HIV/AIDS in Latin America hivaids.jpg
HIV/AIDS (What is it):

The difference between HIV and AIDS
AIDS is not something that can be transmitted, the virus you can acquire that leads to AIDS is HIV. HIV is transmitted primarily through intercourse, sharing of needles and breast milk (in babies), though it is possible to transmit this virus in any situation where there is an exchange of bodily fluid. A person is HIV-positive when a blood test is run and special antibodies are found that are produced by your body in order to fight off the HIV infection. As the HIV virus continues to live in the body, it slowly wears down your immune system.
Acquired Immune Deficiency Syndrome (or AIDS) is a condition that is diagnosed after your immune system is seriously damaged. An indicator of this can be getting diagnosed with an opportunistic infection(contracting a virus that is not related to AIDS, but the damage to your immune system allows it to take over easily) or having less than 200 CD4 cells (T-Helper cells – the cells directing all the other cells in the immune system).

This video explains how the HIV virus becomes defined as AIDS and some of the common opportunistic infections:


What does the HIV virus do to the body?



When the HIV virus attacks a T-cell, it turns the cell into a factory to produce more HIV. The virus keeps the cell alive as long as possible in order to produce more HIV. Your immune system identifies the infected cells and kills them, all the while producing new cells to keep your cell count up. However, because the HIV virus is in the blood, it is only a matter of time before the new cells become infected as well.


Key Affected Groups

Men who have sex with men:
According to the World Health Organization the number of men infected with HIV is higher than the number of women in Latin America. This is largely due to sexual transmission between men. Males in Latin America who have sex with males have a one in three chance of becoming infected with HIV (Barton-Knott , 2010).
Prevention campaigns often neglect to mention this target group. Due to the culture in some areas of Latin America, the problem of contracting HIV/AIDS through men sleeping with men is generally hidden because of homophobia in the region. The statistics for contracting HIV/AIDS in Latin America are often unreliable as men who contract it from other men are frequently afraid to admit how they became infected leaving them classified in the incorrect group. Other countries in the region of Latin America openly acknowledge the primary group in which the epidemic is spread. By acknowledging and addressing the situation at hand these countries can spread awareness and educate the masses about the epidemic. (Avert, 2010)
This group is a key affected group and more susceptible than others because they have anal sex - when this is done without protection it has a higher risk of HIV transmission than unprotected vaginal sex. Another reason they are more at risk is that in some countries homosexuality, or sexual acts between men are looked down upon or even criminalized making it difficult to educate individuals on the dangers/spread of HIV/AIDS (Avert, 2010).
Sex Workers:
Individuals that work in the sex industry (specifically individuals that have sex for money) are not only a key affected group but play a large role in the transmission of HIV in Latin America. However, this varies from country to country. A study has shown that individuals that work in brothels are less at risk than individuals that work on the street. It may be undesirable for individuals paying for sex to use proper protection (condoms), forcing the sex workers to have unprotected sex and make themselves more vulnerable to contracting sexually transmitted infections. On the flip side, individuals taking part in sexual acts with sex workers may contract the disease from them and pass them on to their significant others (Avert, 2010). Sex workers are particularly at risk because their high rate of exposure. Sex workers usually have hundreds of sexual partners in just one year. Not only is a sex worker at risk of contracting HIV but they could spread it to all of their clientele. According to statistics many sex workers also open themselves up to the possibility of contracting HIV/AIDS through the use of drugs as it often comes with the lifestyle (Root-Bernstein, 1993).

Injecting drug users:
There has been an increase in drug usage in Latin America since the switch from a dictatorship to a democracy - the freedom lead to an increase in experimentation with drugs. According to (Frasca, 2005) “Around 1986 there was a tremendous fascination, especially among intellectual circles and intravenous drugs. People wanted to try everything, and I think it was in some way a result, a legacy, of the military dictatorship because during the dictatorship you couldn’t do anything”. This change in authority not only lead to an increase in the use of drugs, but an increase in the spread of HIV. According to the United Nations Office on Drugs and Crime cocaine and heroine are the most frequently injected drugs. According to the United Nations office on drugs and crime this leaves cocaine users more likely to contract HIV because they inject drugs more frequently. Programs to help reduce the chances of contracting diseases from used needles have been implemented in Latin America, however, some countries are not allowed to implement such programs contributing to a continuing increase of HIV positive individuals (2010).

Injecting drug users are considered a key affected group and they often engage in an act that leads to the spread of HIV. In desperation to get drugs in their systems (due to poverty, or simply being under the influence), individuals may inject themselves with used needles that have been infected by an HIV positive individual, they may also share needles with other individuals which can ultimately lead to the spread of HIV.

Migrants:
Migration takes place frequently in Latin America, this has historically been due to politics and constant conflict. A major area for migration occurs between Mexico and the United States. Not only is there a lot of migration between Mexico and the United states, but historically millions of people migrated to Latin America during the slave trade - most likely bringing HIV positive individuals over. Migration is connected to the spread of HIV in Latin America. This can be due to numerous factors; poverty, lack of health services, rape, contact with sex workers, and in some cases even individuals have been migrated for the purpose of human trafficking often making them sex workers. (International Organization for Migration, 2005)

Migrants are considered key infected groups for the reason that they frequently put themselves into risky situations that can ultimately lead to the spread of HIV/AIDS.

Distribution of HIV/AIDS

LAMap.jpg
Name0of0Country
#0of0people0living0with0HIV/AIDS0
Argentina
120,000
Belize
3,600
Bolivia
8,100
Brazil
730,000
Chile
31,000
Colombia
170,000
Costa Rica
9,700
Ecuador
26,000
El Salvador
35,000
Guatemala
59,000
Guyana
13,000
Honduras
28,000
Mexico
200,000
Nicaragua
7,700
Panama
20,000
Paraguay
21,000
Peru
76,000
Suriname
6,800
Uruguay
10,000
Venezuela
~110,000
Total
1,700,000
(Avert)

Attitudes associated with HIV/AIDS

The Catholic Church and AIDS
AIDS arrived in Latin America after its appearance in Africa and the United States of America. Authorities did not take the virus as seriously as they should have, citing “superior moral habits and a modern health system” (Frasca 6)

They may have been right about superior moral habits; after all, 71% of Latin Americans are Catholics. It is in fact the most Catholic region in the world. In most situations, the Catholic Church is seen as a force for positive change. The church leaders are held in such high esteem that they are often called upon as mediators in situations that have nothing to do with religion. In the case of AIDS however, the Catholic Church maybe hindering efforts to stop the epidemic rather than helping.

Consider the Catholic Church’s negative stance on condom use. According to the UNAIDS Coordinator for Honduras, Nicaragua and Costa Rica, “in Latin America the use of condoms has been demonized, but if they were used in every relation I guarantee the epidemic would be resolved in the region" 1. The attitude of the Catholic Church towards condoms is allowing the virus to spread more easily, and is a large contributing factor to the severity of the epidemic.

In Latin America homosexuality is far less acceptable than it is here in Canada. It is an uncomfortable topic for many Latin Americans. In Guatemala (and likely elsewhere), these attitudes may have had a serious effect on attempts to curtail the AIDS epidemic. According to government statistics, only 15% of AIDS victims acquired the virus through homosexual relations. Activists within the country dispute this number, saying 40% is a more accurate number. As a result of inaccurate statistics, AIDS information campaigns may be targeting the wrong people. Gay men do not feel comfortable admitting their sexual orientation and health care professionals do not feel comfortable asking. This can be attributed, at least in part, to the Catholic Church’s attitude towards homosexuality, which they describe as a “grave depravity” 2. The Catholic catechism says that relations between gay men and women “are contrary to the natural law. They close the sexual act to the gift of life. They do not proceed from a genuine affective and sexual complementarity. Under no circumstances can they be approved.” 2

Ignorance and AIDS
Not only is ignorance aiding the spread of the virus, it is also making the day to day lives of suffers that much harder. “I had to learn to live with HIV, initially without treatment and in silence to avoid social discrimination, and most of all to protect my little daughter, who was in school at the time” 3, admits a woman living with the disease in Uruguay. People are unsure of exactly how AIDS is transmitted, and so they are justifiably fearful of sufferers. In most countries, sexual education is not mandatory and is left up to the discretion of the school. This often results in sexual education being absent or incomplete.

In Conclusion
Latin Americans do not know enough about the disease and how to prevent it. There are not enough support structures in place for victims. Many people have an attitude of fear toward the disease, and this paired with the population’s unease with homosexuality makes it very hard to talk directly about the problem and provide accurate, effective solutions. Homosexuals are far more likely than heterosexuals to have AIDS. If the epidemic is ever to be stopped, efforts must be focused on this group.


Preventing the Transmission of HIV

How To Prevent the Transmission of HIV/AIDS
Education:
It is essential that people be educated with accurate information of how HIV is spread, how the spread of HIV can be prevented, and the possible fatality associated with HIV/AIDS
(Limanonda, 2010).

Preventing Unprotected Sexual Transmission:
  • Implement programs that promote condoms, and distribute condoms (if infected individuals decide to not abstain from sexual activity they can attempt to protect themselves).
  • Free screening for sexually transmitted diseases may also prevent infected individuals from engaging in sexual activity.
  • According to the United Nations Program on HIV/AIDS circumcision has been scientifically proven to reduce a mans risk of becoming HIV positive by up to 60% (Winter, 2007).

Prevention of Mother-to-Child Transmission:
  • Avoid unwanted pregnancies of infected mothers (provide better contraception services).
  • Provide the mother with antiretroviral therapy. Antiretroviral therapy has been proven to reduce transmission.
  • Avoid breastfeeding, as the disease can be transmitted through breast milk.

Prevention of Blood Transmission:
  • Provide needle and exchange programs for injecting drug users (this way the amount of needle sharing will be reduced).
  • In the case of blood transfusions donated blood should always be screened for HIV.
  • In health care systems needles and syringes should never be re-used.
  • When getting a tattoo or piercing individuals should ensure there is a brand new, sterile needle being used.

Effective HIV Prevention in Latin America

In Latin America there are two countries that specifically stand out for their prevention programs.
Brazil:
Brazil is known to have one of the best HIV prevention programs in the developing world. The government promotes condom use through media campaigns and distributing them. Needle exchange programs have been implemented nationally. The majority of HIV positive women that are pregnant take drugs to help prevent transmission to the child and the number of drug users that share needles has dropped significantly.
Cuba:
In Cuba began screening for HIV, and individuals that were HIV positive were quarantined and provided with education about the transmission of the disease as well as medical care. Cuba has now become less strict - HIV positive individuals now have to attend a course, after completion of the course they can stay quarantined (where they will get free care) or go home (where they are not as supported by the government) (Avert, 2010).

HIV/AIDS Treatment


Pre-Exposure Prophylaxis (PrEP):
PrEP is a daily medication taken by HIV negative individuals that are high risk, it is taken to lower their chances of becoming infected if they are exposed to HIV.
Zidovudine (AZT):
AZT has been shown to slow disease progression and prolong life (NIAID, 2009).
Antiretroviral Drugs
Antiretroviral medication is organized into five drug classes:
Reverse Transcriptase (RT) Inhibitors:
RT’s convert HIV RNA to HIV DNA, there are two types of inhibitors:
  1. Nucleoside/nucleotide RT inhibitors which block HIV from replicating in a cell.
  2. Non-nucleoside RT inhibitors which bind to RT and interfere with the ability to convert the HIV RNA into HIV DNA.
Protease Inhibitors:
These interfere with the enzyme that HIV uses to produce infectious viral particles.
Fusion/Entry Inhibitors:
These inhibitors interfere with the virus’ ability to fuse with the cellular membrane, thereby blocking entry into the host cell.
Integrase Inhibitors:
These block integrase (the enzymes HIV uses to integrate genetic material of the virus into its target host cell)
Multidrug Combination Products:
These are a combination of drugs from different classes into a single product to combat virus strains from becoming resistant to antiretroviral drugs. (NIAID, 2009)

The following is a chart from http://www.avert.org/treatment.htm:

Antiretroviral drug class
Abbreviations
First approved to treat HIV
How they attack HIV
Nucleoside/Nucleotide Reverse Transcriptase Inhibitors
NRTIs,
nucleoside analogues,
nukes

1987
NRTIs interfere with the action of an HIV protein called reverse transcriptase, which the virus needs to make new copies of itself.
Non-Nucleoside Reverse Transcriptase Inhibitors
NNRTIs,
non-nucleosides,
non-nukes

1997
NNRTIs also stop HIV from replicating within cells by inhibiting the reverse transcriptase protein.
Protease Inhibitors
PIs
1995
PIs inhibit protease, which is another protein involved in the HIV replication process.
Fusion or Entry Inhibitors

2003
Fusion or entry inhibitors prevent HIV from binding to or entering human immune cells.
Integrase Inhibitors

2007
Integrase inhibitors interfere with the integrase enzyme, which HIV needs to insert its genetic material into human cells

Number of Pills/Frequency of Dose
The number of pills differs depending on the combination of pills. Most treatments require swallowing many large pills, numerous times a day. Some pills must be taken with food, and others on an empty stomach which can lead to a lifestyle change to accommodate the medication.

Side Effects
Side effects vary in severity and duration. Common side effects include:

  • Diarrhea
  • Nausea and Vomiting
  • Rashes
  • Lipodystrophy (losing/gaining body fat)
  • Lipid abnormalities and the heart
  • Fatigue
  • Insomnia
  • Liver damage (Avert, 2010).


International Support

In the last decade, international funding for HIV/AIDS has grown tremendously. Due to a multitude of new initiatives such as the Global Fund for AIDS and the Global AIDS Programme, spending has continued to increase as organizations struggle to "make the money work." In 2004, the "Three Ones" principles brought the United Kingdom, The United States, and UNAIDS together as they made it their goal to achieve the most effective use of financial aid (UNAIDS). There have been a number of international campaigns targeted at the issue of HIV/AIDS in Latin America. Some campaigns have been targeted at a more international level while others have focused specifically on the region of Latin America. Examples of such include The World AIDS' Campaign's "CIAT Project," The Global Media AIDS Initiative, Fundacion Huesped, Family Health International, World Health Organization, UN AIDS, UNICEF, and Doctors Without Borders. These are only several of the many campaigns and organizations formulated by the international community in response to the HIV/AIDS epidemic.
external image 31841.jpg

THE WORLD AIDS' CAMPAIGN'S "CIAT PROJECT"
"CIAT" stands for "Coalición Internacional de Activistas en Tratamientos en Latinoamérica," or "International Treatment Preparedness Coalition in Latin America." This project focuses on Latin America's access to antiretroviral treatment and the funding of meetings for those affected by HIV/AIDS. CIAT has also been providing financial support to smaller organizations within Latin America. The project introduced the concept of "Don't Leave Me Alone," which focuses on providing support, education, and fulfillment of human rights to all people living with HIV/AIDS (World AIDS Campaign).

The Global Media AIDS Initiative

The GMAI seeks to recognize the power of media when it comes to influencing the spread of HIV/AIDS in Latin America. They have created strong relationships with many of Latin America's major broadcasters and have made plans to implement HIV/AIDS based programming. To this day, TV Globo has devoted many hours of such programming, thus raising awareness and providing the affected public with new resources and knowledge (IMLAS).

Fundacion Huesped
Funacion Huesped is based in Argentina and since 1989, has been in the fight against AIDS. Their vision focuses on a world where HIV/AIDS are not causes of death and discrimination. Their campaign seeks to provide the public with information, prevention, and treatment. They are also behind various forms of research and testing which will hopefully contribute towards the overall prevention of the epidemic. Fundacion Huesped has contributed a number of consultations and interviews to those living with HIV/AIDS. In addition, it has also provided psychological assistance, the promotion of rights, and the development of communities and resources throughout Argentina. Through this organization, over 150,000 condoms and 20,000 pamphlets have been distributed. 220 health professionals have been trained in HIV/AIDS counseling and more than 70 communities have been educated in prevention strategies. Argentina is home to over 120,000 people living with AIDS and through programs like Funacion Huesped, awareness and prevention are being spread in hopes of lowering that number (Fundacion Huesped).

Family Health International
This organization is one of the most significant with regards to providing technical assistance and support to nations in which HIV/AIDS is of epidemic proportions. It has over 2,500 staff who work in 55 countries where they conduct research and help advance the state of healthcare. FHI has also addressed issues such as malaria and tuberculosis. The mission of the organization is to improve the lives of people through the use of advanced technology and hard work. It has implemented a variety of public health programs which target aspects such as counseling and testing services, increased quality of care, and expanding family planning services. The FHI has an extremely strong influence in Latin America, especially in the nations of Brazil, The Dominican Republic, Haiti, Jamaica, Mexico, and many others. For example, in Brazil, FHI "strengthened the capacity of the Ministry of Health" as well as the STI/AIDS Control Program. As a result, HIV/AIDS programs were implemented in Ceará, Bahia, São Paulo and Rio de Janeiro. In addition, in Haiti, the FHI has been active in the area of family planning and the distribution of contraceptives. (Family Health International).

World Health Organization
The WHO is another example of an international organization which helps nations gain better quality of treatment, prevention services, and medicine. The World Health Organization is concerned with universal health access as it is collaborating with other agencies in order to reach this goal. The WHO works in 193 countries where its goals are focused on five strategic decisions which include enabling people to be aware of whether or not they have HIV/AIDS and accelerating the rate of treatment if they do. They are working with countries in an effort to develop departments that correspond to the health of children, reproductive health, and research of the HIV/AIDS virus (World Health Organization).

UN AIDS
This organization also has goals to halt the spread of HIV and AIDS by providing the world with universal access to its prevention and treatment. UNAIDS is a joint venture of the members of the United Nations and works in over 80 countries. One of its main focuses is the universal access of health services for all people in all nations (UNAIDS).
UN AIDS
UN AIDS

UNICEF
UNICEF is focusing on the children through its high-profile "Unite for Children, Unite Against AIDS" campaign. In Brazil, both UNICEF and the national government are hoping to eliminate the rate of mother-to-child transmission of HIV/AIDS (UNICEF).

Doctors Without Borders
Doctors Without Borders has become very involved in the prevention of HIV/AIDS as it believes in providing patients with the highest level of quality medical care. The organization is currently focusing on the creation of new drugs for patients who have shown resistance to first-line HIV/AIDS medicines. Doctors Without Borders has been influential in Brazil's AIDS program since in 2001, the organization called for the U.S. government to withdraw from an action that would have handicapped the Brazilian AIDS control program. According to Doctors Without Borders, the USA threatened a system on which hundreds of peoples' lives depended on. At the time, the USA had filed a request for a World Trade Organization "dispute settlement procedure" on Brazil's laws concerning its HIV/AIDS treatment programs, an action which was very threatening towards these programs and the people who had been depending on them
(Doctors Without Borders).

The International HIV/AIDS Alliance
external image Latin_America_regional_right.jpgexternal image Latin_America_regional_Left.jpg
The International HIV/AIDS Alliance is based on the principles of "local leadership, commitment, and responsibility." When this organization combines these elements with support and helping hands, it strives to make a difference in the HIV/AIDS world community. Its goals are to reduce the spread of HIV/AIDS, provide treatment, and lessen the impact that HIV/AIDS has on peoples' lives. The Alliance recognizes that those affected are often marginalised from the rest of the population and so it takes pride in the importance of working with these individuals in order to lessen the hardships that they have to face on a daily basis. This organization works in over 40 countries including many in Latin America. Not only does the International HIV/AIDS Alliance try to lessen the impact of the epidemic but it also tries to lessen the stigma and discrimination which comes with it. In Latin America, The Alliance is concentrating on the key populations and those who are at the most risk- transgendered individuals, sex workers, drug users, and gay men among several other groups. The Alliance recognizes that these people all suffer from horrible amounts of discrimination and are often ignored by the government and key institutions. Recently, The Alliance launched a website called Portal SIDA. This website, written in Spanish, presents information about HIV/AIDS and local events pertaining to it (The International HIV/AIDS Alliance).

Conclusion

HIV/AIDS is a condition which attacks the immune system to the point of deterioration. It affects a number of regions, all of which differ with regards to statistics, those affected, distribution, and stigmas associated with the disease. In Latin America, key affected groups include men who have sex with men, sex workers, drug users, and migrants. The distribution of HIV/AIDS varies significantly from country to country; with Brazil having the most cases and Belize with the least. The stigma surrounding HIV/AIDS is heavily based on the heavy influence of Catholicism within the region of Latin America. In Catholicism, the use of condoms and homosexuality are strongly demonized. As a result, not only is HIV/AIDS more likely to spread, but men who contract it through homosexual intimacy are heavily stigmatized and discriminated against. This stigma not only affects homosexual men- it affects everyone as those with HIV/AIDS often suffer in silence since the stigma surrounding the epidemic is so negative. Despite these stigmas, many prevention programs and methods of international support have been arising in many regions of Latin America. The objectives to prevent unprotected sexual intercourse, mother-to-child transmission, and blood transfusion have all contributed towards the effort to decrease the number of HIV/AIDS incidences throughout Latin America. In addition, a variety of international organizations have helped combat HIV/AIDS by providing Latin America with greater resources, better quality of medical care, and research in hopes of preventing this epidemic which affects so many people worldwide.

With regards to potential solutions to the problem, the first step that Latin America could take is to alleviate the amount of stigma surrounding HIV/AIDS. The negative attitudes surrounding those affected by HIV/AIDS prevent victims from seeking appropriate medical help and raising awareness for the cause. If Latin America's attitude can be adjusted, those who need help will not be so afraid to get it. Its really quite a shame how heavy the stigma surrounding this issue is. It may seem hard for a Canadian to grasp how awful this issue is but there do exist cases in our own nation where stigma forces us to avoid seeking help, even in extreme medical circumstances. For example, there is a heavy stigma surrounding females and sexually transmitted diseases. If a young woman feels the need to simply get tested for conditions such as chlamydia or gonorrhea, often times, she will have to deal with people referring to her as promiscuous and lacking self-respect. Such stigmas often force young women to avoid getting tested, seeking treatment for easily treatable infections, and feeling free to discuss the issue with other females within their own peer groups. Imagine this stigma but on a stronger level against an epidemic of much more deteriorating proportions. The first step to helping Latin America's HIV/AIDS epidemic is to neutralize the attitudes surrounding it so that the individuals which do suffer feel free to gain help! Thanks to the heavy amount of international support and prevention campaigns in Latin America, the help IS available. The problem is that many times, people want to avoid the stigma and so they avoid the treatment and medical awareness as well. But how can this attitude be removed? For this reason, the world needs more HIV/AIDS activists. A variety of amazing and powerful individuals have come forward to discuss their stories and experiences with HIV/AIDS. Many times, their stories have motivated others to come out and talk about their own situations. Its amazing how much of a difference merely speaking about a topic can make. Once the population feels free to get help, the numbers of incidences will decrease. Slowly but surely, HIV/AIDS can be fought. All it takes is a voice.

external image normal_photo_no_2577.jpg
This is Mark Harrington. He is an American living with HIV.
He is speaking at the XVII International AIDS Conference in Mexico City.
He is the Executive Director of the Treatment Action Group.

external image normal_photo_no_2587.jpg
This is Karen Dunaway Gonzalez speaking at The International AIDS Conference in Mexico City.
She is an HIV positive activist. (Avert).

VOICE --> LESS STIGMA --> GETTING TREATMENT -->
DECREASING THE CHANCES OF SPREADING HIV/AIDS --> LESS CASES


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