in Latin America. Within individual countries this ranges from 33 percent in the Dominican Republic, to 56 percent in Peru. 7 As many as 12 percent of MSM in Latin America are living with HIV. 8 However, the epidemic among this population is largely hidden, since homophobia and ‘machismo’ (strong/aggressive masculinity) culture are common throughout the region and sex between men is highly stigmatised. The extent of HIV infection among MSM is downplayed in many countries, and prevention campaigns often neglect this group.
As one civil society worker explained, MSM in the region are often hesitant to reveal how they became infected and many are mistakenly classed as heterosexual:
“Unless he’s a total queen, a man will always be [counted as] heterosexual. Plus, people don’t want to be recognised [as homosexual].” - Ruben Mayorga, civil society worker, Guatemala City 9
In Peru, a large amount of research is being conducted relating to HIV and MSM. 12.4 percent of Peruvian MSM are living with HIV, compared to 0.4 percent of the general population. 10 The country is now recognised by researchers around the world as an important base for studies of HIV infection among this group.
As is the case in other Latin American countries, large numbers of MSM in Peru do not identify themselves as homosexual, and have sex with women as well as men, forming a 'bridge' population. It is vital that HIV prevention programmes reach MSM, in order to slow the HIV epidemic among both this vulnerable group and the general population. However, only half of MSM in the region were reached by HIV prevention programmes in 2012. 11
Female sex workers
It is thought that 6.1 percent of female sex workers (FSW) in Latin America are living with HIV. With the exception of Honduras, in 2012 all reporting countries found that more than 95 percent of FSW used a condom with their last client. 12 This is an important achievement as it reduces the likelihood of HIV transmission between clients and sex workers, and then onwards to other partners.
For example, HIV prevalence among sex workers in Argentina is 5.4 percent, compared to a national prevalence of 0.4 percent. However 96 percent of sex workers report consistent condom use, helping to prevent further spread of HIV from sex workers to clients and their partners. 13
The extent to which sex workers are affected varies between locations. One study of different countries, which looked at brothel-based sex workers, found HIV prevalence ranging from 0 percent to 6.3 percent. 14 However, higher rates are found among street-based sex workers, who are harder to reach with HIV prevention services. In Guatemala, for instance, surveillance suggests that 15 percent of street-based sex workers are living with HIV. 15
Positively, more funds for HIV prevention initiatives targeting FSWs were sourced domestically than internationally in 2012, showing that regional governments are increasingly acknowledging and committing resources to the HIV epidemic among this population. 16
People who inject drugs
There are over 2 million people who inject drugs (PWID) in Latin America, and as many as a quarter of these people are living with HIV. 17 HIV transmission via injecting drug use is prevalent across the whole region, and accounts for the greatest share of HIV infections in Mexico, and in a number of Southern Cone countries (those found in the southernmost area of South America). In Argentina, injecting drug use has been a major factor driving the spread of HIV, with 49.7 percent of PWID living with HIV. This figure is 48 percent in Brazil, of whom only 25 percent are on antiretroviral treatment. 18
However, the popularity of injecting drugs has declined across Latin America and been replaced by people who favour smoking or inhaling drugs. 19 It was previously thought that this may reduce HIV infections because fewer people are sharing needles. In fact, those who smoke drugs have an elevated risk of HIV infection compared to the general population. 20 21 22
In several Southern Cone countries, ‘pasta base’ or ‘paco’, (a form of cocaine which is smoked) has become extremely popular in recent years. However there is little effort to address this issue. The provision of clean crack pipes is extremely low, and there is no substitution medicine available for crack cocaine. Paco use is causing increasing concern regarding HIV transmission via smoking drugs. 23 24
Latin America is forward thinking in its drive to decriminalise drug use, with many national drug policy reforms having taken place in the last few years. Colombia has decriminalised the possession of small amounts of cocaine or marijuana. Brazil has invested US$2 billion into 300 new health centres for PWID. 25
However, these majority of these reforms have focused on reducing the supply and trafficking of drugs, rather than addressing the huge demand for them. As a result, little change has taken place, with large numbers of PWID imprisoned. No prisons in Latin America have harm reduction initiatives. 26
- Harm reduction
Harm reduction programmes, including needle and syringe exchange programmes (NSPs) and opioid substitution therapy (OST), are limited across Latin America. NSPs are present in Argentina, Brazil, Mexico, Paraguay and Uruguay, although no more countries have joined this list since 2010. Only 2 percent of PWID access these NSPs, and on average they only receive one new needle per person per year.
OST is only available in Colombia and Mexico. Colombia has a large drug using population and unusually it has OST services, but no NSPs - they are treating established addictions but not preventing them. 27
Migration occurs on a large scale throughout Latin America. International migration, particularly between Mexico and the United States, is also increasingly common. 28 Studies have now established a link between the movement of people and the spread of HIV in Latin America. Below are some of these factors:
- Gender norms - the 'machismo' culture in Latin America leaves many women unable to negotiate safer sex practices such as condom use.
- Multiple sexual partners - many migrants travel alone and may visit sex workers or have multiple sexual partners whilst away from home. This increases the risk of HIV transmission both to themselves, and onwards to their partner when they return home. Many migrants also turn to sex work themselves, in order to generate extra income.
- Illegal migration - many people migrate illegally without the proper documentation needed to access healthcare, limiting their access to HIV services.
- Low socioeconomic status - many migrants have low literacy/education, and have a low economic status, limiting their access to HIV services. 29
HIV prevention in Latin America
Sex education - the number of new HIV infections among young people in Latin America declined by 20 percent between 2001 and 2011. The HIV prevalence among young people aged 15-24 reflects this - 0.2 percent. 30 This suggests that the knowledge of HIV transmission and how to prevent it has risen among young people, as more are accessing sex education at school.
Prevention of mother-to-child transmission (PMTCT) - there was a 24 percent drop in new HIV infections among children between 2009-2011, suggesting an increase in the number of pregnant mothers being tested and treated to prevent HIV transmission to their children. 31 83 percent of pregnant mothers living with HIV received antiretrovirals (ARVs) to prevent mother-to-child transmission of the virus in 2012. This is significantly higher than the 75 percent of all people living with HIV accessing treatment. 32
Condom promotion - HIV prevention efforts have focused on high-risk groups such as sex workers and men who have sex with men, and attempts have been made to reduce the stigma that these groups face. However, just over half of MSM and PWID across Latin America reported using a condom last time they had sex, suggesting more could be done to promote condom use across the region. 33
Community mobilisation - many of the most effective HIV prevention initiatives have succeeded because outreach work has taken information directly to the people at highest risk of HIV exposure. By closely working with vulnerable groups and communities, organisations can ensure that the intended messages and resources are accessed by the people who need them. This is also a very effective way to promote and advocate for rights and access to HIV services. 34 Brazil has incorporated HIV testing into community health campaigns, encouraging the link between testing and referrals to treatment services. 35
On a wider scale, most countries still need to expand harm-reduction programmes for people who inject drugs; raise a greater level of awareness about HIV; tackle the stigma surrounding AIDS,;improve testing facilities, and encourage more people to use condoms.
HIV treatment in Latin America
Access to HIV treatment across Latin America is impressive. In 2012, an estimated 75 percent of those needing antiretroviral therapy (ART) were receiving it. This is the highest percentage for a region of low- and middle-income countries. 36 Unusually, 75 percent of eligible children are also receiving ART - child access to treatment is often lower than adult access in other regions.
Treatment coverage is highest in Brazil (81-93%), Chile (86%), Mexico (82%), Argentina (81%), and lowest in Bolivia (36%) and Ecuador (42%). 37
Latin America follows the Treatment 2.0 initiative, which focuses on achieving universal access to treatment, and using treatment as a form of prevention. 38 One of the most effective ways of achieving both these goals is to encourage treatment centres to work with community groups. Argentina are demonstrating the success of this approach as treatment adherence is rising thanks to communications between treatment centres and community groups. 39
However, the most recent World Health Organisation (WHO) antiretroviral treatment guidelines of 2013 have increased the number of people eligible for ART significantly. Many Latin American countries have highlighted that it will be a challenge to provide access to treatment for a much greater number of people. 40
In 2011, the global proportion of people on HIV treatment who were receiving 1st line treatment was 96 percent. In Latin America this was just 77 percent. This suggests that treatment monitoring and adherence needs to be improved, in order to prevent 1st line antiretroviral therapy regimes from failing and the need to switch to 2nd line treatment. 41
Stigma and discrimination in Latin America
“Is AIDS a big problem in Chile?” people often ask me, to which the only possible response is yes: If you get AIDS in Chile, it is a big problem.” - Tim Frasca
Some Latin American countries have taken steps to address the problem of stigma and discrimination, mainly through media campaigns to raise awareness about HIV. The Pan-American Health Organization have campaigned to reduce discrimination against sexual minorities and people living with HIV in the provision of HIV services. Peru, Columbia, Brazil and Mexico have recently launched new actions plans to raise awareness among health providers and government officials of the importance of non-discrimination on the basis of sex, race, religion, sexual orientation and HIV status. 42
People living with HIV themselves have also done a great deal to fight this problem, forming citizen groups and standing up to discrimination through protests and campaigns. Governments must continue to support these groups, and expand their own anti-stigma efforts.
Fear of stigma often prevents people from accessing HIV testing and treatment. Discrimination also stops people from talking openly about HIV and AIDS, which leads to a climate of silence in which people are unaware that they may be at risk. HIV is not confined to groups such as MSM, PWID or sex workers. Yet people continue to associate the epidemic with these groups, who are already highly stigmatised by people who have objections to their lifestyles.
Additionally, HIV carries its own stigma. Since HIV directly affects less than 1 percent of the population in most Latin American countries, the epidemic has a low visibility and many people are ignorant or fearful of HIV and AIDS.
“[His family] fed him in the same plate ever, and like that, he had his own cup, glass, fork, knife, spoon, you get the idea, he was isolated by his own family. His razors where always trashed, and his tooth brush too, also, no one was ever taking care of his pills... One week before he died, in the middle of a discussion because of he having AIDS he was thrown out of his house by his older sister... he died alone.” Lover of an HIV-positive man in Honduras 43
Restrictions on entry, stay and residence
Latin American governments also differ in their views and laws regarding HIV. For example, the majority of countries have no restrictions on entry, stay and residence for people living with HIV. This is an exception in Belize, Nicaragua and Paraguay. However, Paraguay has stated that lifting the ban is a priority and aims to achieve this by 2015. 44
Funding for HIV in Latin America
17 percent of all global HIV funding in 2012 was spent tackling the HIV epidemic in Latin American countries. This is the second highest share behind sub-Saharan Africa. 94 percent of all Latin American funding for HIV is generated domestically, highlighting the commitment of their governments, and the sustainability of their funding methods. 45
The HIV epidemic varies between countries
The table below shows how variable the HIV epidemic is between countries. In the following example, Belize is highlighted as the country with the highest HIV prevalence and Mexico with the lowest. However, there are 167,000 more people living with HIV in Mexico than in Belize. 46
|LATIN AMERICA HIV STATISTICS 2012||BELIZE||MEXICO|
|HIV prevalence (%)||1.4||0.2|
|People living with HIV (number)||3,100||170,000|
|New HIV infections (number)||<200||9,300|
|Adults needing and receiving treatment (number)||1,600||100,000|
|Access to treatment (% of those in need of treatment)||73||82|
|People in need of treatment based on WHO Treatment Guidelines 2013||2,500||250,000|
For more figures regarding HIV in Latin American countries, see our Latin America Statistics Page.
The future of HIV and AIDS in Latin America
Latin America boasts the highest percentage of people living with HIV receiving treatment than any other low- and middle-income region in the world. At 75 percent, the region is on track to achieve universal access to treatment of 80 percent in the near future if efforts are maintained.
However, implementing WHO's 2013 Treatment Guidelines will be a big challenge for Latin American countries. The region's commitment to domestic funding is already impressive, but further efforts will be needed to provide treatment to more people.
As well as continuing to provide treatment and care for people living with HIV, prevention schemes need to be improved, specifically around targeting groups of people who are more vulnerable to HIV.
Efforts to tackle stigma and discrimination must run parallel to these programmes, because prevention is likely to be ineffective while the fear and ignorance surrounding HIV is so widespread.
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Factors That Influence HIV Risk among Hispanic Female Immigrants and Their Implications for HIV Prevention Interventions', International Journal of Family Medicine,
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