How can We Prevent HIV and End the AIDS Epidemic in Latin America and the Caribbean?

Copyright © 2016. Inter-American Development Bank. If you wish to republish an article, please ask for permission at sph-communication@iadb.org.

By Sarju Sing Rai and Meghana Kulkarni.

Did you know that every hour approximately 10 people get infected with HIV in Latin America and the Caribbean?

HIV/AIDS is one of the most challenging and destructive diseases in human history with 36.7 million people currently living with HIV and 2.1 million infected with the virus every year. In Latin America and the Caribbean, there are 2 million people living with HIV and 100,000 people infected with HIV every year.

Anti-retroviral therapy can help those infected live as long as a HIV-negative people. However, this treatment is expensive and continued adherence to treatment places a substantial burden on individuals, families and countries, driving them into economic hardship and impoverishment.

Although HIV/AIDS has been a major public health concern for the last three decades, this virus is very much preventable. UNAIDS estimates that if we can prevent new HIV infections and provide treatment to those infected, we can end AIDS globally by the year 2030.

Unfortunately, existing HIV prevention efforts are not sufficient and decline in new HIV infections among adults has stalled. The UNAIDS Prevention gap report shows that an estimated 1.9 million adults worldwide become infected with HIV every year and the same reality exists in Latin America and the Caribbean. Given these staggering figures and slow progress, there is an urgent need to reinvigorate HIV prevention.

This year, World’s AIDS Day is highlighting the importance of HIV prevention. Celebrated on December 1st to raise awareness about HIV/AIDS, this year’s theme “Hands up for #HIVprevention”, focuses on breathing new life into HIV prevention efforts and inspiring the next generation to rethink HIV prevention.

How can we prevent HIV in Latin America and the Caribbean?

There are a number of strategies available which, when used in combination, can effectively help prevent HIV transmission:

1. Consistent use of condoms during sex;

2. Harm reduction for people who inject drugs like providing clean syringes and counseling;

3. Voluntary medical male circumcision, which lowers the risk of HIV infection by 60%;

4. Pre-Exposure Prophylaxis (PrEP), which includes regular use of HIV medication by uninfected people who are at high risk of infection;

5. Post-Exposure Prophylaxis (PEP) which can be taken within 72 hours of unprotected sex;

6. Treatment as Prevention (TasP) that includes consistent use of HIV medication for people who have HIV, as a measure to help prevent transmission to their sexual partners;

7. Promotion of gender equality and sexual and reproductive health education.

In order to effectively prevent HIV infection we must consider ‘key populations’ who are the most vulnerable to HIV infection. In Latin America and the Caribbean, the HIV epidemic affects mainly men who have sex with other men, sex workers, and intravenous drug users. People from these key populations and their sexual partners account for nearly two thirds of new HIV infections in the region.

Furthermore, women and youth are disproportionately affected by HIV in the region. It is estimated that 31% of adults living with HIV in Latin America and 52% of adults in the Caribbean are women. Young people, especially girls in the region, are also vulnerable to HIV. Approximately one third of new infections occur in young people aged 15 to 24. According to UNWOMEN , in Latin America, young women aged 15-24 made up 36% of new infections, while in the Caribbean they make up 46% of new HIV infections.

Within the region, there are specific hot spots or regions which have higher prevalence of HIV. In Latin America, Brazil has the largest number of people living with HIV, and new infections increased by 11% in 2015. In the Caribbean, Haiti alone accounts for 55% of all people living with HIV, and the situation is projected to worsen with the recent devastation of Hurricane Matthew.

Can we end the epidemic of AIDS in Latin America and the Caribbean?

The answer is ‘Yes’ – the epidemic of AIDS can be ended, but we need a renewed commitment to achieve this incredible feat. According to Dr. John Edward Greene, The United Nations Secretary-General’s Special Envoy for AIDS in the Caribbean, there are five key strategies to bring an end to the AIDS epidemic in the region:

1. Strengthening social support by enhancing family life and focusing on those in need;

2. Increasing access to treatment including affordable medicines;

3. Promoting prevention, focusing on access to sexual and reproductive health and rights, including age appropriate education;

4. Reducing gender inequality including violence against women and girls;

5. Achieving legislative reforms for modifying and repealing AIDS related discriminatory laws.

Dr. Greene stresses the need for strong leadership and collaboration to reinvigorate HIV response such as the Pan Caribbean Partnership against HIV & AIDS (PANCAP), which has been a successful model in the Caribbean to bring together governments, civil societies, faith-based organizations, and national and international organizations in the movement towards ending AIDS.

He underscores the importance of addressing the specific needs of populations that are being left behind: Ensuring their rights, eliminating HIV-related stigma and discrimination, discriminatory and punitive laws and policies against people living with HIV, and providing access to adults and youth to HIV prevention tools and services.

What can you do to help?

What is your responsibility in ending AIDS by 2030? First, get tested for HIV. According to WHO, currently, only 54% of people with HIV know their status. The Centers for Disease Control and Prevention (CDC) recommends that everyone aged 13-64 years old get tested for HIV at least once as well as all pregnant women and those planning to get pregnant. As a general rule, individuals at a high risk for HIV infection (drug users, sex workers, and those with sexually transmitted diseases, hepatitis, or tuberculosis) should get tested once per year and sexually active gay and bisexual men should get tested as often as every 3 to 6 months. Additionally, all those who are sexually active, particularly those who have multiple sex partners should get tested. Even individuals in monogamous relationships should know their partner’s status.

We can also help within our own families and communities to increase awareness on HIV/AIDS by promoting HIV prevention strategies, helping reduce HIV-related stigma and discrimination, and respecting and supporting those with HIV.

Are you ready to help end AIDS once and for all? Tell us what you think is the major barrier to ending AIDS in your community. Let us know what you can do to help end AIDS. Use the comments section below or mention @BIDgente on Twitter.

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The authors would like to thank Dr. John Edward Greene, The United Nations Secretary-General’s Special Envoy for AIDS in the Caribbean, for his expert insights in helping write this blog.

Sarju Sing Rai is a Public Health Pharmacist and a researcher and advocate on HIV/AIDS. He holds Masters Degrees in Global Health and Community Medicine.

Meghana Kulkarni is a sexual violence prevention advocate and holds a Bachelor’s Degree in Women Studies and community action and social change.

They are currently working as Global Health Corps fellows at the Joint United Nations Programme on HIV/AIDS (UNAIDS) and Together for Girls.