Day 3 at AIDS 2010: A Look at Latin America
July 22, 2010
Deputy Director and Senior Fellow, Global Health Policy Center
For at least the last few meetings the International AIDS Conference has featured special focus sessions on the state of the HIV/AIDS epidemic in various world areas, allowing participants to assess that state of the epidemic in various settings and to discuss priorities for regional action at the policy, advocacy, and research levels. These special symposia give delegates from the zone a chance to network and exchange information, and they facilitate planning for panels dedicated to area issues in future meetings. Since the 2008 conference met in Mexico City, and since AIDS 2008 co-chairs Pedro Cahn of Fundación Huésped in Argentina and Luis Soto-Ramírez of Mexico’s Instituto Nacional de Ciencias Médicas y Nutrición made raising awareness about and promoting action regarding the challenge of HIV/AIDS in Latin America goals of their meeting, I decided to attend today’s session on Latin America to see how things look two years after 25,000 delegates descended on Mexico’s capital.
The session was chaired by Ruben Pecchio of Panama and Micaela Cyrino of Brazil, and featured four speakers, including former co-chair and past International AIDS Society (IAS) president Pedro Cahn; former co-chair of the scientific program in Mexico City, Mario Bronfman; Lilian Abracinskas of Uruguay, and Gloria Carreza of Mexico.
Cahn spoke first and provided an update on the epidemic in the region. There are now an estimated 2 million people living with HIV/AIDS in Latin America and the Caribbean. In 2008 the estimated number of new infections was 170,000. The population most vulnerable to infection with HIV is relatively heterogeneous; men who have sex with men, commercial sex workers, and intravenous drug users comprise groups in which the epidemic is concentrated in some countries, while in others heterosexual transmission is the dominant mode of infection. According to Cahn, homophobia, transphobia, gender inequality, poverty, poor governance, migration, inadequate sexual education, and a low level of investments in the health sector are among the many structural factors contributing to the spread of HIV today.
Among the obstacles to improved efforts to address HIV/AIDS in Latin America are a lack of access on the part of the population to testing; relatively late diagnosis; inadequate case referrals; and a lack of lab capacity to manage the region’s diagnostic needs. Argentina, Brazil and Mexico are the countries where anti-retroviral coverage is the highest. In many cases, cost is a deciding factor, and the cost of providing life-saving drugs can vary considerably, depending on the drug prices a country’s health officials are able to negotiate with multinational pharmaceutical companies.
When it comes to funding for programs and health services, another challenge is the considerable economic inequality that characterizes the region. Most countries are considered too wealthy to be eligible for most forms of support from the Global Fund and other mechanisms, but the vast differences in income within countries speak to important funding needs at the regional and community levels. Emphasizing that treatment is cost effective and allows patients to enjoy productive lives, Cahn warned that the region could see a greater feminization of the epidemic, higher mortality rates, and a rise in the incidence of extremely drug resistant tuberculosis if the effort to address HIV/AIDS is not maintained. He argued that improving information systems for health and reducing gender and social inequality would be important steps toward maintaining the region’s gains and avoiding future setbacks.
Several panelists focused on the legal obstacles to improved response to the HIV/AIDS pandemic. Mario Bronfman, who is head of the Ford Foundation office in Mexico City, signaled the persistence of legislation that criminalizes vulnerable populations, such as MSM, CSW and IDU; the lack of sexual education, and the efforts of the Catholic Church, evangelical groups, and conservative political parties to prevent the implementation of meaningful sexual education; and the uneven implementation of human rights and anti-discrimination legislation, as important challenges.
Bronfman also outlined a series of priorities for promoting respect for human rights in the effort to fight HIV/AIDS in Latin America and the Caribbean: ensuring the sexual and reproductive rights of women; improving access to prevention programs and information for young people; strengthening the access of people living with HIV/AIDS to legal resources; ensuring judges within civil and military courts are knowledgeable about HIV/AIDS; promoting the national and local-level implementation of international human rights agreements; and strengthening the capacity of NGO’s to monitor state compliance with human rights legislation. In addition, he emphasized the importance of studying stigma and discrimination and working to eliminate homophobia and transphobia; integrating sexual and reproductive health and HIV/AIDS services; and convincing politicians and local as well as national leaders of the ways in which protecting human rights can lead to improved health outcomes in the long term.
Lilian Abracinskas of Mujer y Salud en Uruguay focused her remarks on the results of a study in the Mercosur region of South America focused on the links between gender based violence and HIV status. Noting that the demographic transition in the region had offered women important gains, including lower fertility rates and improved opportunities to enter the labor force, she nevertheless observed that workplace discrimination, pay gaps, and unequal access to promotions characterize the experienced of women across the zone. At the same time, adolescent pregnancy rates in the region remain high, and the region is not doing a good job protecting the health of children born with HIV, with significant numbers falling outside formal health systems and lacking access to necessary care. In the Mercosur study, she noted, 78.1% of women living with HIV had experienced violence by a spouse or intimate partner, and many had left the work force as well, leaving them economically vulnerable. Abracinskas urged policymakers to consider reforms to ensure the provision of health and social services to all sectors of the population, regardless of employment status, and to incorporate a gender perspective into health financing schemes.
Gloria Carreza, of the Universidad Nacional Autónoma de México (UNAM) spoke about the issue of sexuality vis a vis the epidemic in Latin America and the Caribbean. She noted that sexual transmission of the virus is an important route of infection and decried the fact that in most countries sexual education programs, despite recent commitments to improvement, remain minimal at best. At the same time, when researchers analyze “men who have sex with men” or “gender inequality” without exploring the cultural and social identities research subjects embrace, it will be impossible to meaningfully enforce anti-discrimination or human rights legislation. Civil society groups can play an important role in demanding policymakers address sexual rights and sexual diversity, and Carreza noted the important linkages among feminist groups, LGBT organizations, and associations focused on people living with HIV/AIDS in recent years.
The role of Latin American civil society groups in fighting HIV/AIDS also came up several times during the question and answer period. Some participants noted the important participation at AIDS 2008 by regional NGOs at the Mexico City conference and urged support for efforts by young people living with HIV/AIDS, in particular, to organize advocacy networks in the Americas. Some representatives of NGOs with booths in the Global Village lamented the apparent segregation between the conference’s formal program and the Global Village agenda, and urged organizers to make it possible for activists representing the most vulnerable groups to speak at the main sessions, regardless of their academic or professional achievements compared to the scientific or policy delegates. Others emphasized the importance of recognizing the rights of sex workers, male and female, to both organize and work, noting that the persistence of legislation criminalizing prostitution at the national and local levels in many places makes it difficult for them to share information with each other about HIV/AIDS prevention and treatment options because they fear repression by law enforcement entities.