HIV/AIDS IN LATIN AMERICA The Challenges Ahead

220 Pages·2003·1.81 MB·English

by  World Bank Group

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About this series...
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This series is produced by the Health, Nutrition, and Population Family e
(HNP) of the World Bank’s Human Development Network. The papers z Anabela Garcia-Abreu, Isabel Noguer and Karen Cowgill
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in this series aim to provide a vehicle for publishing preliminary and o
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The findings, interpretations, and conclusions expressed in this paper A
are entirely those of the author(s) and should not be attributed in any e
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manner to the World Bank, to its affiliated organizations or to members s
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of its Board of Executive Directors or the countries they represent. cl
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March 2003
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HIV/AIDS IN LATIN AMERICA
The Challenges Ahead

Anabela Garcia-Abreu, Isabel Noguer and Karen Cowgill
March 2003
Health, Nutrition and Population (HNP) Discussion Paper

This series is produced by the Health, Nutrition, and Population Family (HNP) of the World Bank's
Human Development Network (HNP Discussion Paper). The papers in this series aim to provide a
vehicle for publishing preliminary and unpolished results on HNP topics to encourage discussion and
debate. The findings, interpretations, and conclusions expressed in this paper are entirely those of the
author(s) and should not be attributed in any manner to the World Bank, to its affiliated organizations or
to members of its Board of Executive Directors or the countries they represent. Citation and the use of
material presented in this series should take into account this provisional character. For free copies of
papers in this series please contact the individual authors whose name appears on the paper.

Enquiries about the series and submissions should be made directly to the Editor in Chief. Submissions
should have been previously reviewed and cleared by the sponsoring department which will bear the cost
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ISBN 1-932126-72-4

© 2002 The International Bank for Reconstruction and Development / The World Bank
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All rights reserved.
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Health, Nutrition and Population (HNP) Discussion Paper

HIV/AIDS in Latin America
The Challenges Ahead

Anabela Garcia-Abreua , Isabel Noguerb and Karen Cowgillc

aSector Manager, South Asia Region, Health Nutrition and Population, The World Bank, Washington DC, USA
bConsultant, LCSHH, The World Bank, Washington DC, USA
cConsultant, The World Bank, Washington DC, USA

Paper prepared as part of Advisory and Analytical Activities on HIV/AIDS in the Latin America
and the Caribbean Region

Abstract: Information on HIV/AIDS epidemics in Latin America is disperse and lacks comprehensiveness.
Sound and timely policies can limit the current and future impact of the epidemics but good policies are built on a
strong epidemiological base and according to the countries’ needs. The aim of this study was to assemble all the
information available on the epidemiological pattern of the epidemics in Latin America and to gather information on
current national surveillance capacity, national responses of the health sector to identify key areas where specific
interventions are needed.

Through national statistics, data published by international organizations, and databases searches, we collected data
on the extent, trends and patterns of HIV/AIDS epidemic in 17 Latin American countries. Data on national
surveillance systems and national responses from the health sector were gathered through questionnaires applied to
managers of the national HIV/AIDS surveillance system, director of the National HIV/AIDS program, NGOs, and
physicians.

Despite relatively high rates of HIV infection in most countries, many Latin American countries have not yet faced a
full-scale AIDS epidemic. HIV/AIDS falls within the framework of a low endemic setting; in the majority of the
countries the epidemic is still concentrated in high-risk populations. Latin America has the necessary infrastructure
to efficiently and effectively confront the HIV/AIDS epidemic. However, the capacity to respond has been limited
by political, technical and social problems. Several key problems on the areas of prevention, access to health and
social services, human rights and national capacity were identified.

The results of our study suggest that the main challenges to meeting the current needs are (i) availability of
resources; (ii) institutional capacity to provide training in all areas; and (iii) cultural, social and religious factors.

Keywords: HIV/AIDS; Latin America, Prevention; Surveillance; Multi-sectoral collaboration.

Disclaimer: The findings, interpretations and conclusions expressed in the paper are entirely those of the authors,
and do not represent the views of the World Bank, its Executive Directors, or the countries they represent.

Correspondence Details: Anabela Garcia-Abreu; The World Bank, 1818 H Street NW, Mail Stop MC 11-1114;
Tel: [phone]; Fax: [phone]; Email: [email protected]; Web: www.worldbank.org
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Table of Contents

Abbreviations and Acronyms………………………………………………..……...….. vii
Foreword…………………………………………………………………..……………. ix
Acknowlegements……………………………………………………………………… xi
Background...............................................………………………………………………xiii
Executive Summary…………………………………………………………………… xvii

CHAPTER 1: EPIDEMIOLOGICAL OVERVIEW AND ECONOMIC IMPACT

Summary………………………………………………………………………… 1
Quantifying the Epidemic……………………………………………………….. 3
Mexico....................................................................................................................8
Central America………………………………………………………………….10
Brazil……………………………………………………………………………. 15
Andean Region…………………………………………………………………..17
Southern Cone…………………………………………………………………...22
The Economic Impact of HIV/AIDS in Latin America………………………….26

CHAPTER 2: EPIDEMIOLOGICAL SURVEILLANCE

Summary………………………………………………………………………... 31
Introduction……………………………………………………………………... 33
Resources for HIV/AIDS Surveillance................................................................. 34
HIV/AIDS Information Systems and Reporting……………………………….. 34
Sentinel Surveillance of HIV…………………………………………………… 40
HIV Testing and Diagnosis Policies……………………………………………. 42
Blood Supply Safety………………………………………………………….….44
What do the Countries Identify as Basic Needs for Improving Epidemiological
Surveillance of HIV/AIDS?…………………………………………………….. 45
Conclusions: Strengths and Challenges………………………………………... 46

Annex 2.1: HIV/AIDS Case Definitions
Annex 2.2: Countries/Sub-Regions with Reporting Forms for Case Notification
Annex 2.3: Legislation Regarding Confidentiality Issues
Annex 2.4: Under-reporting and Delays in Notification
Annex 2.5: Systematization of Records of HIV and AIDS
Annex 2.6: Results of HIV Sentinel Surveillance Studies
Annex 2.7: People Living with HIV
Annex 2.8: Cost of HIV Testing in Public and Private Health Centers

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CHAPTER 3: NATIONAL RESPONSES TO THE EPIDEMIC

Summary………………………………………………………………………... 65
Introduction……………………………………………………………………... 67
National Agreements and Multisectoral Coordination..........................................68
Interventions for the General Population and Specific Groups………………… 71
NGOs’ Contributions to HIV/AIDS Control in Latin America………………… 78
The Population’s Level of Knowledge of Methods of Transmission and
Prevention of HIV/AIDS……………………………………………………….. 82
Prevention of Mother-to Child Transmission……………………………….…. 85
Health and Social Services………………………………………………………86
Collaboration with International Agencies……………………………………... 94
Principal Barriers and Needs for More Effective Control of the HIV/AIDS
Epidemic………………………………………………………………………... 95

Annex 3.1: Additional Tables
Annex 3.2: Legal Restrictions to Homosexuality

CHAPTER 4: KEY INTERVENTIONS AND CHALLENGES AHEAD

Summary……………………………………………………………………….. 109
Introduction…………………………………………………………………….. 111
National Response to the Epidemic: Prevention….…………………………... 112
Access to Health and Social Service……………………...………………….…117
Human Rights…………...…………………………………...………………. 120
National Capacity: Structure and Management.………………………………..121
Conclusions……………………………………………………………………..124

APPENDIX 1 Country Fact Sheets

APPENDIX 2 Collaborators in the Study

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ABBREVIATIONS AND ACRONYMS

AIDS Acquired Immune Deficiency Syndrome
ARV Antiretrovirals
CDC Centers for Disease Control and Prevention
CSW Commercial Sex Worker
HAART Highly Active Antiretroviral Therapy
HIV Human Immunodeficiency Virus
IBRD International Bank for Reconstruction and Development
IDUs Injecting Drug Users
IFA Immuno-Florescence Assay
INH Isoniazide
MoH Ministry of Health
MSM Men who have Sex with Men
NGOs Non-Governmental Organizations
PAHO Pan American Health Organization
PLWHA People Living with HIV/AIDS
STIs Sexually Transmitted Infections
UNAIDS Joint United Nations HIV/AIDS Program
WB Western Blot
WHO World Health Organization

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