*EPF510 09/29/00
Text: Pan American Health Organization Resolution on AIDS
(PAHO urges AIDS prevention and treatment) (1890)

The Pan American Health Organization (PAHO) September 28 approved a resolution to consolidate national efforts against AIDS. Adopted during a meeting of the 42nd Directing Council September 24-29 in Washington, D.C., the resolution emphasizes better surveillance and prevention of HIV transmissions.

The council comprises all the region's health ministers, and it urges countries to "continue to focus on appropriate measures that permit universal access to preventive measures, drugs, and policies on breast-feeding based on scientific advances."

The health ministers also expressed concern about the ability of countries to buy drugs at lower prices, and asked PAHO to continue work on a regional purchasing plan for health supplies, according to a PAHO press release.

In a report to the council, PAHO director Dr. George Alleyne said about 2.6 million people in the region are living with HIV. He added, "These figures continue to increase and it is estimated that between 600 and 700 people are newly infected with HIV every day in this Region. On the other hand, the HIV epidemic in the Americas is still contained in the sense that it has not widely impacted the general population. However, there are some areas where the epidemic has reached worrisome proportions."

The Alleyne report provides detailed statistical data about the occurrence of HIV/AIDS cases in the region, describing the situation as "a mosaic of different epidemics, all of which will need to be addressed more forcefully to prevent a generalized epidemic in the region."

The following is the text of the press release.

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PAN AMERICAN HEALTH ORGANIZATION

AIDS Prevention, Comprehensive Treatment Urged by Health Ministers at PAHO Meeting

Ministers of Health today urged all countries in the Americas to use comprehensive approaches to prevent AIDS and offer access to treatment including antiretroviral drugs for all people with HIV/AIDS in their countries.

In a meeting of all health ministers of the Americas, the Pan American Health Organization's Directing Council, the ministers approved a resolution calling on the countries to consolidate national efforts against AIDS, emphasizing better surveillance of trends, focusing on prevention of sexual transmission, mother to child transmission, and transmission through intravenous drug use. They urged the countries to "continue to focus on appropriate measures that permit universal access to preventive measures, drugs, and policies on breast-feeding based on scientific advances."

The health authorities also asked PAHO to continue working on a Regional Revolving Fund for Strategic Public Health Supplies to help countries buy drugs at lower prices, and to facilitate the sharing of information on prices for antiretrovirals.

In a report to the ministers, PAHO Director Dr. George Alleyne noted that " These figures continue to increase and it is estimated that between 600 and 700 people are newly infected with HIV every day in this Region. The death toll at the end of 1999 had reached more than half a million. On the other hand, the HIV epidemic in the Americas is still contained in the sense that it has not widely impacted the general population. However, there are some areas where the epidemic has reached worrisome proportions."

The report noted that the vast majority of HIV-positive people in the Caribbean were infected during unprotected heterosexual sex. Haiti is the most affected country in the subregion. In some studies, 13 percent of pregnant women tested positive for HIV in 1996. The country estimates that around 10 percent of adults in urban areas and 4 percent in rural areas are infected with HIV. Guyana, the Bahamas, and the Dominican Republic have also been hit hard by the epidemic. Guyana found close to 7.1 percent of pregnant women and 46 percent of female commercial sex workers in the capital city of Georgetown to be HIV-positive. The Bahamas showed a prevalence of 3.6 percent among pregnant women in 1995, and double that percentage (7.2 percent) in high-risk groups (patients with sexually transmitted infections [STI] nationwide). HIV prevalence among commercial sex workers averaged 5.5 percent in 1998 across the Dominican Republic, representing an increase from 3.3 percent observed only 2 to 3 years earlier. In Puerto Rico, 24,352 cases of AIDS have been reported and 15,188 people have died from the disease. The main exposure categories are related to intravenous drug use in men (55 percent of cases) and heterosexual contact in women (59 percent of the cases).

Some of the countries of Central America, the PAHO report said, are among the most affected by the epidemic in Latin America. In Honduras there are signs of the epidemic spreading to the general population (1.4 percent among pregnant women nationwide in 1998). Epidemiological studies of HIV infection among other groups, such as female sex workers in San Pedro Sula, showed that one in five was infected with HIV. In five other cities (1998) prevalence averaged 10 percent among sex workers. In Belize, El Salvador, and Guatemala the epidemic is already a cause for concern, with 1.4 percent HIV prevalence among pregnant women in Belize. Other populations registered higher figures, such as Puerto Barrios, Guatemala, where 11 percent of sex workers tested HIV positive compared with 4.7 percent in Guatemala City. In El Salvador, 6percent of STI patients tested HIV positive in 1995-1996. In Costa Rica and Panama, the epidemic is greatest in men who have unprotected sex with men.

In Mexico, the National AIDS Program estimates that there were about 174,000 people living with HIV in Mexico at the end of 1999. The epidemic continues to be driven by men that have unprotected sex with men, the report said. In some studies 14.2percent of this group were found to be infected with HIV, and probably act as a bridge to the general population. AIDS is the third most common cause of death in men and the sixth most common cause of death in women in Mexico.

Brazil, the report said, has reported 170,078 AIDS cases and estimates that around 540,000 people were living with HIV and AIDS at the end of 1999. Most of the infections are concentrated in major urban areas and among men who have sex with men. Although the latter group continues to be important in transmitting HIV, in recent years injecting drug use has contributed significantly to the rising numbers of HIV-infected people. In sexually transmitted diseases (STD) clinics, 3.7percent of male and 1.7 percent of female clients tested HIV positive in the same month. Among patients in hospital emergency rooms, 1.7 percent of men and 1.2 percent of women tested HIV positive.

In the Southern Cone, men who have sex with men and injecting drug users (IDU) continue to be the main groups affected by the epidemic, the PAHO report noted. It is believed that between 5 percent and 10 percent of adults are HIV-infected as a result of sharing of syringes or needles and other paraphernalia used by IDU. Injecting drug use is responsible for the shifting of the epidemic toward a younger age group (from 30-49 to 20-34 years), and for the growing numbers of women being infected, which increased from no cases in 1985 to more than 20 percent of cases in 1996. Particularly in Argentina, IDU has played a substantial role in the spread of the epidemic almost from its start, and since 1990 it is the most prevalent risk category. In the latest figures, IDU accounted for more than 40 percent of the reported AIDS cases. Chile has found only limited HIV infection in the general population in several areas of the country, including Santiago, the capital city, where risk behavior is thought to be highest. Among pregnant women between 1992 and 1997, HIV prevalence rates remained below 1 per 1,000. In Uruguay, similarly low rates were recorded among over 8,000 workers tested in 1997. Just 0.26 percent of samples tested were HIV positive.

The Andean Area seems to be relatively little affected by HIV to date, although there is no room for complacency since risk behavior is well established in several countries, the report noted. Colombia estimated that 67,000 people were living with HIV in 1998. The overall seroprevalence rate was 0.24 percent in a large national campaign (130,000 people tested) to promote counseling and voluntary HIV testing in the mid-1990s. Since the beginning, the epidemic has affected mainly men. However, the male to female ratio decreased from 37:1 in 1987 to 5:1 in 1998. In the highlands, HIV is spread principally through unprotected sex between men, while in coastal areas the epidemic is largely driven by unprotected heterosexual sex. In 1996, Bogota had a prevalence of 0.1 percent among pregnant women compared to 0.4 percent in Cali. In Peru, HIV prevalence among pregnant women was 0.23 percent and 0.07 percent among blood donors in 1998. Among high-risk groups, an ongoing study of sex workers found 1.6 percent HIV positive in Lima and 0.6 percent in the provinces. In all groups prevalences were higher in cities than in rural areas. In Bolivia, regular sentinel surveillance among pregnant women found little HIV infection. In 1997, just 0.5 percent of 980 pregnant women tested positive for HIV. Among female sex workers tested in Santa Cruz, only 0.3 percent were found to be HIV positive in 1998.

In North America, the PAHO report said, the wide use of combination antirretroviral therapies has had a positive impact on mortality and in delaying the progression of HIV infection to AIDS. Of the more than 760,000 AIDS cases reported in the Unites States up to May 2000, almost 90 percent of cases were in men who had sex with men (MSM) and/or injecting drug users (IDU). Only 10 percent were attributed to heterosexual transmission. Recent trends of HIV infection have disclosed that both groups (MSM and IDU) continue to be the most affected groups, although heterosexual transmission among women has continued to increase. These trends are particularly noticeable in inner cities and among marginalized groups. In Canada, HIV prevalence is very low, but HIV transmission is increasingly related to heterosexual contact and injecting drug users as the principal sources of transmission. At the beginning of the epidemic (1985), sex between men used to account for most of the HIV cases (75 percent); 10 years later only 36.5 percent of cases continue to be related to this category. In contrast, injecting drug use, which in 1994 accounted for only 9 percent of the cases, is at present between 29 percent and 33.5 percent of all HIV infections. The sex ratio of newly reported HIV cases went from 9.4 infected men for every infected woman in 1985 to 1.5 by 1998.

"In general the HIV/AIDS epidemic in the Americas continues to be a mosaic of different epidemics, all of which will need to be addressed more forcefully to prevent a generalized epidemic in the Region," the PAHO document said.

PAHO, founded in 1902, works with all the countries of the Americas to improve the levels of health of its peoples. It also serves as the Regional Office for the Americas of the World Health Organization. Its annual health ministers' meeting, being held this week in Washington, brings together top leaders from throughout the Americas to set policy on a wide variety of health issues.

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(Distributed by the Office of International Information Programs, U.S. Department of State. Web site: http://usinfo.state.gov)
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