USIA Washington File - November 29, 199

Washington -- A new report by the United Nations says HIV, the virus that leads to AIDS, is spreading in the Americas.

The "AIDS Epidemic Update," a report published by the Joint United Nations Program on HIV/AIDS and the U.N. World Health Organization, says the prevention challenge for HIV remains "acute" in the region, against a backdrop of evidence that infections are on the rise. The report said the Caribbean Basin ranks second behind the sub-Saharan region of Africa with the worst HIV epidemic.

In Latin America and the Caribbean combined, some 1.7 million people will enter the 21st century with the HIV infection -- almost 30,000 of them children, according to estimates cited in the report. This number, the U.N. said, is somewhat less than the total given in 1998 because estimates for two populous countries, Brazil and Mexico, were revised downwards on the basis of new data.

In Guatemala in 1999, some 2 to 4 percent of pregnant women tested at prenatal clinics in major urban areas were found to have HIV. In Guyana, HIV prevalence was recorded at 3.2 percent among blood donors, who are generally thought to represent a population at low risk of infection.

The U.N. said the last time Haiti performed HIV surveillance among pregnant women, in 1996, close to 6 percent tested positive for the virus. Infection rates approaching 8 percent had already been registered in some Haitian prenatal clinics as early as 1993.

Some countries in Latin America have joined the ranks of those providing antiretroviral treatment for people infected with HIV, according to the U.N. Brazil, for example, spent $300 million in 1999 providing such drugs for about 75,000 people. Antiretrovirals are also being used in Argentina, where the rate of new AIDS cases reported each year fell about 40 percent, from a peak of 71.6 cases per million people in 1996 to 41.3 cases per million people in 1998.

While the antiretroviral treatment is expensive, the savings in hospitalization and medical care for patients go "a long way towards justifying the costs of drugs which stave off the progression of HIV/AIDS," the U.N. said. "There are also considerable savings of the indirect costs of illness. Without antiretroviral therapy, many more people with HIV would develop opportunistic infections associated with a damaged immune system." The U.N. said estimates show that over a one-year period between 1997 and 1998, Brazil averted about $136 million in hospital admission and treatment costs alone for people with HIV.

The report said that in Central America and the Caribbean island states, access to antiretroviral therapy is far more limited than it is in South America. Guatemala, for instance, which spends $64 per person per year on health, estimates that just 185 people have access to antiretrovirals out of an estimated 50,000 or more people living with HIV and AIDS.

Worldwide, the report said, the HIV-positive population is still expanding and the number of AIDS deaths can be expected to increase for many years before peaking. The report said about 33 million adults and 1.2 million children will be living with HIV by the end of 1999. This year, some 2.6 million deaths resulted from HIV/AIDS -- a higher global total than in any year since the beginning of the epidemic.

The report said the overwhelming majority of people with HIV -- some 95 percent of the global total -- live in the developing world. That proportion is set to grow even further as infection rates continue to rise in countries where poverty, poor health systems and limited resources for prevention and care fuel the spread of the virus.

The U.N. said this is especially true in Africa -- notably sub-Saharan Africa -- where social and economic safety nets that might help families cope with the impact of HIV are badly frayed, in part because of the epidemic itself.

Following behind sub-Saharan Africa and the Caribbean Basin with the worse percentages of the HIV/AIDS prevalence rate were South Asia and Southeast Asia, East Asia and the Pacific, and Latin America.

The report concluded that the huge gap in HIV infection rates and AIDS deaths between rich and poor countries is likely to grow even larger in the next century. However, on a positive note, the report said "massive national and international efforts may yet help to end the stifling silence that continues to surround HIV in many countries, and to explode myths and misconceptions that translate into dangerous sexual practices." A trail of successful responses to fighting HIV/AIDS has already been "blazed by a small number of dedicated communities and governments," the U.N. said. The "challenge for the leaders of Africa and their partners in development is to adapt and massively expand successful approaches that make it harder for the (HIV) virus to spread, and that make it easier for those affected to live full and rewarding lives." (The Washington File is a product of the Office of International Information Programs, U.S. Department of State.)