Special Science Issue Examines HIV/AIDS in Latin America and the Caribbean

Cover of Science - 28 July

Science correspondent Jon Cohen, a prize-winning author and one of the world's foremost HIV/AIDS experts, reports on the battle against HIV and AIDS across Latin America and the Caribbean, in the journal's 28 July issue.

Over the course of nine months, Cohen traveled to 12 countries in Central and South America and the Caribbean, visiting clinics, brothels, laboratories, drug-shooting galleries, ministries of health, gay sex clubs, universities, slums, migrant way stations, prisons and the homes of many people who struggle to live with the virus.

The result is a package of 10 news stories that provide an in-depth look at both the epidemics and the responses by governments, nongovernmental organizations and the affected communities.

[Read Science's new stories on HIV/AIDS in Latin America and the Carribean here. And click here to see "The Overlooked Epidemic," a multimedia presentation produced by Science and Biocompare, featuring video clips, interviews, maps and more to expand on the content in Science's new HIV/AIDS issue]

Una traducción en español de la nota de prensa sobre los artículos de la revista Science que se tratan de la HIV/SIDA en América Latina y el Caribe está disponible aqui.

With the exception of Haiti, no country in Latin America or the Caribbean has seen a marked drop in HIV prevalence. By 2015, according to projections from the World Health Organization and the Joint United Nations Programme on HIV/AIDS (UNAIDS), the 2 million HIV-infected people in Latin America and the Caribbean today will climb to nearly 3.5 million.

Currently, AIDS claims 90,000 lives per year in the region. But between now and 2015, another 1.5 million Latin Americans and Caribbean islanders, at a minimum, are projected to die from the disease.

The epidemics in these countries have common themes, such as poverty, migration, lack of leadership, homophobia and a dearth of research into patterns of transmission. But Cohen's stories also highlight the significant differences, even those between countries that are next-door neighbors.

As Peter Piot, who heads UNAIDS in Geneva, Switzerland, says about the region: “When it comes to AIDS, it's just not one place.”

Jon Cohen

Some of the countries that Cohen reports from are:

• Brazil, where antiretroviral drugs are available to every resident who needs them, at least in theory. Government officials have so far refrained from breaking patents and making copies of new antiretroviral drugs, instead cutting deals with the big pharmaceutical companies.

  In 1992, the World Bank predicted that Brazil would have 1.2 million cases of HIV by the year 2000. However, at the end of 2005, only 620,000 Brazilians were infected, according to UNAIDS estimates. Between 1996 and 2002, AIDS mortality dropped 50 percent, seemingly because of the use of antiretroviral drug cocktails. The government says it saved 90,000 patients from death as well as $1.2 billion that would have been spent on hospitalization and treatment of opportunistic infections.

• Argentina, where the epidemic's heterosexualization has produced rates of new infection in men and women that are almost the same. By 2005, the HIV prevalence rate was 0.6 percent. Government data showed 50.7 percent of people with AIDS had been infected through heterosexual sex. By contrast, an analysis from 1982 to 2001 showed that 40.1 percent of cases were contracted through intravenous drug use.

• Mexico, where the spread of HIV is linked to men who have sex with men, migration, the sex industry, gangs and crowded prisons. The epidemic in Mexico has not spread as quickly as feared, according to researchers, but epidemiologists say they are most concerned about the heterosexual spread of the virus in rural communities.

  Another source of concern is migration, which researchers are finding is a major factor in increased infection. Preliminary data suggest that migrants have more sexual partners, use drugs and alcohol more often and hire sex workers more frequently.

• Haiti and the Dominican Republic, which share the island of Hispaniola, have 85 percent of the Caribbean's cases. At the end of last year, the Caribbean's HIV/AIDS prevalence rate of 1.6 percent was the second-highest in the world, after sub-Saharan Africa.

  Haiti has an adult prevalence rate of 3.8 percent, and the Dominican Republic 1.1 percent. Although the Dominican Republic's prevalence rate is less than one-third of Haiti's, surprisingly the Dominican Republic's HIV/AIDS programs are far inferior. "It's 1,000 times better in Haiti," says Keith Joseph, a physician at Columbia University who has provided HIV/AIDS care in both countries.

  Researchers estimate that 78 percent of infections in the Dominican Republic now occur through heterosexual sex, some of which is linked to a booming sex trade. Prevalence rates as high as 12 percent have been documented among sex workers.

The other news stories in the special issue are about the HIV/AIDS epidemics in Puerto Rico, Guatemala , Honduras, Belize and Peru.

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A Spanish translation of the AAAS news release on Science's special HIV/AIDS issue is available here.

See a AAAS news release on Jon Cohen's 2004 Science series on AIDS in Asia, and a related interview with the author, here.

Kathy Wren and Michaela Jarvis

27 June 2006