HIV/AIDS reached the LAC region in the early 80s and spread heterogeneously. The Caribbean has been and continues to be the one of the most affected regions in terms of prevalence, second only to some African regions (UNAIDS, 2019[21]). The UN has set the goal of eliminating the epidemic of AIDS as a public threat as an SDG for 2030, which has been defined as reducing the number of new HIV infections and AIDS-related deaths by 90% relative to 2010 (UNAIDS, 2014[22]).
In LAC27, the prevalence in adults between 14 and 49 years old ranges from 0.2% in Mexico and Nicaragua to 2% in Haiti in 2018 (Figure 3.26, left panel). Although overall prevalence in the region is not very high, the number of people living with HIV is over 2 million in reporting countries, most of which live in Brazil with more than 900 000 people, followed by Mexico with 230 000 and Colombia and Haiti with 160 000 each.
Expanded access to antiretroviral therapy has increased the survival rates of people living with HIV, but about half of the people eligible for HIV treatment do not receive it worldwide. In LAC26, the estimated coverage was particularly low (<40%) in Belize and Jamaica while it is over 70% in Peru, Colombia, Cuba and Mexico (Figure 3.27). This indicates that some countries with high prevalence (e.g. Mexico) are addressing the issue of treatment coverage, but the region remains substantially far from the goal of treating 90% of people living with HIV/AIDS.
The trend is positive in recent years however, with most LAC countries reducing incidence rates. Between 2010 and 2018, El Salvador, Bahamas and Nicaragua reduced incidence rates by 50%, 33% and 30%, respectively, followed by Colombia, Haiti and Cuba that have all reduced the number of new cases of HIV infection by more than 25% (Figure 3.28). Among the five countries that show an increase, Chile has the largest HIV incidence growth of 23%, followed by Brazil with 13% and Costa Rica with 11%, but these three countries remain below the LAC average for HIV prevalence.
Strengthening the agenda on HIV prevention and treatment could further tackle the AIDS public health threat in the region. The UNAIDS 90‑90‑90 approach is central, stating that by 2020, 90% of all people living with HIV will know their HIV status, 90% of people with an HIV diagnosis will receive ART, and 90% of people receiving ART will achieve viral suppression. The rapid scale-up antiretroviral therapy in LAC provides unprecedented opportunity to successfully implement not only antiretroviral-based interventions for prevention and treatment, but also to integrate with other key services related to sexual and reproductive health and rights, hepatitis C virus, tuberculosis, provision of clean needles and syringes, medication-assisted therapy and non-communicable diseases. The benefits of antiretroviral therapy and integrated services can be fully realised only if people living with HIV are diagnosed and successfully linked to care. This will require targets efforts and removing barriers especially among key affected populations, for instance, sex workers, their clients, men who have sex with men, transgender persons and injection drug users, along with active stakeholder’s collaboration, including civil society in each country (Bekker et al., 2018[23]).
