This week we had promised to continue with Gender and HIV however a question from a student has prompted us to focus briefly on “Who is at Risk for HIV in the Latin America and The Caribbean’ the information taken comes from the PAHO HIV Regional Plan for the Health Sector.

The general population is at risk of contracting HIV in all countries and HIV should not be seen as connected to certain groups, classes, or socio-economic characteristics. The society is responsible for assuring that everyone who seeks their services is provided with relevant and timely information regarding HIV and STI and the risks associated with them. Nonetheless, certain groups are at particular risk due to social, economic, structural, and biological characteristics. Those populations mentioned below are at high risk due to a combination of factors. Socio-economic marginalization and gender inequalities are cross-cutting issues that increase vulnerability and contribute to a lack of access to health services for prevention and treatment.

 

Those under 25 represent 30% of the population in the Region, but many young people are not involved in national social and economic building processes and have limited access to goods and services. The situation of young people is compounded by poverty in many areas in the Region. This vulnerability, combined with a tendency to engage in risk behaviors including unprotected sex, alcohol use, and drug use, make young people highly susceptible to HIV and STI. Children orphaned by HIV are particularly disadvantaged. Even HIV negative orphaned children still lack the support and nurturing offered by a stable family environment. For those infected, pediatric formulations for children remain highly inadequate, as industry has not invested resources into this area due to the small number of children infected with HIV in the industrialized world.

  

Although not a problem in the Turks and Caicos Islands, injecting drug use plays an important role in the spread of the epidemic, particularly in North America, Brazil, and the Southern Cone. In some cities in Brazil, the HIV prevalence rate among injecting drug users in 2004 was 60 times higher than the rate in the general population.

In 2002, injecting drug users represented 43% of cumulative reported cases of AIDS in Bermuda. In Puerto Rico in 2003, 50% of all infections were associated with injecting drug use.

In Argentina, the HIV prevalence rate among injecting drug users was 7.8% compared to 0.3% among pregnant women in 2003. Although injecting drug users have become a significant factor in the Regional epidemic, with infection rates reaching 60% in some cities, there is limited political support for the development of programs for this group.

 

Unprotected sexual intercourse between men continues to play a major role in the spread of the epidemic. HIV sero-prevalence rates among this group are above 5% in most Member States. In selected countries, percentages are considerably higher. Recent surveys have shown HIV prevalence rates among men who have sex with men are as high as 17.7% in El Salvador and 15% in

Mexico. Rates of infection in this group are also high in the Andean sub-Region. In Lima, Peru infection among men who have sex with men was as high as 21% in 2002. Discrimination forces

 en who wish to engage in sexual activities with other men to go “underground” and deny the existence of risk behavior. This deters prevention programs from reaching them and puts their unknowing female sexual partners at risk.

 

Studies have shown that commercial sex workers are disproportionately affected by the epidemic.

A recent multi-centric study conducted in Central America showed that HIV prevalence among female sex workers varied from less than 1% in Nicaragua to over 10% in Honduras. In the Dominican Republic, the prevalence rates varied between 4.5% and 12.4% in the study sites in 2000. In Jamaica, HIV prevalence among female sex workers in Kingston was 10% and in Montego Bay 20% in 2001. In Suriname, 21% of female sex workers were infected by HIV in 2003, while in neighboring Guyana the prevalence rate was 31% in 2000. Gender inequalities are a central issue to HIV. Women are biologically more susceptible to contracting the disease through sexual intercourse than men. The presence of inflammation and/or sores or ulcers in the genital tract resulting from a sexually transmitted infection that remains undiagnosed and untreated, increases several-fold the chances of becoming infected with HIV if exposed to infecting fluids.

 

The mobility of populations plays an important role in the spread of HIV. Mobile populations, including migrant workers, are vulnerable due to the complications of poverty, lack ofaccess to services, and lack of information, as well as the transient nature of their relations andlong periods away from families resulting in increased engagement in transactional sex. Migrantworkers who do not have the necessary documents to remain legally in the host country may facedifficulties in receiving health care services or may hesitate to seek services out of fear of beingdeported.

 

The male-to-female sex ratio of reported AIDS cases is declining rapidly in the Region. Region-wide the proportion of all reported adult cases (for which sex is reported) occurring in women has increased over time, from 6.1% before 1994 to 15.8% in 1999; in 2002, the proportion was 16.5%. We discussed last week that in Turks and Caicos Islands the raito is almost 1:1.

 

What we do have to understand is that although these are the populations that are most at risk, we must remember that HIV does not discriminate and that anyone from any social group or economic situation or sex can become infected.

 

Please remember to call the National AIDS Program for further information our contact numbers are 941-4984 in Providenciales and 946-1675