AIDS IN THE AMERICA - A PUBLIC-HEALTH PRIORITY FOR THE REGION

The AIDS epidemic continues to grow in the Americas at different velocities in different countries due to the different times of introduction of the virus and because of a host of social/behavioral factors which remain to be elucidated. In some subregions the pattern of transmission is changing rapidly from the homosexual/bisexual to the heterosexual transmission pattern with a consequential increase in perinatal transmission. While the clinical presentation of HIV-1 infection varies throughout the region, the adaptation of a modified case definition for AIDS will aid in the recognition and surveillance of AIDS cases. The recent introduction of HIV-2 into the region has further complicated the increasing prevalence rates of HIV-1 and HTLV-I/II and the associated morbidity and mortality rates observed with these retroviruses. Furthermore, some countries are already beginning to feel the impact of AIDS on their health-care delivery system, and those countries which have yet to feel the impact of AIDS must prepare for the inevitable consequences of a relatively broad epidemic of HIV-1 infection. Consequently, if we are to respond effectively to the AIDS and HIV pandemic, prevention efforts and the mobilization of resources should become a priority at the local, national and global levels.; 156 countries have reported over 250,000 AIDS cases to the WHO. Taking underreporting into account in developing countries, this figure grows to over 600,000 with 300,000 deaths. HIV-1 infection rates are estimated at between 5-10 million people. Projections indicate that there will be 5 million AIDS cases by 2000. AIDS is an unprecedented health problem that has enormous social, political, medical, and economic implications. The Americas account for 61% of the total cases reported to the WHO. Of the 46 countries in the Americas there have been 153,720 cases reported as of May 1, 1990. 96% of these cases were reported in the US, Brazil, Canada, Haiti, and Mexico. The geographic distribution of AIDS is not homogeneous because of a variety of factors. It was not introduced simultaneously in all countries; some were exposed later than others. Some countries have better detection systems. Excluding North America, the English-speaking Caribbean countries account for only 2% of the population, while the Latin Caribbean countries have 6%, yet they have 10% and 21% of the cases, respectively. Sexual transmission patterns reveal that bisexual men are the largest bridge between the homosexual and heterosexual community, not IV drug users. Studies show that blood donors who are paid are 18 times more likely to be HIV-1 positive in some areas. As AIDS prevalence increases in the heterosexual community, the rate of perinatal transmission also increases. This in turn increases the infant mortality rate because of increases in pediatric AIDS cases. Pediatric cases currently threaten much of the progress that has been made in developing countries in lowering the infant mortality rate. If this pandemic is to be stopped, prevention efforts must be increased as well as a shift in resources at the local, national, and global levels to find some effective method of containment.