Although the highest rate of HIV transmission occurs in sub-Saharan Africa, the Latin America and the Caribbean region has become a source of major concern because of its own almost unnoticed but fast-growing HIV-infected population. The United Nations and other leaders in health and development expressed deep concern about the "relentless growth" of HIV/AIDS in the region. Media coverage of dramatic figures of HIV-infection in Africa has overshadowed the growing AIDS crisis in other continents.

Executive Director Peter Piot of the Joint United Nations Programme on HIV/AIDS (UNAIDS) warned in 2000 that "the recognition that Latin America is facing a growing AIDS crisis is just not there, except in the case of Brazil". His statement did not raise enough alarm bells to stir serious prevention programmes into action. If, according to Mr. Piot, "the response (was) absolutely insufficient" three years ago, figures in July 2003 show that Latin America's status has not improved; in fact, it has worsened.

A UNAIDS companion report estimated that 1.5 million persons in Latin America are living with HIV/AIDS, with an additional 420,000 in the Caribbean, where HIV is spreading even faster.

The Anonymous AIDS Testing Centre in Rio de Janeiro, Brazil, provides information and counselling on AIDS, as well as confidential testing for its clients. WHO photo/Waak

The most affected country is Haiti, where the prevalence rate among the adult population exceeds 6 per cent. The Andean countries, including Argentina, Bolivia, Colombia, Ecuador and Peru, have the lowest rate of infection. Despite its critical situation during the early 1990s, Brazil has made admirable progress in the provision of treatment and care, but these rays of hope cannot be generalized for the region as a whole.

Poverty, illiteracy and poor sex education and information exacerbate the spread of the AIDS epidemic and deter the enforcement of prevention programmes in many other countries. The rate of infection is accelerated by a deteriorating health infrastructure caused, in part, by insufficient investment. A less explicit reason is a culture that tends to limit women's ability to negotiate safe sex and yet looks the other way when men engage in sex with multiple partners. This can also hinder education programmes from reaching those individuals at highest risk, such as homosexuals and sex workers who conceal their sexual orientation or profession.

The lack of access to education has long been a problem aggravating AIDS issues and curtailing people's ability to protect themselves against HIV. Infected individuals in Latin America and the Caribbean face additional hurdles. About 50 per cent of Latin Americans live below the poverty line and most cannot afford expensive antiretroviral drugs. In June 2003, Argentina, Bolivia, Chile, Colombia, Ecuador, Mexico, Paraguay, Peru, Uruguay and Venezuela signed a letter of intent with a number of pharmaceutical companies that opens the way to lower prices for anti-retroviral drugs and HIV diagnostic and monitoring tests. These ten countries intend to reduce the prices of these drugs by up to 92 per cent for some, allowing a further 150,000 HIV-infected persons in the region to receive treatment.

Brazil has also been able to secure large discounts on antiretroviral drug prices and is now considered a model for other countries. This predominantly Catholic nation responded early to the AIDS epidemic by broadcasting bold national television campaigns and distributing free condoms. In 1996, the Government passed a federal law that mandates the free provision of antiretroviral therapy through the public health system, which reduced the AIDS death rate by half in the late 1990s. The drug treatment programme has also had a positive effect on HIV prevention.

Brazil remains the only country in the developing world to provide free drug treatment to all of its citizens. In June 2003, it received a $100-million loan from the World Bank for the third time to finance the implementation of the AIDS and STD [sexually transmitted disease] Control III Project. The reluctance of some other countries in Latin America and the Caribbean to follow Brazil's steps in the fight against AIDS stems from varying cultural and economic factors; Brazil tends to be less conservative and has one of the most advanced economies in the region.

In a world where no cure for AIDS has yet been found, prevention programmes remain the only weapon to combat the epidemic. AIDS education should be a top priority in facing this health crisis. In most affected communities, the incidence of HIV infection is high and prevention efforts are low.

Studies from UNAIDS and non-governmental organizations (NGOs), including Christian Aid and AIDS Alliance, reported that the impact of religious beliefs sometimes hindered the effectiveness of educational prevention programmes. This is true not only of large religions. The spiritual tenets of many isolated indigenous cultures in Brazil, Haiti, Central America and the English-speaking Caribbean encourage sexual and health myths that can also complicate education and prevention programmes.

Several international institutions, including the World Health Organization, UNAIDS, the Pan American Health Organization and local NGOs, are caught in a vicious cycle. They lack sufficient funding and human resources to implement HIV/AIDS monitoring and educational projects that are essential to maximize the effectiveness of their reports. As a result, they have difficulty attracting large donors.

Notwithstanding the impact of deeply-rooted religious factors on AIDS education in the region, the momentum in the fight against this disease has accelerated over the last two years. Caribbean leaders have implemented joint cross-border collaboration on HIV/AIDS issues, and several countries, including Brazil, have established themselves as global leaders for their efforts in expanding health-care access to HIV/AIDS patients. In June 2003, UN agencies called on countries in the region "to significantly strengthen their national responses to HIV/AIDS through a comprehensive and multisectoral approach, so as to reduce the vulnerability of populations at risk and of young people, and empower them to become active partners in the effort against the epidemic".

The HIV/AIDS pandemic has reached such proportions that UN agencies now prioritize the issue at all levels of their organizations. In June 2003, the UN General Assembly looked at this fundamental challenge facing Latin America and the Caribbean, but with better hopes that Member States, civil society and the private sector would take the urgent measures needed to combat this escalating crisis.