The HIV/AIDS Epidemic in Latin America

Last updated: December 6, 2007

QUITO, Ecuador -- The spread of AIDS in Ecuador's most populated province is reaching levels comparable to those in Africa and the Caribbean a decade ago and could mushroom into a national epidemic if left unchecked, U.N. officials warned.

According to Ecuador's Health Ministry, there are between 4,800 and 5,000 reported AIDS cases in a country of more than 13 million people, but the number of unreported cases could be as high as 50,000. Mauricio Valdez, the U.N.'s coordinator in Ecuador, said "80 percent of the cases are on the coast in Guayas," where the provincial capital and Ecuador's largest city, Guayaquil, is located.

Latin America -- 2000 --- Report

HIV and AIDS in the Americas: an epidemic with many faces (A Document in Microsoft Word Format)

November 2000

Latin American and Caribbean Epidemiological Network

Monitoring the AIDS Pandemic Network

Foro (Forum) 2000, Latin America and the Caribbean STD/AIDS

* Joint United Nations Programme on HIV/AIDS (UNAIDS) 

* World Health Organization

* Pan American Health Organization (PAHO)

* Monitoring the AIDS Pandemic (MAP)

Dr. Mabel Bianco and Joyce Hunter

Dr. Peter Piot, executive director of UNAIDS, said: "Worldwide, more than half of all people who become infected with the human immunodeficiency virus (HIV) acquire the virus when they are under 25 years old. It is tragic that HIV should single out a youthful and otherwise healthy population group. "But it is hardly a coincidence, given the daily circumstances of many young people's lives. As we have learned from two decades of experience with this epidemic, the path of HIV is eased by poverty, lack of skills, violence and harmful social norms such as machismo and early sexual debut."...

-Early sex is generally unprotected. A Caribbean survey found that half of all sexually active adolescents did not use contraception at last intercourse. A study in Peru found that only 11 percent of young adults used condoms consistently

-Early sex is often forced sex. In Chile, 3 percent of young women said their first sexual experience was rape, usually at the hands of friends, relatives and partners. From 4 percent to 30 percent of women who are raped contract sexually transmitted disease in the attack.

-Sexual exploitation threatens children. Piot said, "Sex tourism, often perceived as an Asian problem, is another growing AIDS-related problem in the region. Preferred destinations for sex tourism with minors are Costa Rica and the Dominican Republic, but increasingly Brazil, Guatemala, Haiti, Honduras, Nicaragua and other countries are being cited."

"HIV risk does not occur in a vacuum," Piot said. "It is hard to overstate the HIV risk from machismo, a Spanish-language word that has come into widespread use in other languages too because it so neatly sums up the constellation of risk-taking and often predatory behaviors with which young men are expected to prove their masculinity in many parts of the world." Piot said machismo puts these men's lives in danger from AIDS, and endangers the lives of their female partners.

...For anatomical reasons, women are about four times more vulnerable than men are to sexually transmitted diseases, including HIV. But their lower social and economic status in many societies also increases their risks. And nowhere, perhaps, is this more obvious than in Latin America and the Caribbean where a culture of "machismo" makes it acceptable for married men to have more than one sexual partner. Women who speak out against their husbands' infidelity may be beaten.

..."It's very much connected to machismo and the position of women in society," Hanquet said. "We have to teach them they don't have to accept everything from a man. They should be able to protect themselves." Many married women, and women of childbearing age in the Americas are being infected -- a situation which leads to the infection of newborns and to an increase of AIDS orphans.

* Sexual abuse and sexual exploitation of children, often associated with poverty and dysfunctional families, open the door to major HIV risks in Latin America and the Caribbean.  Girls subjected to sexual abuse in childhood are typically robbed of self-esteem and control over their lives, increasing their risks of drug-taking and commercial sex later on. In one country, 80% of children entering the sex trade had been sexually abused, often by a relative.

Economic pressures in the region have forced an ever-increasing number of people into absolute poverty. Domestic laborers are open to sexual exploitation and assault by the males in the employer's family. Sex tourism, often perceived as an Asian problem, is another growing AIDS-related problem in Latin America and the Caribbean. Preferred destinations for sex tourism with minors are Costa Rica and the Dominican Republic, but increasingly Brazil, Honduras, Guatemala, Haiti, Nicaragua and other countries are also being cited.

* Machismo (the risk-taking and often predatory behaviours with which young men are expected to prove their masculinity) typifies the role models that are particularly dominant in countries of Latin America and the Caribbean.  Machismo puts lives in danger not least the lives of the young men themselves. Young men are expected to demonstrate their virility with early and frequent sex, and multiple partners.   Those who are not knowledgeable about sex cannot afford to admit this and wind up running the consequent risks.

...The other side of the machismo coin is vulnerability for young women, who are expected to be ignorant about their bodies and sexual matters, to defer to male sexual demands and decision-making, even when they know their partner may be infected through other relationships, and are often emotionally and financially dependent on him. While for young men the major HIV threat is from drug use and male-male sex, the threat to young women is mainly through heterosexual transmission.

Macho attitudes can help to sow the seeds of violence. While the prime victims of male violence are other men, these acts rarely amplify the HIV risk directly (exceptions include cases of rape in all-male settings such as detention centers). However, women who are targets of male violence (often at the hands of their husband/partner) are put at risk of HIV...

...Machista [macho-ist] values influence legislation on rape. In 14 Latin American countries a man may legally rape his wife or fiancée and in some countries including Argentina and Chile-a rapist need only propose marriage to escape prosecution.

The scale of male-female violence is horrifying even with regard to children.  In Mexico, 7 out of 10 child victims of violence are girls, and 60% of women dying a violent death were younger than 13.

In Latin America and the Caribbean, 400,000 people become infected with HIV every year. UNAIDS estimates indicate that 65,000 young people in the age group 15- 24 and 8,000 children under 15 became infected with HIV during 1998. According to UNAIDS, more than 50% of new HIV infections occur in people in the age group 10-24. The virus principally affects poor people and people with limited access to adequate information on and means of protection. In comparison to Latin America, HIV infection rates are considerably higher in the Caribbean.

"The situation for HIV-positive people [in rural areas] is critical. Not only can't they get the medicines they need, but they face the prejudices from the society and from the doctors," said Hugo Palma, director of the group Michoacan Residents for Health.

     As recently as three years ago, only three of the 32 states in Mexico had AIDS education and prevention programs, said Patricia Uribe, Mexico's top AIDS official. Even today, she said, many resources for AIDS prevention remain in the capitals of the states and are not shared with rural areas.

     This disparity worries health workers on the front lines, who say a lack of knowledge about the disease jeopardizes both men who migrate to the United States without basic safe-sex education and village women who don't protect themselves.

     A 1997 survey of 501 Mexican migrants from Jalisco state found that only 21% of respondents used condoms during intercourse and that 30% thought they could tell from a person's appearance whether he or she was infected.