Latin America and the Caribbean

Latin America and the Caribbean

Latin America and the Caribbean are currently less badly affected by AIDS than is Africa. Still, in some countries more than 2% of adults are infected with HIV. Across the region the virus is spreading from established high-risk groups – sex workers, injecting drug users and men who have sex with men – into the general population.

Brazil

Brazil is seen as having one of the developing world’s best records of HIV prevention; the adult HIV prevalence has remained stable at around 0.5% in recent years. The response started in the early 1980s, at a time of great political change, and was led by newly formed non-governmental organisations. The Brazilian authorities cooperated with these groups and supported a strong programme of integrated HIV prevention and care, with special attention paid to marginalised communities. The government has vigorously promoted condom use – often through very explicit mass media campaigns – and has distributed hundreds of millions of free condoms. At the same time it has worked hard to combat homophobia and stigma related to HIV. Needle exchanges and other harm reduction programmes were established in key cities in the early 1990s, and were later expanded nationally. Prisoners are helped to access clean needles as well as condoms.³⁰ Although an exact estimate is unavailable, between 49% and more than 95% of HIV-positive pregnant women received drugs to help prevent mother-to-child transmission in 2009.³¹

In recent surveys, 90% of female sex workers reported condom use with their most recent client. Amongst injecting drug users condom use among injecting drug users is high (70% used a condom last time they had sex), whereas just over half used sterile injecting equipment last time they injected.³² Regular condom use among adults with more than one sexual partner is higher among men (43%) than women (34%). In 2009, HIV prevalence among MSM was very high at 12.6%.³³ HIV testing needs to be improved among high-risk groups in Brazil, as 2009 figures show that a very small percentage of individuals from across all high-risk groups have been tested in the last 12 months and know the result.³⁴

Cuba and Jamaica

Discrimination stops HIV prevention measures from reaching many of those at highest risk of infection

Cuba also has had remarkable success in controlling HIV, though it has taken a very different approach to Brazil’s, with much less emphasis on human rights and education. In 1986 the island began routinely screening its citizens for HIV, and within seven years around 12 million tests were performed.³⁵ To begin with, those who tested positive were quarantined indefinitely in sanatoriums, where they would receive medical care and education about how to avoid transmitting the virus, while authorities set about tracing their sexual partners. Since 1993 the rules had been less strict. Someone diagnosed with HIV still has to attend an eight-week course at a sanatorium, but after that they can choose whether to stay (and receive free care) or go home (and get less help from the state). Many have chosen to remain in sanatoriums.³⁶ Authorities maintain a database of everyone diagnosed with HIV and all of their sexual partners.³⁷

Although most experts and activists believe that Cuba’s heavy-handed approach is not a good example for other nations to follow, it has certainly been successful. Adult HIV prevalence at the end of 2009 was around 0.1% - the lowest in the Americas.³⁸ Drugs to prevent mother-to-child transmission have been universally available for many years, and infection among children is almost unheard of. Nevertheless, Cuba cannot afford to be complacent. One of the factors that previously helped to protect the island from HIV was its social isolation from countries with high prevalence. Recently tourism has grown substantially, and so has the sex industry. Many Cubans believe that HIV is not a threat to them, and the government, keen to celebrate its success so far, has done little to challenge this view. The need for education and condom promotion has never been greater.³⁹

Homophobia is much less of a problem in Cuba than it once was, but elsewhere in the Caribbean it is still rife. In Jamaica – where around 1.7% of adults were living with HIV at the end of 2009 – any act of physical intimacy between men is illegal, and punishable by up to ten years hard labour.⁴⁰ Gay men are shunned by society, and in some cases violently attacked because of their sexuality. Such discrimination stops HIV prevention measures from reaching many of those at highest risk of infection.⁴¹ Attempts to distribute condoms to prisoners have been vigorously opposed by inmates and prison officers.⁴²