AIDS in the Americas: a public health priority for the region.

PIP: 156 countries have reported over 250,000 AIDS cases to the WHO. Taking underreporting into account in developing countries, this figure grows to over 600,000 with 300,000 deaths. HIV-1 infection rates are estimated at between 5-10 million people. Projections indicate that there will be 5 million AIDS cases by 2000. AIDS is an unprecedented health problem that has enormous social, political, medical, and economic implications. The Americas account for 61% of the total cases reported to the WHO. Of the 46 countries in the Americas there have been 153,720 cases reported as of May 1, 1990. 96% of these cases were reported in the US, Brazil, Canada, Haiti, and Mexico. The geographic distribution of AIDS is not homogeneous because of a variety of factors. It was not introduced simultaneously in all countries; some were exposed later than others. Some countries have better detection systems. Excluding North America, the English-speaking Caribbean countries account for only 2% of the population, while the Latin Caribbean countries have 6%, yet they have 10% and 21% of the cases, respectively. Sexual transmission patterns reveal that bisexual men are the largest bridge between the homosexual and heterosexual community, not IV drug users. Studies show that blood donors who are paid are 18 times more likely to be HIV-1 positive in some areas. As AIDS prevalence increases in the heterosexual community, the rate of perinatal transmission also increases. This in turn increases the infant mortality rate because of increases in pediatric AIDS cases. Pediatric cases currently threaten much of the progress that has been made in developing countries in lowering the infant mortality rate. If this pandemic is to be stopped, prevention efforts must be increased as well as a shift in resources at the local, national, and global levels to find some effective method of containment.^ieng