Science correspondent Jon Cohen, a prize-winning author and one of the world's foremost journalists covering HIV/AIDS, reports on the battle against the disease across Latin America and the Caribbean, in the journal's 28 July 2006 issue.
Over the course of nine months, Cohen traveled to 12 countries in Mexico, Central and South America, and the Caribbean, visiting clinics, brothels, laboratories, shooting galleries, ministries of health, gay sex clubs, universities, slums, migrant way stations, prisons and the homes of many people who struggle to live with the virus.
The result is a package of 10 news stories that provide an unprecedented, in-depth look at both the epidemic in the region, and the responses of governments, nongovernmental organizations and the affected communities.
With the exception of Haiti, no country in Latin America or the Caribbean has seen a marked drop in HIV prevalence. By 2015, according to projections from the World Health Organization and the Joint United Nations Programme on HIV/AIDS (UNAIDS), the 2 million HIV-infected people in Latin America and the Caribbean today will climb to nearly 3.5 million.
Currently, AIDS claims 90,000 lives per year in the region. But between now and 2015, another 1.5 million Latin Americans and Caribbean islanders, at a minimum, are projected to die from the disease.
The epidemics in these countries have common themes, such as poverty, migration, lack of leadership, homophobia and a dearth of research into patterns of transmission. But, Cohen's stories also highlight the significant differences, even those between countries that are next-door neighbors.
As Peter Piot, who heads UNAIDS in Geneva, Switzerland, says about the region, "When it comes to AIDS, it's just not one place."
Some of the countries that Cohen reports from are:
Brazil, where a pioneering government program that offers antiretroviral drugs to all in need now finds itself facing escalating costs that threaten its future. Although the government saves costs by making several of the older drugs itself, officials have so far refrained from breaking patents and making copies of newer preparations, instead cutting deals with the big pharmaceutical companies.
Brazil also has had a model prevention program. In 1992, the World Bank predicted that Brazil would have 1.2 million cases of HIV by the year 2000. However, at the end of 2005, only 620,000 Brazilians were infected, according to UNAIDS estimates. Between 1996 and 2002, AIDS mortality dropped 50 percent, apparently because of the use of antiretroviral drug cocktails. The government says it saved 90,000 patients from death as well as $1.2 billion that would have been spent on hospitalization and treatment of opportunistic infections.
Argentina, where the epidemic's characteristics have changed dramatically. Once driven mainly by gay men and injecting drug users, today HIV mainly spreads by sex between men and women, who now have nearly the same new infection rate. By 2005, the HIV prevalence rate was 0.6 percent. Government data showed 50.7 percent of people with AIDS had been infected through heterosexual sex. By contrast, an analysis from 1982 to 2001 showed that 40.1 percent of cases were contracted through intravenous drug use.
Mexico, where the spread of HIV is linked to men who have sex with men, migration, the sex industry, and near the U.S. border, injecting drug use. The epidemic in Mexico has not spread as quickly as feared, according to researchers, but epidemiologists say they are most concerned about the heterosexual spread of the virus in rural communities.
Another source of concern is migration, which researchers are finding puts people at a much higher risk of becoming infected. . Preliminary data suggest that migrants have more sexual partners, use drugs and alcohol more often, and hire sex workers more frequently.
Haiti and the Dominican Republic At the end of last year, the Caribbean's HIV/AIDS prevalence rate of 1.6 percent was the second-highest in the world, after sub-Saharan Africa. The island of Hispaniola, which Haiti and the Dominican Republic share, is home to 85 percent of the cases:
Haiti has an adult prevalence rate of 3.8 percent, and the Dominican Republic 1.1 percent. Although the Dominican Republic's prevalence rate is less than one-third of Haiti's, surprisingly the Dominican Republic's HIV/AIDS programs are criticized by many for being far inferior. "It's 1,000 times better in Haiti," says Keith Joseph, a physician at Columbia University who has provided HIV/AIDS care in both countries.
Researchers estimate that 78 percent of infections in the Dominican Republic now occur through heterosexual sex, some of which is linked to a booming sex trade. Prevalence rates as high as 12 percent have been documented among sex workers.
The other news stories in the special issue are about the HIV/AIDS epidemics in Puerto Rico, Guatemala, Honduras, Belize and Peru.
Cohen has done similar packages of stories for Science about HIV/AIDS in Africa and Asia.
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