AIDS emerges from the shadows

Unless countries act now, the epidemic will become uncontrollable

By Charo Quesada

In June, the United Nations held a special session of the General Assembly to address the critical situation of the HIV/AIDS epidemic worldwide. The U.N. only calls for a special session when there is a threat to peace somewhere in the world. For the first time, it decided to elevate a health problem to the level of a war threat, calling for a global mobilization to treat AIDS as a matter of international security.

For Latin American and Caribbean countries, the U.N. meeting came at an opportune time. For years, the region’s response to the HIV/AIDS crisis has been inconsistent and generally inadequate. Financial upheavals, natural disasters, and the ongoing struggle to defend new democracies have been some of the issues diverting attention and crucial resources from an assault on the epidemic. With the noteworthy exceptions of Brazil and the Caribbean, there is a lack of political leadership, multisector activities, and regional partnerships that could coordinate more aggressive, effective initiatives.

An alarming alternative. UNAIDS, the international agency set up to address the problem, came to the podium armed with overwhelming evidence and concrete proposals. The agency’s message: Act now or the epidemic will become uncontrollable. The figures speak for themselves. In 20 years, the AIDS virus has infected 58 million people and caused more than 15 million deaths. By the end of 2000, 36.1 million people were infected worldwide, 90 percent of them in developing countries, 25.3 million in Africa alone. Without access to effective treatment and assistance, another 15 million will die in the next five years.

"Countless others have become more impoverished as a consequence [of the disease]," a UNAIDS official told those in attendance. "Children have lost their parents; families have lost their property; communities have lost teachers, health workers, business and government leaders; nations have lost their investments in decades of human resource development; and societies have lost untold potential contributions to social, economic, political, cultural and spiritual life."

For years, as the tragedy unfolded, most world leaders looked the other way. They acted as if the battle was being fought on the fringes of society, in the ghettos of homosexuality, prostitution and drug abuse. Whatever it was that was happening, it did not warrant altering the course of national policy or government spending. Stigma, discrimination, and ignorance thus obscured the HIV/AIDS epidemic for almost two decades.

Wake-up call for the region. This was the case in Latin America and the Caribbean until the figures finally began to demand attention. Societies gradually became aware that AIDS is no longer limited to the "high risk" groups (homosexuals, sex workers, drug addicts), but is attacking other groups in society: women, youth, children, and low-income adults. Most infected people in the Caribbean and Central America today are heterosexual. Among the most vulnerable groups are adolescent girls, many of whom are pregnant. In Guyana 7 percent of these girls are HIV-positive. In Belize, 2.5 percent are infected, and between 2 and 5 percent in the Honduran city of San Pedro Sula. About 3.1 percent of new cases of contagion in Venezuela are in newborns.

In Haiti the situation is cause for even more concern: 8 percent of adults in urban areas are infected, some 4 percent in the countryside and 13 percent of pregnant women. At the end of 1999, 74,000 children had been orphaned by AIDS.

In Brazil, with half a million people infected by HIV according to the latest figures, the epidemic has broken out of the circle of homosexuality and drugs and reached the heterosexual population. The disease seems to be following the same pattern in other countries in the region as well, after it initially appeared to have exclusively targeted certain groups, like homosexuals (Venezuela and Mexico) or drug users (Argentina and Brazil).

The epidemic today. According to UNAIDS, there are nearly one million people infected with HIV in Latin America and 360,000 in the Caribbean. In 2000, 210,000 new cases were reported in the region in both adults and children, 13 percent higher that the estimate for 1999, when AIDS deaths totaled 48,000. In 20 years, the epidemic has claimed 557,000 lives in the region.

The statistics for Latin America are not as alarming as the figures for Africa (although in many countries recent data is not available). The figures for the Caribbean, however, are raising a red flag, and many unknowns have yet to be clarified. Social stigma, discrimination, and insufficient resources mean that many HIV/AIDS cases are still not being reported to the agencies monitoring the epidemic. In fact, some people are even questioning the reliability of methods being used to review the available data and make projections.

A recent Pan American Health Organization (PAHO) report warns that the extreme variations in the intensity, transmission patterns and levels of care for the disease in Latin America and the Caribbean may increase the risk of the disease spreading even faster. "All forms of transmission–sexual, blood and maternal to child–coexist in the Americas and affect population groups," noted a PAHO document presented in June at the United Nations. "Governments need better information to understand the patterns of spread and design appropriate responses."

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Date posted: September 2001

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HIV/AIDS clouds the Caribbean
Peter Piot: The cost of silence