X HIV/AIDS Prevention and Care in Resource-Constrained Settings

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Singapore and Hong Kong. Therewere intense focal epidemics in thelate 1980s among IDU populationsin Australia, Thailand, northeastIndia, several provinces inChina, Malaysia, Myanmar,Vietnam and, most recently, Nepal.Major heterosexual epidemics, primarilydriven by sex work, havereached seroprevalence levels of onepercent to three percent among the15- to 49-year-old population inCambodia, Myanmar, Thailandand several states in India.Epidemiological studies over thepast decade also have shown thatHIV epidemics among MSM,IDUs and heterosexual populationsmay develop independently of eachother, depending upon the sexualbridges between these populations.HIV prevalence has remainedrelatively low (less than .01 percent)in the total 15- to 49-year-old age group insome developing countries in the region, despite comparablyhigh levels of other STDs in segments of thispopulation. Even among CSWs in the Philippines andIndonesia, HIV infection levels have remained minimal.As we come to better appreciate the quantitativedifferences in sexual behavior—as influenced by cultureand religion—between these countries and thosethat have experienced severe sexual spread, it shouldbe increasingly possible to make longer term predictionsof the trends in the spread of the epidemic overthe next several decades.From a regional perspective, the ultimate impact ofHIV/AIDS in this region will be determined by theextent of ongoing epidemics in a number of key countries:Cambodia, Myanmar, Thailand, and, because oftheir population size, Indonesia, India and China.■The epidemics in this region feature:An exceedingly complex epidemic in India thatinvolves multiple epidemic foci, such as outbreaksamong IDUs and extensive HIV spread amongfemale CSWs and their clients in several regions.F igure 4HIV Prevalence for General Population bySex, 1995–1996, Zambia, UrbanHIV Prevalence (%)■■FemalesMales15-19 20-24 25-29 30-39FylkenesSubstantial heterosexual epidemics with comparablyhigh levels of HIV in pregnant women inThailand, Cambodia and parts of Myanmar, withconcentrations among IDUs and CSWs in othercountries, such as Vietnam.Ongoing low HIV prevalence (less than 0.1 percent)in the total 15- to 49-year-old population insome countries. In the Philippines, HIV surveillancehas found only a few cases of HIV infectionamong female CSWs, male STD clinic patientsand MSM. Indonesia likewise has reported only asmall number of AIDS cases and low levels of HIVinfection.T HE EPIDEMICS OF LATIN AMERICAAND THE CARIBBEANThere are two distinct epidemics in Latin Americaand the Caribbean, one in the island and coastal countriesof the Caribbean, another in mainland SouthAmerica. With eight percent of the world’s population,the Latin American and Caribbean region is home toHIV/AIDS Prevention and Care in Resource-Constrained Settings XI
F igure 5HIV Seroprevalence for Commercial SexWorkers in Selected Urban Areas of Asia: 1987–1999HIV Seroprevalence (%)60Phnom PenhMumbai (Bombay)40200KatmanduNortheastCalcuttaNorthCentralSouthernThailandHa NoiHo Chi Minh1987 1989 1991 1993 1995 1997 1999Source: U.S. Bureau of the Census, HIV/AIDS Surveillance Data Base, 2000.4.9 percent of all people living with HIV/AIDS(PLHA) at the beginning of the 21st century. Thereare close to 1.3 million PLHA in Latin America andanother 360,000 in the Caribbean. Because of thewide diversity of HIV epidemics, these regional figuresmask huge differences in epidemic levels and patternsof transmission.Although the Caribbean is geographically small, ithas a total population of more than six million. Someparts of Haiti and the Dominican Republic have HIVprevalence rates higher than any other country in theworld outside of sub-Saharan Africa. HIV testing ofpregnant women attending antenatal clinics suggeststhat at least one in 12 adults between ages 15 and 49is living with HIV. Guyana has also been hit harshlyby HIV. In 1996, 7.1 percent of pregnant Guyanesewomen tested for HIV were found to be infected.Outside the Caribbean, the hardest hit area in thisregion is Central America. In Honduras, Guatemalaand Belize, the epidemic appears to be heterosexuallydriven and increasing. In San Pedro Sula, the HIV epicenterin Honduras, HIV infection among pregnantwomen has fluctuated between two percent and fivepercent for several years. In Costa Rica, on the otherhand, HIV is concentrated among MSM and seems tobe contained at relatively low levels.XII HIV/AIDS Prevention and Care in Resource-Constrained Settings
Page 1 and 2: Edited byPeter R. Lamptey, MD, DrPH
Page 3 and 4: © 2001 Family Health International
Page 5 and 6: SECTION II:Chapter 6PAGE 137Chapter
Page 7 and 8: Chapter 21PAGE 501Chapter 22PAGE 51
Page 9 and 10: I N T R O D U C T I O NPAUL R. DE L
Page 11 and 12: F igure 1Factors That InfluenceThe
Page 13: F igure 3HIV Seroprevalence for Pre
Page 17 and 18: F igure 7HIV Seroprevalence for Pre
Page 19 and 20: F igure 9Life Expectancy With and W
Page 21 and 22: F igure 11Population of Zimbabwe,Wi
Page 23 and 24: invest; and feedback further amplif
Page 25 and 26: R EDUCING MOTHER-TO-CHILDTRANSMISSI
Page 27 and 28: F igure 13HIV Seroprevalence in Adu
Page 29 and 30: ACKNOWLEDGEMENTSWe wish to express
Page 32 and 33: SOFIA GRUSKIN, JD, MIAAssistant Pro
Page 34 and 35: THOMAS M. PAINTER, PHDBehavioral Sc
Page 36 and 37: glossary of A C R O N Y M SACTG AID

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