UNAIDS, the multi-agency UN coordinating body for AIDS prevention and control, has produced its increasingly horrifying review of the world AIDS situation, just ahead of next month's world AIDS conference in South Africa. We present here an edited version of five of the organization's "fact-sheets" relating to the most affected regions and countries, including - here and there - some hints of success:
The HIV epidemic in Latin America is highly diverse. Several Caribbean island states have worse epidemics than any country outside of sub-Saharan Africa.
In Central American countries and countries on the Caribbean coast, HIV is spreading mainly through sex between men and women.
Brazil too is experiencing a major heterosexual epidemic, but there are also very high rates of infection among injecting drug users and men who have sex with men. In Mexico, Argentina and Colombia, HIV infection is also confined largely to these sub-populations. The Andean countries are currently among those least affected by HIV infection, although risky behaviour has been recorded in many groups.
The countries with the highest HIV rates in the region tend to be found on the Caribbean side of the continent. According to the most recent figures, over 7% of pregnant women in urban Guyana tested positive for HIV.
In Honduras, Guatemala and Belize there is also a fast-growing heterosexual epidemic, with HIV prevalence rates among adults in the general population of between 1 and 2%. In 1994, less than 1% of pregnant women using antenatal services in Belize District tested positive for HIV, while one year later the prevalence had risen to 2.5%.
In the Honduran city of San Pedro Sula, the rate of HIV infection among pregnant women has fluctuated between 2% and 5% for several years. Much of the problem is concentrated in teenagers, suggesting that the worst is still to come.
Heterosexual transmission of HIV is rarer in other countries of Central America. In Costa Rica, for example, HIV is transmitted mainly during unprotected sex between men. In Mexico, too, HIV has affected mainly men who have sex with men, more than 14% of whom are currently infected. According to one study, fewer than 1 in every 1000 women of childbearing age is infected.
Brazil, where over half a million adults are living with HIV, has strong prevention programmes. While in 1986 less than 5% of young men reported using a condom the first time they had sex, the figure in 1999 was close to 50%, a tenfold increase.Also, close to 90% of 16-25-year-old men reported consistent condom use with casual sex partners - an impressively high figure corroborated by an upsurge in the sale of male condoms, from 70 million in 1993 to 320 million in 1999. In a survey of Brazilian women at increased risk of HIV exposure who tried out female condoms for the first time, 75% said they were satisfied. Subsequently, 43% of these continued using them.
A low prevalence of HIV infection among heterosexuals is the norm in the Andean region, at least in countries where data are available. In Colombia, nowhere is the rate of HIV infection greater than 1 in 250 among pregnant women. Even amongsex workers, the figure is below 2%.
Argentina has typically high rates of HIV infection among injecting drug users and men who have sex with men, but a relatively low average prevalence of 0.4% among pregnant women.
Haiti is the worst-affected nation in the Caribbean. In some areas, 13% of anonymously tested pregnant women were found to be HIV-positive. Overall, around 8% of adults in urban areas and 4% in rural areas are infected. It is estimated that 74,000 Haitian children had lost their mothers to AIDS by the end of 1999.
In the Bahamas the adult prevalence rate is 4%. In the Dominican Republic 1 adult in 40 is HIV-infected, while in Trinidad and Tobago the rate is 1 adult in 100.
At the other end of the spectrum lie Saint Lucia, the Cayman Islands and the British Virgin Islands, where fewer than 1 pregnant woman in 500 tested positive for HIV in recent surveillance studies.
Heterosexual HIV transmission in the Caribbean is driven by the deadly combination of early sexual activity and frequent partner exchange by young people. In Saint Vincent and the Grenadines, a quarter of men and women in a recent national survey said they had started having sex before the age of 14, andhalf of both men and women were sexually active at the age of 16.
In Trinidad and Tobago, in a large survey of men and women in their teens and early twenties, fewer than a fifth of the sexually active respondents said they always used condoms, and two-thirds did not use condoms at all.
Age mixing - younger women having sex with older men - also drives the Caribbean epidemic. HIV rates are five times higher in girls than boys aged 15-19 in Trinidad and Tobago. At one surveillance centre for pregnant women in Jamaica, girls in their late teens had almost twice the prevalence rate of older women.
While in some countries, even treatment for opportunistic infections is problematic, other countries have responded to demands from groups of patients, doctors and human rights organizations and now lead the developing world in providing access to antiretrovirals. Argentina, Brazil, Colombia, Costa Rica and Uruguay provide a legal right to some form of antiretroviral therapy, though the application of the law is somewhat patchy. Coverage of eligible patients has been reported to be 100% in Brazil, 70% in Argentina, 65% in Chile and Uruguay, 40% in Panama and 20% in Ecuador.