The HIV epidemic in Latin America

Abstract

Purpose of review To describe how countries in Latin America and the Caribbean are (or are not) meeting 2016 WHO guidelines on the use of antiretroviral drugs for treating and preventing HIV infection, that is, their progress on the adoption of ‘Treat All’ and of preexposure prophylaxis (PrEP) as an additional prevention tool for people at substantial risk of HIV infection. Recent findings The HIV epidemic in the region continues largely concentrated in vulnerable populations with MSM and transgender women (TGW) suffering the highest burden. On treatment, the challenges of late initiation as well as suboptimal adherence persist. On prevention, recent studies on PrEP willingness in key populations show promising results, meanwhile PrEP implementation projects as well as actual PrEP adoption by national health systems is expanding. A glimpse of real-world PrEP uptake is shown through Brazil's first-year experience of offering PrEP in multiple cities in all regions of the country. Summary In conclusion, accomplishments have been made though challenges for fully addressing the HIV epidemic persist. The impact of both treatment and PrEP will be limited by the availability and prompt use of all services, including HIV testing.

Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems

“…These trends may also reflect prevalent gender norms [ 49 ], unequal access to timely diagnosis and treatment [ 48 ], or differences in disease burden from comorbidities between genders [ 1 ]. The spatial distribution of high-risk groups possibly also contributes to the HIV epidemic remaining concentrated in large urban centres [ 6 ]. For example, one important driver of spatial differences in HIV mortality is prison populations, where HIV transmission is high due to overcrowding, violence, and lack of information on the risk of HIV acquisition [ 53 ].…”

“…Notably, our analysis in Ecuador only extends to 2014 and patterns of HIV mortality may have changed with the recent emphasis on community testing and treatment in metropolitan areas [ 63 ]. While all countries have expanded access to treatment and documented increases in ART coverage, albeit at different time periods, persistent disparities in access to quality health services and adherence to ART remain [ 6 , 64 , 65 ] and may contribute to differences in HIV mortality declines observed in this analysis. Further, in all countries in our analysis, communities with socioeconomic and health disadvantages—such as indigenous communities, sex workers, and transgender populations—often have unequal access to treatment and are an emerging or establish public health priority [ 66 , 67 ].…”

“…These covariates were selected because they are factors or proxies for factors previously identified in the literature as associated (not necessarily causally) with HIV mortality. Specifically, these four variables were included as measures or proxies for connectedness and urbanicity as HIV historically spread among high-risk groups in urban areas [ 6 , 42 ] and is typically found to be higher in more urban compared to more rural locations. Each covariate was obtained in a raster format at a 5 × 5-km resolution and required aggregation to the modeled municipality level for inclusion in our modeling framework.…”

“…Beyond this, however, detailed subnational estimates at the second administrative level in many countries in Latin America are absent. This lack of subnational estimates is alarming given the localized burden of HIV in urban areas and among high-risk subgroups such as people who inject drugs, sex workers, and men who have sex with men (MSM) [ 6 – 10 ]. Additionally, inequalities in HIV burden across local geographies likely occur given that many underlying drivers of HIV infection and death—such as poverty, incarceration, undernutrition, distribution of health practitioners, and access to health services—vary across geographic areas and through time [ 11 – 14 ].…”

The HIV epidemic in Colombia: spatial and temporal trends analysis

“…Even after a health system restructuring in 2008 that guaranteed more access to ART [ 8 ], Colombia still ranks low on various indices among all LA countries in terms of overall ARV coverage, HIV testing and PLWHA population proportion with suppressed viral load. In addition, by the end of 2018, Colombia still had not adopted the Pre-Exposure Prophylaxis (PrEP) to HIV [ 6 , 22 ]. Countries that adopted the Universal Treatment and Test for HIV policy (UTT) have observed an increasing number of PLWHA with suppressed viral load and decreasing HIV incidence and AIDS-related deaths [ 23 , 24 ].…”