The HIV epidemic in Latin America

Luz, Paula M.; Veloso, Valdiléa G.; Grinsztejn, Beatriz

doi:10.1097/coh.0000000000000564

Cited by 65 publications

(36 citation statements)

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“…Even after a health system restructuring in 2008 that guaranteed more access to ART [ 8 ], Colombia still ranks low on various indices among all LA countries in terms of overall ARV coverage, HIV testing and PLWHA population proportion with suppressed viral load. In addition, by the end of 2018, Colombia still had not adopted the Pre-Exposure Prophylaxis (PrEP) to HIV [ 6 , 22 ]. Countries that adopted the Universal Treatment and Test for HIV policy (UTT) have observed an increasing number of PLWHA with suppressed viral load and decreasing HIV incidence and AIDS-related deaths [ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

The HIV epidemic in Colombia: spatial and temporal trends analysis

et al. 2021

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Background Colombia has the fourth highest incidence rate of HIV/AIDS among all Latin American countries and it has been increasing since the 1980s. However, the number of studies that addresses this trend is limited. Here, we employed spatial and temporal trend analyses to study the behaviour of the epidemic in the Colombian territory. Methods Our sample included 72,994 cases of HIV/AIDS and 21,898 AIDS-related deaths reported to the National Ministry of Health between 2008 and 2016. We employed the joinpoint regression model to analyse the annual HIV/AIDS incidence and AIDS mortality rates. In the spatial analysis, we used univariate autocorrelation techniques and the Kernel density estimator. Results While the HIV/AIDS incidence had an increasing trend in Colombia, the AIDS mortality rate was stable. HIV/AIDS incidence and AIDS mortality showed a downward trend in the 0–14 age group. An upward trend was observed for HIV/AIDS incidence in people older than 15 years and with the highest trend in the 65 years and above group. AIDS mortality showed an increasing trend among people aged 65 years or older. The comparison between the sexes showed an upward trend of HIV/AIDS incidence in all age groups and AIDS-mortality rates in 65 years and above in men, while in women, the incidence was upward among those aged 45 years and above, and concerning the AIDS-mortality rate in the 45–64 group. The high–high clusters of HIV/AIDS incidence and AIDS mortality were located in the Andean and Caribbean regions. Conclusion Our study found an upward trend in HIV/AIDS incidence and a stable trend in the AIDS mortality rate in Colombia. The downward trend in HIV/AIDS incidence and AIDS mortality rate in the 0–14 age group reflects the downwards mother-to-child HIV transmission. The upward trend in HIV/AIDS incidence in older women and AIDS mortality in younger women rates, compared with men, may be due to late diagnosis and treatment. The Caribbean and the ‘coffee belt’ regions were the most impacted by the HIV epidemic, most likely due to sexual tourism. Our results provide crucial information that may help Colombian health authorities fight HIV transmission.

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Section: Discussionmentioning

confidence: 99%

The HIV epidemic in Colombia: spatial and temporal trends analysis

et al. 2021

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“…These trends may also reflect prevalent gender norms [ 49 ], unequal access to timely diagnosis and treatment [ 48 ], or differences in disease burden from comorbidities between genders [ 1 ]. The spatial distribution of high-risk groups possibly also contributes to the HIV epidemic remaining concentrated in large urban centres [ 6 ]. For example, one important driver of spatial differences in HIV mortality is prison populations, where HIV transmission is high due to overcrowding, violence, and lack of information on the risk of HIV acquisition [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

“…Notably, our analysis in Ecuador only extends to 2014 and patterns of HIV mortality may have changed with the recent emphasis on community testing and treatment in metropolitan areas [ 63 ]. While all countries have expanded access to treatment and documented increases in ART coverage, albeit at different time periods, persistent disparities in access to quality health services and adherence to ART remain [ 6 , 64 , 65 ] and may contribute to differences in HIV mortality declines observed in this analysis. Further, in all countries in our analysis, communities with socioeconomic and health disadvantages—such as indigenous communities, sex workers, and transgender populations—often have unequal access to treatment and are an emerging or establish public health priority [ 66 , 67 ].…”

Section: Discussionmentioning

confidence: 99%

“…These covariates were selected because they are factors or proxies for factors previously identified in the literature as associated (not necessarily causally) with HIV mortality. Specifically, these four variables were included as measures or proxies for connectedness and urbanicity as HIV historically spread among high-risk groups in urban areas [ 6 , 42 ] and is typically found to be higher in more urban compared to more rural locations. Each covariate was obtained in a raster format at a 5 × 5-km resolution and required aggregation to the modeled municipality level for inclusion in our modeling framework.…”

Section: Methodsmentioning

confidence: 99%

“…Beyond this, however, detailed subnational estimates at the second administrative level in many countries in Latin America are absent. This lack of subnational estimates is alarming given the localized burden of HIV in urban areas and among high-risk subgroups such as people who inject drugs, sex workers, and men who have sex with men (MSM) [ 6 – 10 ]. Additionally, inequalities in HIV burden across local geographies likely occur given that many underlying drivers of HIV infection and death—such as poverty, incarceration, undernutrition, distribution of health practitioners, and access to health services—vary across geographic areas and through time [ 11 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems

Cork¹,

Henry²,

Watson³

et al. 2021

BMC Med

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Background Human immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico. Methods We performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of Disease Study 2017. Results All countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for women. Despite decreases in national HIV mortality in all countries—apart from Ecuador—across the period of study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative inequality over time in all countries. In all six countries included in this analysis, 50% or more HIV deaths were concentrated in fewer than 10% of municipalities in the latest year of study. In addition, national age patterns reflected shifts in mortality to older age groups—the median age group among decedents ranged from 30 to 45 years of age at the municipality level in Brazil, Colombia, and Mexico in 2017. Conclusions Our subnational estimates of HIV mortality revealed significant spatial variation and diverging local trends in HIV mortality over time and by age. This analysis provides a framework for incorporating data and uncertainty from incomplete VR systems and can help guide more geographically precise public health intervention to support HIV-related care and reduce HIV-related deaths.

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Factors associated with long‐term HIV pre‐exposure prophylaxis engagement and adherence among transgender women in Brazil, Mexico and Peru: results from the ImPrEP study

et al. 2022

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Introduction The HIV epidemic continues to disproportionately impact Latin‐American transgender women (TGW). We assessed factors associated with long‐term pre‐exposure prophylaxis (PrEP) engagement and adherence among TGW enrolled in the Implementation of PrEP (ImPrEP) study, the largest PrEP demonstration study in Latin America. Methods HIV‐negative TGW aged ≥18 years reporting 1+eligibility criteria in the 6 months prior to enrolment (e.g. sex partner known to be living with HIV, condomless anal sex [CAS], transactional sex or having a sexually transmitted infection [STI]) who could safely take PrEP were enrolled. Follow‐up visits were conducted at 4 weeks and then quarterly. We conducted logistic regression to identify factors associated with long‐term PrEP engagement (3+ follow‐up visits in 52 weeks) and complete self‐reported adherence (no missed pills in the past 30 days) during follow‐up. For both outcomes, we constructed multivariable models controlling for country, socio‐demographics, sexual behaviour, substance use, STIs and self‐reported adherence at 4 weeks (long‐term engagement outcome only). Results From March 2018 to June 2021, ImPrEP screened 519 TGW, enrolled 494 (Brazil: 190, Mexico: 66 and Peru: 238) and followed them for 52 weeks. At baseline, 27.5% of TGW were aged 18–24 years, 67.8% were mixed‐race and 31.6% had >secondary education. Most, 89.9% reported CAS, 61.9% had >10 sex partners and 71.9% reported transactional sex. HIV incidence was 1.82 cases per 100 person‐years (95% confidence interval [CI]: 0.76–4.38). Almost half of TGW (48.6%) had long‐term PrEP engagement, which was positively associated with reporting complete adherence at week 4 (aOR:2.94 [95%CI:1.88–4.63]) and was inversely associated with reporting CAS with unknown‐HIV partner (aOR:0.52 [95%CI:0.34–0.81]), migration (aOR:0.54 [95%CI:0.34–0.84]), and being from Mexico (aOR:0.28 [95%CI:0.14–0.53]). Self‐reported adherence was associated with TGW aged >34 (aOR:1.61 [95%CI:1.10–2.34]) compared to those aged 25–34 and those with >secondary education (aOR:1.55 [95%CI:1.10–2.19]) and was lower among TGW from Peru (aOR:0.29 [95%CI:0.21–0.41]) or reporting PrEP‐related adverse effects (aOR:0.63 [95%CI:0.42–0.92]). Conclusions Although TGW were willing to enrol in ImPrEP, long‐term PrEP engagement and complete self‐reported adherence were limited, and HIV incidence remained relatively high. A successful HIV prevention agenda should include trans‐specific interventions supporting oral PrEP and exploring long‐acting PrEP strategies for TGW.

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The HIV epidemic in Latin America

Cited by 65 publications

References 53 publications

The HIV epidemic in Colombia: spatial and temporal trends analysis

The HIV epidemic in Colombia: spatial and temporal trends analysis

Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems

Factors associated with long‐term HIV pre‐exposure prophylaxis engagement and adherence among transgender women in Brazil, Mexico and Peru: results from the ImPrEP study

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