Posed by the HIV Epidemic in Latin America and the Caribbean 2009
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CTP PARA COUCHE PLACA 61.5 X 72.4 6 DE PINZA X 5 COLORES PONER BARRA DE COLOR CHALLENGES Posed by the HIV Epidemic in Latin America and the Caribbean 2009 Challenges Posed by the HIV Epidemic in Latin America and the Caribbean 2009 October 2009 PAHO Library Cataloguing-in-Publication Data: Challenges Posed by the HIV Epidemic in Latin America and the Caribbean 2009. Priority interventions: HIV/AIDS, Universal access, Latin America 1. Acquired immunodeficiency syndrome – prevention, care and treatment. 2. HIV response. 3. Challenges. 4. Universal access. 5. Most vulnerable populations. 6. PAHO, UNICEF, UNAIDS ISBN 978-92-75-13052-0 (NLM classification: WC 503.4) © Pan American Health Organization 2009 The Pan American Health Organization (PAHO), the United Nations Children’s Fund (UNICEF), and the Joint United Nations Programme on HIV/AIDS (UNAIDS) collaborated to produce this report. The Pan American Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. Applications and inquiries should be addressed to the HIV/AIDS Unit, Pan American Health Organization, Washington, DC, USA, which will be glad to provide the latest information on any changes made to the text, plans for new editions, and reprints and translations already available. This report is available at www.paho.org, www.unicef.org , and at www.unaids.org. Publications of the Pan American Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights are reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Pan American Health Organization, the United Nations Children’s Fund, or the Joint United Nations Programme on HIV/AIDS concerning the status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. All reasonable precautions have been taken by the Pan American Health Organization, the United Nations Children’s Fund, or the Joint United Nations Programme on HIV/AIDS to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall Pan American Health Organization, the United Nations Children’s Fund, or the Joint United Nations Programme on HIV/AIDS be liable for damages arising from its use. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the Pan American Health Organization, the United Nations Children’s Fund, or the Joint United Nations Programme on HIV/AIDS in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. This document does not necessarily represent the decisions or policies of the Pan American Health Organization, the United Nations Children’s Fund, or the Joint United Nations Programme on HIV/AIDS. The Pan American Health Organization is an international public health agency with over 100 years of experience working to improve health and living standards of the people of the Americas. It enjoys international recognition as part of the United Nations system, serving as the Regional Office for the Americas of the World Health Organization, and as the health organization of the Inter-American System. Further information: www.paho.org. Printed in Lima, Peru. TABLE OF CONTENTS Contributions ................................................................................................................................................................................................................................................... 9 Preface ............................................................................................................................................................................................................................................................... 11 Introduction Universal Access: Progress and Challenges Ahead in the Response to HIV in Latin America and the Caribbean ......................................... 13 Chapter 1 by Carlos F. Cáceres Men who have Sex with Men and the HIV Epidemic in Latin America and the Caribbean ......................................................................... 19 Chapter 2 by Diana Rossi HIV among People Who Use Drugs in Latin America and the Caribbean............................................................................................................... 29 Chapter 3 by Francisco I. Bastos, Alexandra Angulo-Arreola, and Mônica Malta Sex Work and HIV in Latin America and the Caribbean: Challenges and Responses ....................................................................................... 41 Chapter 4 by Arachu Castro Prevention of Mother-to-Child Transmission of HIV and Syphilis in Latin America and the Caribbean .............................................. 55 Chapter 5 by Jesús M. García-Calleja, Marco Vitoria, and James Fitzgerald Antiretroviral Therapy in the Latin America and Caribbean Region: An Overview and Challenges for the Future ....................... 75 Chapter 6 by Giovanni Ravasi and Noreen Jack HIV Drug Resistance in Latin America and the Caribbean ............................................................................................................................................... 87 Annexes List of Tables .................................................................................................................................................................................................................................................. 95 List of Figures ................................................................................................................................................................................................................................................ 95 List of Boxes .................................................................................................................................................................................................................................................... 96 List of Acronyms ......................................................................................................................................................................................................................................... 96 7 Challenges Posed by the HIV Epidemic in Latin America and the Caribbean 2009 CONTRIBUTIONS This document was developed with a joint collaborative effort of PAHO, UNICEF and UNAIDS. Editor: Arachu Castro Technical peer review and coordination: Authors: Mónica Alonso González Chapter 1 ¨Men who have Sex with Men and the HIV Epidemic Paloma Cuchí in Latin America and the Caribbean¨ Carlos F. Cáceres. Jesús M. García-Calleja Chapter 2 ¨HIV among People Who Use Drugs in Latin Gottfried Hirnschall America and the Caribbean¨ Diana Rossi. Vivian M. López Chapter 3 ¨Sex Work and HIV in Latin America and the César A. Núñez Caribbean: Challenges and Responses¨ Francisco I. Bastos, Alexandra Angulo-Arreola, and Mônica Malta. Peer-review group: Chapter 4 ¨Prevention of Mother-to-Child Transmission of Mónica Alonso González HIV and Syphilis in Latin America and the Caribbean¨ Arachu Maria Etelvina Barros Castro. Bilali Camara Chapter 5 ¨Antiretroviral Therapy in the Latin America and Sonja Caffe Caribbean Region: An Overview and Challenges for the Paloma Cuchí Future¨ Jesús M. García-Calleja, Marco Vitoria, and James Bertha Gómez Fitzgerald. Raúl González Chapter 6 ¨HIV Drug Resistance in Latin America and the Gottfried Hirnschall Caribbean¨ Giovanni Ravasi and Noreen Jack. Noreen Jack Vivian M. López Paulo Lyra Matilde Maddaleno Rafael Mazín Bremen de Mucio César A. Núñez María Dolores Pérez-Rosales Matilde Pinto Amalia del Riego Keith Sabin Cecilia Sánchez Karen Sealey Omar Sued María Tallarico Rebekah Thomas Luis Villa 9 Challenges Posed by the HIV Epidemic in Latin America and the Caribbean 2009 Preface This report comes more than three years after Latin America and Caribbean countries committed to the target of universal access to HIV prevention, treatment, care, and support, as set forth by the United Nations General Assembly High Level Meeting on HIV/AIDS in 2006. PAHO, UNICEF, and UNAIDS present to you Challenges Posed by the HIV Epidemic in Latin America and the Caribbean 2009 to contribute to making progress towards this target. The report focuses on the epidemiological characteristics of HIV in the region and provides the reader with a discussion of major challenges still faced by countries as they move towards scaling up their national AIDS programs and services. The report also suggests areas in which a critical mass of knowledge, greater emphasis, and focused action are still required to overcome these challenges and help support countries to reach their national universal access targets. By presenting evidence, discussing challenges, and providing recommendations for policy and programming, the report prioritizes several overarching issues that have been selected based on epidemiological and programmatic significance to guide public health action for HIV control in the region. While this publication does