Report on the Global HIV/AIDS epidemic

Report on the global HIV/AIDS epidemic - June 2000

The Dominican Republic, which has conducted systematic HIV surveillance among
pregnant women, sex workers and patients with sexually transmitted infections every
year since 1991, also has a substantial heterosexual epidemic. The HIV prevalence rate
among new mothers in the capital, Santo Domingo, more than doubled over the sevenyear period for which surveillance results are available, reaching 1.9% in 1997, while the
average rate in sex workers and patients with sexually transmitted infections was
around 6-8%.
The heterosexual epidemics of HIV infection in the Caribbean are driven by the deadly
combination of early sexual activity and frequent partner exchange by young people. In
Saint Vincent and the Grenadines, where the prevalence of sexually transmitted infections such as syphilis is high for the region, a quarter of men and women in a recent
national survey said they had started having sex before the age of 14, and half of both
men and women were sexually active at the age of 16. In a large survey of men and
women in their teens and early twenties in Trinidad and Tobago, fewer than a fifth of the
sexually active respondents said they always used condoms, and two-thirds did not use
condoms at all. A mixing of ages - which has contributed to pushing the HIV rates in
young African women to such high levels - is common in this population too: while most
young men had sex with women of their age or younger, over 28% of young girls said
they had sex with older men. As a result, HIV rates are five times higher in girls than boys
aged 15-19 in Trinidad and Tobago, and at one surveillance centre for pregnant women
in Jamaica, girls in their late teens had almost twice the prevalence rate of older women.
Eastern Europe and Central Asia: drug injecting is still the
main risk
In the countries of the former Soviet Union, the HIV epidemic continues to be concentrated heavily in injecting drug users. The absolute number of cases has remained small
in many countries so far, but overall the growth has been rapid.
In Ukraine, the number of diagnosed HIV infections jumped from virtually zero before
1995 to around 20 000 a year from 1996 onwards, about 80% of them in injecting drug
users. Around a third of these cases have been seen by a special public health doctor,
after which they are included in the official HIV case registry. While no country's HIV surveillance system can ever be sure of capturing all infections, the data on HIV diagnoses
shown in Figure 5 may well represent the true trend of the epidemic in Ukraine. As HIV
spreads and new infections occur, the total number of people living with HIV continues
to grow, reaching an estimated 240 000 at the end of 1999, compared with 110 000 two
years earlier.
In any country with unsafe drug-injecting practices, a fresh outbreak of HIV is liable to
occur at any time. This is especially true of the countries in Eastern Europe where the
HIV epidemics are still young and have so far spared some cities and sub-populations.
In the Russian Federation, a new outbreak of HIV among injecting drug users in the
Moscow region in 1999 resulted in the reporting of more than three times as many new

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