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... st most young men had sex with women of their own age or younger, over 28 % of young girls said they has sex with older men. As a result, HIV rates are five times higher in girls than boys aged 15 - 19 in Trinidad and Tobago, and at one surveillance centre for pregnant women in Jamaica, girls in their late teens had almost twice the prevalence rate of older women. AIDS is now high on the agendas of many governments in this region, as they are beginning to notice the significant impact of the epidemic on their medical systems and labour force. It remains to be seen if action can and will be taken rapidly enough to avert a crisis.
Latin America The HIV epidemic in Latin America is highly diverse. Most transmission in Central American countries and countries on the Caribbean coast occurs through sex between men and women. Brazil, too, is experiencing a major heterosexual epidemic, but there are also very high rates of infection among men who have sex with men and injecting drug users. In Mexico, Argentina, and Colombia, HIV infection is also confined largely to these sub-populations. The Andean countries are currently among those least affected by HIV infection, although risky behaviour has been recorded in many groups. Around 1. 7 million people are living with HIV in Latin America.
In 2004, around 95, 000 people died of AIDS and an estimated 240, 000 people were newly infected. The countries with the highest prevalence rates in the region tend to be found on the Caribbean side of the continent. Over 7 % of pregnant women in urban Guyana tested positive for HIV in 1996. Strikingly, the rates in pregnant women were similar to those in patients attending clinics for sexually transmitted diseases (STDs) - one would have expected them to be lower. In Honduras, Guatemala and Belize there is also a fast-growing epidemic, with HIV prevalence rates among adults in the general population between 1 and 2 %. In 1994, less than 1 % of pregnant women using antenatal services in Belize District tested positive for HIV, while one year later the prevalence rate had risen to 2. 5 %, the rate in one health centre, in Port Loyola, hitting 4. 8 %.
Much of the problem is concentrated in teenagers, suggesting that the worst is still to come. Heterosexual transmission of HIV is rarer in other countries of Central America. In Costa Rica, for example, HIV is transmitted mainly during unprotected sex between men. In this country, as in many other parts of Latin America, there is little systematic surveillance for HIV among groups with high risk behaviour, but studies among men who have sex with men in Costa Rica showed infection rates of 10 - 16 % as long ago as 1993. In Mexico, too, HIV has affected mainly men who have sex with men, more than 14 % of whom are currently infected.
HIV rates among pregnant women, however, are extremely low. Data from a programme to reduce the transmission of HIV from mothers to infants suggest that less than one in every 1, 000 women of childbearing age is infected. Even among female sex workers in Mexico, the prevalence rate is well under 1 %. A low prevalence of HIV infection among heterosexuals is the norm in the Andean region, at least in the countries for which data are available. For example, Argentina has typically high rates of HIV infection among injecting drug users and men who have sex with men, but a relatively low 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, Cuba and Mexico, are attempting to provide antiretroviral therapy for all people infected with HIV. The governments of these countries have invested and encouraged local pharmaceutical manufacturers to produce generic copies of expensive patented medicines. This allows them to distribute drugs to a much greater proportion of their population that they would otherwise be able to help. Coverage still varies widely, but these efforts are having a definite impact. While they are improving both the length and the quality of people's lives, they are also increasing the proportion of people living with HIV, and thus HIV prevalence figures.
Nevertheless, some concern has been voiced over the risk that HIV prevention activities may suffer if too much effort and money is devoted to providing treatment. High-income Countries In high-income nations, HIV infections have historically been concentrated principally among injecting drug users and gay men, and this is largely still where the main thrust of the epidemic lies. However, in several Western European countries a significant proportion of new HIV diagnosis (59 % more, overall, between 1997 and 2001) is occurring through heterosexual intercourse. Very early in the epidemic, once information and services for prevention had been made available to most of the population, the level of unprotected sex fell in many countries and the demand rose for reproductive health services, HIV counselling and testing and other preventive services. Among gay men, the virus had spread widely before it was even identified and had established a firm grip on the population by the early 1980 's. With massive early prevention campaigns targeted at gay communities, risk behaviour was substantially reduced and the rate of new infections dropped significantly during the mid-and late 1980 's.
Recent information suggests, however, that risky behaviour may be increasing again in some communities. People think that the danger is over because of lack of media coverage of the issues around HIV and AIDS - and new infections continue to occur While the infection rates have been low in high-income countries, some countries have been reporting increases in their HIV rates. For example, Sweden currently has one of the lowest rates of HIV infection in the world. According to the Swedish Institute for Infectious Disease Control the rate of new HIV cases in Sweden rose by 48 % during the first half of 2001. Prevention work in high-income countries has declined, and sexual-health education in schools is still commonly not by any means guaranteed, in spite of the fact that the risks of HIV are well-known to governments. Political factors have been allowed to control the HIV prevention work that is done, and politicians are commonly keen to avoid talking about any sexual issues.
Furthermore, it's very hard to show that a number of people are not HIV+ who otherwise would be - and politicians like the electorate to see results. Some communities and countries, however, have initiated aggressive HIV prevention efforts, particularly among high-risk groups such as injecting drug users, containing the HIV prevalence rate at below 5 %. In many places, however, the political cost of implementing needle-exchange and other prevention programmes has been considered too high for such programmes to be started or maintained. As a result, there are continuing high prevalence rates among injecting drug-users in many high-income countries. For example, in Spain, a recent study in Barcelona found a prevalence rate of 51 % among injecting drug users. Many high-income countries suffer from the belief that HIV is something that effects other people, not their own populations.
On a national level, this belief prevents policy-makers and budget-setters from seeing the epidemic on their own door-steps, looking instead to the situation in areas such as Africa. Many high-income countries fund medication provision for low-income countries whilst failing to provide medicines for their own citizens who have AIDS. Even in the US, there are people who are unable to afford to buy the drugs they need. Where do we go from here? Spending Money is finally being spent on both treating the disease and on preventing new infections from occurring. This spending needs to increase both in it's magnitude and it's effectiveness.
Many people fail to realise that actually spending money, in the very large sums the fight against HIV requires, is a difficult task, and one which many organisations have little experience of. The Global Fund, an organisation created to channel money to where around the world it is most needed, is an already-existing way of effectively spending money. Many governments, however, wish to exert control over how their donations are spent and on what projects, so they prefer to channel their funding through other diverse organisations, which may often have no experience of spending such sums. The Global Fund, as a direct result of this, is in danger of being unable to meet it's funding agreements. Governments need to meet their promises to the Global Fund, and to increase them. Education In the early days of the epidemic, HIV prevention work was done at a high-profile, national level in many high-income countries.
This work has all-but foundered, and needs to be re-invigorated. Education has already been proved to be effective and necessary, both for people who are not infected with HIV, to empower them to protect themselves from HIV, and for people who are HIV+, to help them to live with the virus. There is a huge wealth of educational resources available around the world, and yet in many places people still lack the knowledge they need to protect themselves. Medication Anti-retroviral AIDS medication is now being distributed to low-income, high prevalence countries, but it is taking a long time to actually reach the people who need it. The provision and distribution of medication needs to be greatly speeded up if millions of deaths are to be avoided. When the medication finally reaches the areas where it is needed, trained nurses must be available to carry out HIV tests, administer the medicines, and teach people how to use them.
HIV has now finally been recognised as a global threat, and people are beginning to take action to prevent it killing many more millions than those who have already died. This action needs not only to continue, but to be speeded up considerable. The HIV epidemic is growing, and efforts to fight it need to grow at a greater rate then the epidemic if they are to be successful. An ever-growing AIDS epidemic is not inevitable; yet, unless action against the epidemic is scaled up drastically, the damage already done will seem minor compared with what lies ahead. This may sound dramatic, but it is hard to play down the effects of a disease that stands to kill more than half of the young adults in the countries where it has its firmest hold.
Entire families, communities and countries will begin to collapse if this situation is allowed to occur.
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