This is the third in a multipart series of articles by United Press International on the status of the global AIDS epidemic.
--
AIDS outbreaks in Africa and the huge population masses of central and southern Asia might seem far from the United States, but the epidemic rages just as ferociously in the nearby Caribbean and in Latin America.
In fact, according to the Joint United Nations Programme on AIDS, "In several Caribbean countries, adult HIV prevalence rates are surpassed only by the rates experienced in sub-Saharan Africa -- making this the second-most affected region in the world."
Controlling the epidemic is possible in the region, evidenced by efforts in the Bahamas, Barbados, Cuba and Brazil. However, there still are 12 countries where infection with the human immunodeficiency virus -- the organism that causes AIDS -- is greater than 1 percent of the population. That level might not sound alarming, but it represents a threshold of serious infection.
Because some nations have learned how to control HIV/AIDS, there should be ways to export that control around the globe. And, experts said, there are ways to do it.
"There are four keys to controlling AIDS," said Dr. Richard Keenlyside of the Centers for Disease Control and Prevention in Atlanta. "It requires a plan, a budget, political will at the highest levels of government and inclusion of extended non-governmental agencies to spread policies and prevention messages," he told United Press International.
"We can use prevention tactics to control HIV infection
," said David Holtgrave, professor of behavioral science and health education at Emory University, also in Atlanta. "It is a matter of will. We know what kind of interventions work. We know what needs to be done. We know what it will cost," he said earlier this year.
"A major problem is money and political will. Most of the time the non-governmental agencies are ready to go," said Dr. Scott Hammer, professor of infectious diseases at Columbia University in New York City.
Unfortunately, among the governments of the Caribbean and South and Central America, there are few plans, little money and an overwhelming lack of governmental will. Even if governments manage backing for plans, said Keenlyside, those plans do not seem to get implemented.
Keenlyside, associate director for external relations and public health practice for CDC's Global AIDS Program, said he is encouraged by work being done in the Bahamas -- the nation of islands off the coast of Florida; in Barbados
, a Caribbean island nation, and in Brazil
, the largest country in Latin America, both in geographical size and population.
The rest of the region
, however, remains on the edge of a burgeoning epidemic.
"I don't think that the situation in Latin America and the Caribbean will ever come close to Africa
, where infection rates among adults exceed 20 percent," Keenly side said. "But there are already a number of countries in Latin America that have infection rates that exceed 1 percent -- and that really is troublesome."
Among such nations in the region are impoverished Haiti at 6 percent and, despite its anti-AIDS efforts
, the Bahamas at 3.5 percent. Throughout the region, 1.9 million people -- nearly half a million in the Caribbean -- are infected with HIV.
"We are concerned about the rising epidemic in Guyana," Keenlyside said. The small nation on the northern Caribbean shore of South America has an HIV prevalence rate of 2.7 percent among adults ages 15 to 49.
According to surveillance data collected by UNAIDS and the World Health Organization, in Guyana's pre-natal clinics, from 4 percent to 7 percent of pregnant women are testing positive for HIV infection. The situation is much worse in the capital of Georgetown, where the prevalence of HIV infection -- zero in 1987 -- rose to 25 percent by 1990, and was 44 percent in 1997. Clinics dealing with sexually transmitted diseases reported in 1997 that 25 percent of men and 18 percent of women were HIV-positive.
Even more troubling, the stigma surrounding AIDS since it was identified 20 years ago continues to affect how governments and populations look at the disease. AIDS is spread by homosexual and heterosexual relations, by unsafe injecting drug use, and sometimes by infected blood products and medical paraphernalia. Generally, homosexual men initially are infected, followed by injecting drug users
, commercial sex workers and people who have multiple sexual partners.
"There still is a tendency," Keenlyside explained, "among the general population and even some political leaders to stigmatize people with HIV/AIDS, considering that these people are paying the price for their lifestyle."
In addition, lack of knowledge about the disease, even among health care workers
, makes treatment and care of the infected a problem, he said. "There are still many health care workers who believe that casual contact with patients with AIDS can spread the disease and, therefore, they are reluctant to treat or see these individuals."
Keenlyside said nations such as Brazil, which have enough funds to supply patients with anti-retroviral medications (HIV is a retrovirus) are discovering that treatment can save lives.
Dr. Jose Marins
, of the University of Campinas in Sorocaba, Brazil, writing in the journal AIDS, said people diagnosed with AIDS in the 1980s survived only about five months. In 1995, that period had been extended to 18 months following diagnosis, and since 1996 -- with the introduction of highly active anti-retroviral drugs -- survival following a diagnosis of AIDS has lengthened to 58 months.
"These findings demonstrate that universal access to anti-retroviral treatment in a developing country can produce benefits on the same scale as in rich countries," Marins said.
The regional AIDS anomaly is Cuba, with an infection rate one-tenth that of the United States. Haiti, in comparison, has a rate 200 times higher. Although Cuba effectively controls HIV spread with compulsory HIV education, generic anti-retroviral drugs and universal, mandatory testing, however, its Draconian methods are unlikely to be copied in democratic nations, Keenlyside said.
One of the Bush administration's aims in the United States is to fund projects that will affect the epidemic in the Western Hemisphere. However, the protracted struggle to approve the funding for the projects shows that political will -- or lack thereof -- will determine if AIDS is corralled in the Americas or roars with deadly, catastrophic results.
(Ed Susman, a medical writer for UPI, has been covering the AIDS epidemic for more than 20 years)
(Editors: UPI photos WAX2003091701, WAX2003091702 and WAX2003091703 are available)
