Report on the Global HIV/AIDS epidemic

AIDS in a new millennium: a grim picture with glimmers of hope
through the sharing of drug-injecting equipment and through unprotected sex
between men. Myanmar, too, has witnessed simultaneous epidemics of HIV among
injecting drug users, men who have sex with men, and heterosexuals with a high
turnover of partners.
In Cambodia, the spread of HIV is driven by a norm of premarital and extramarital
sex for men, usually with women who are paid. As in India, high infection rates
among prostitutes and their male clients are followed by a wave of HIV transmission
to wives. But there are early signs that some pilot prevention programmes may be
resulting in greater use of condoms by men who have extramarital sex (see pages
45-46). If scaled-up programmes such as these are accompanied by offers of decent
alternatives to sex work for poor women, Cambodia has a good chance of stemming
the steep rise in its HIV infection rates.
Many other countries in Asia have yet to see a significant spread of HIV, despite evidence that many men regularly have sex outside of marriage. It may be just a matter of
time before infections reach a critical level in populations with the highest risk behaviour and begin to spread more widely. Certainly, there is no room for complacency.
Latin America: an epidemic with many faces
The HIV epidemic in Latin America is highly diverse. Most transmission in Central
American countries and countries on the Caribbean coast occurs through sex
between men and women. Brazil, too, is experiencing a major heterosexual epidemic, but there are also very high rates of infection among men who have sex with
men and injecting drug users. In Mexico, Argentina and Colombia, HIV infection is
also confined largely to these sub-populations. The Andean countries are currently
among those least affected by HIV infection, although risky behaviour has been
recorded in many groups.
The countries with the highest prevalence rates in the region tend to be found on the
Caribbean side of the continent. Over 7% of pregnant women in urban Guyana
tested positive for HIV in 1996. Strikingly, the rates in pregnant women were similar
to those in patients attending clinics for sexually transmitted infections, who are usually considered a sub-population with especially high-risk behaviour. This suggests
that many people in the general population may be linked in extensive sexual networks. Studies of sex workers in the capital, Georgetown, showed that 46% of
street- and brothel-based women were infected with HIV, and over a third of the
women said they never used condoms with clients.
In Honduras, Guatemala and Belize there is also a fast-growing heterosexual epidemic, with HIV prevalence rates among adults in the general population between 1
and 2%. In 1994, less than 1% of pregnant women using antenatal services in Belize
District tested positive for HIV, while one year later the prevalence had risen to 2.5%,

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