RUSTON, Louisiana — According to UNAIDS data, HIV affected 2.1 million people across Latin America in 2019. That same year, reports showed 120,000 new infections. Additionally, 37,000 people died from AIDS-related illnesses. While the epidemic is mostly concentrated, meaning that prevalence among the general population remains low, certain groups such as transgender women, sex workers and men who have sex with men (MSM) disproportionately run the risk of contracting HIV. Progress in both preventing and treating HIV has been moderate to poor, depending on the country. Unfortunately, poverty, homophobia, transphobia and discrimination are impeding progress in the fight against HIV/AIDS in Latin America.
What Do the Numbers Say?
Belize, Panama and Uruguay ranked the highest in prevalence rate for HIV with 1.9%, 0.9% and 0.6%, respectively. In 2019, 77% of people living with HIV were aware of their status. In the past decade, new HIV infections rose to 21% across Latin America. While the numbers are discouraging, AIDS-related deaths dropped 8% slightly from 2010 to 2019.
Evidence from the Pan American Health Organization shows that the COVID-19 pandemic caused a sharp drop in people receiving HIV tests. “Eight Caribbean and Latin American nations reported about 4,000 fewer diagnoses of HIV in the first six months of 2020 compared to the same period in 2019.”
Whose Most Affected by HIV/AIDS?
In 2020, transgender women were 49 times more likely to contract HIV than the general population.
Some of the highest HIV prevalence for transgender women was reported in Ecuador at 35%. The lowest was in El Salvador at 7.4%. HIV prevalence In Colombia, Panama and Guatemala sits at more than 20%.
A 2010 study found that 11% of HIV-positive transgender women in Mexico have no relationship with their families. This is often due to stigma and discrimination.
Transgender women face significantly higher rates of violence compared to other minority groups. Between 2008 and 2015, the Trans Murder Monitoring Project reported 1,573 trans people murdered in Latin America. The highest number reported was in Brazil at 938.
Men who have sex with men (MSM)
MSM are the most affected by HIV in Latin America and are often classed as heterosexual due to hesitation from their positive status being revealed. In 2017, “men who have sex with men accounted for 41%” of Latin America’s total HIV infections.
In Guatemala and El Salvador, HIV prevalence among MSM stands at the lowest in the region at around 7%. Bolivia, Mexico and Paraguay reported HIV prevalence at “25%, 21% and 21%, respectively.”
Homophobia is common throughout Latin America due to strong religious views and machismo culture. Machismo culture asserts male dominance in everyday life. Examples include men having full control of the household, controlling their wives and showing no emotion that could be deemed too feminine or weak.
Due to machismo culture, many MSM “also have sex with women, forming bridge populations.” A bridge population comprises three or more people who, because of a close range to an HIV-positive person, are at a high risk of contracting HIV.
Pre-exposure Prophylaxis (PrEP)
Progress in increasing the number of people who know their status and receive treatment in Latin America has been remarkable. Pre-exposure prophylaxis (PrEP) is part of that progress. PrEP is a once-daily pill that reduces the chances of contracting HIV by 99%. The risk is even lower when one uses condoms and other preventative measures.
In an interview with The Borgen Project, Johnathan Craig, the lab coordinator at the Philadelphia Center, said that “without condom usage and PrEP, you’re going to have a pretty high-risk individual.” Among the countries in Latin America, Brazil is the only country that offers PrEP through public health insurance. In other countries like Chile, Guatemala, Mexico and Uruguay, one can find PrEP through the internet, private health insurance or through NGOs on the ground. “If we can encourage PrEP usage amongst low-income individuals, whether they be LGBTQ plus or heterosexual, we will see lower transmission rates of HIV, and in return, we would see a significant drop in new HIV infections.”
ImPrEP in Brazil, Mexico and Peru
The commitment to providing an effective response to HIV/AIDS in Latin America has been strong. However, research projects like ImPrEP are pushing to end HIV/AIDS in Latin America for good. The ImPrEP study provided same-day PrEP medication to more than 5,000 MSM and transgender women in Brazil, Peru and Mexico. Each participant received HIV and STI testing as well as mental health evaluations. HIV-negative MSM and transgender women received a 30-day supply of PrEP and were re-assessed after 30 days. After a month of being on PrEP and negative HIV tests, they received a 90-day supply of PrEP with checkups every three months.
ImPrEP’s research found that while only “6% of participants did not return,” 71% of participants made two appointments within three months after their first appointment and 97% continued using PrEP thereafter. The continuation of PrEP in Peru was significantly lower than in Brazil and Mexico, with a continuation rate of 53%, 85% and 84%, respectively. Transgender women in all three countries saw a more than 50% continuation rate. MSM saw higher continuation rates.
What’s to Come?
Progress is never easy, and it never comes overnight, especially when it affects billions of people. Eradicating HIV/AIDS in Latin America will take an all-hands-on-deck approach that involves more than just preventing new HIV infections. That’s the first step on the long ladder towards progress. It is important to find solutions to prevent the spread of HIV. Along with that, it is essential to help those affected by HIV/AIDS who live in poverty and/or in war-torn countries. With help from the medical community, NGOs and world governments, a brighter future is closer than ever.
– Sal Huizar