REVIEW ESSAY THE HIV/AIDS PANDEMIC HITS LATIN AMERICA

REVIEW ESSAY THE HIV/AIDS PANDEMIC HITS LATIN AMERICA

Abreu, Anabela Garcia, Isabel Noguer, and Karen Cowgill. HIV/AIDS in Latin American Countries: The Challenges Ahead. Washington, D.C.: The World Bank, 2003. 273 pp.

Bastos, Cristina. Global Responses to AIDS: Science and Technology. Bloomington: Indiana University Press, 1999. 225 pp.

In its AIDS epidemic update released on December 2003, the UNAIDS and the World Health Organization estimated that the global HIV/AIDS epidemic killed more than 3 million people in 2003, and an estimated 3 million acquired the human immunodeficiency virus (HIV), bringing the number of people living with the virus around the world to 40 million. Yet despite the enormous impact of this deadly virus and no signs of abatement, few social scientists have written about the topic.

HIV/AIDS in Latin American Countries: The Challenges Ahead presents new and updated information about the extent and trends of the HIV/AIDS epidemic in Latin America. It evaluates current national surveillance capacity; assesses the national responses of the health sector to the epidemic on a country-by-country basis; identifies key areas in which specific intervention is urgently needed; and outlines the challenges ahead. This study is based on new World Bank-sponsored research, analyses of secondary information, and country-level data covering these 17 countries: Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Venezuela, and Uruguay.

HIV/AIDS in Latin America, according to Abreu et al., falls within the framework of a low endemic setting (p. ix). The HIV/AIDS epidemic is still concentrated among the population groups who engage in high-risk behavior1-commercial sex workers, men who have sex with men, and injecting drug users-but it is accelerating rapidly and is poised to strike the general population. The authors state that an accurate number of people living with HIV/AIDS in Latin America is lacking. However, the best estimate at the end of 2001 was 1.4 million, or approximately 0.50 percent of the Latin American population (p. 5). This figure is probably inaccurate due in part to underdiagnosis and underreporting, which contribute to inexact HIV/AIDS statistics in many Latin American countries. As Abreu et al., point out, "the epidemic in Latin America probably includes 30 percent more cases of AIDS and 40 percent more cases of HIV than are currently estimated" (p. 49).

I would also highlight that in most Latin American countries, "men who had been infected through sexual contact will rarely admit it and are more likely to attribute their infection to transmission from female prostitutes than sexual contact with other men" (Bastos, p. 113). In Brazil especially, the term de risco (of risk; at risk) is today loaded with stigma and guilt and it has quickly turned into a derogatory expression (Bastos, p. 25).

Another area of great concern in the battle against this deadly disease of the 21st century, which former U.S. secretary of State Colin Powell has called "the greatest weapon of mass destruction on the earth," is the "feminization of the epidemic." According to Abreu et al., the "feminization of the epidemic" is evident in decreasing male-to-female ratios among those with AIDS and increasing rates of HIV infection in pregnant women and children. According to UNAIDS, the rate of HIV infection among young people worldwide is growing rapidly: 67% of newly infected individuals in the developing world are young people aged 15 to 24 years. The escalating risk is especially evident among young women and girls (15-24 years), who make up 64% of the young people in developing countries living with HIV or AIDS.2 The UNAIDS Strategy Note also points out that AIDS intensifies the feminization of poverty, particularly in hard-hit countries, and disempowers women. Entire families are affected as vulnerability increases. When women's time is spent caring for the sick, it is taken away from other productive tasks within the household.3 Along with the "feminization of the epidemic," there is also a phenomenon of "ruralization" of the epidemic in Mexico. According to Abreu et al., the epidemic is growing rapidly among rural populations who have precarious living conditions. Migrant agricultural workers who acquire HIV in the United States may infect their partners after returning to their home communities (p. 11).

Abreu et al. also point to another important but often forgotten issue when addressing the AIDS pandemic in Latin America: the number of street children who are highly vulnerable to HIV/AIDS infection. According to the authors, an estimated 40 million children, mostly boys, live on the streets of Latin America. Both boys and girls frequently survive by prostituting themselves or exchanging sex for drugs, thus increasing the likelihood that, if Latin American governments do not take a proactive role in the fight against AIDS-HIV, Latin America could become just as vulnerable to the AIDS pandemic as Sub-Saharan Africa. Abreu et al. also call attention to the fact that commercial sex workers are not only at high risk of acquiring and transmitting HIV but also "act as a bridge between high-risk groups and the general population" (p. 7). Despite the gloomy picture of Latin America's fight against the disease, cases of HIV and AIDS are reported extensively. In every country, it is mandatory to report AIDS cases, and in 94 percent of countries HIV cases must be reported (p. 52). Although allocation of resources and personnel for surveillance has been slow and sometimes neglected by government officials, since the 1980s there has been a steady increase in the willingness of governments to step up to the challenge and attempt to control the spread of HIV/AIDS. According to Abreu et al., "HIV/AIDS surveillance systems are imperative since HIV/AIDS is an infectious disease with serious public health implications; it is distributed heterogeneously throughout populations, but it is also preventable and linked to behavior patterns" (p. 51).