HIV infections in Latin America are reported mostly among men who have sex with men, injection drug users, and sex workers, but has also increased among the women in the general population of Brazil and Uruguay. Brazil, the most populous country in Latin America, has an adult HIV prevalence of 0.5% and comprises almost 30% of the population living with HIV in South and Central America and the Caribbean. High-risk behavior is still widely reported among young Brazilians with almost one-third reporting sexual debut prior to age 15, and 20% of young Brazilians aged 15-24 reporting greater than ten sexual partners. Approximately 73% of the estimated 400,000 people in need of antiretroviral therapy in Latin America received it in 2005. Brazil provides free antiretroviral therapy to those in need of treatment, and approximately 83% of HIV-infected persons receive therapy. Subtype B infections predominate in Latin America, with a smaller representation of subtypes C and F and recombinants totaling about a quarter of infections overall (12, 15). Clade B/F recombinants were common (48%) in a survey of treatment failure patients in Buenos Aires, Argentina (16). Populations at highest risk for HIV infection in Latin American countries are men who have sex with men and female sex workers (17).
The Caribbean is the second most HIV-affected region of the world. About three quarters of the 230,000 people living with HIV infection in the region live in Haiti or the Dominican Republic. 43% of adults living with HIV in 2007 are women. Transmission is largely through heterosexual intercourse; injection drug use (except in the countries of Bermuda and Puerto Rico) plays a minor role in the Caribbean's epidemic. Sex between men is estimated to be responsible for 12% of infection in the Caribbean. Haiti is the most burdened Caribbean country with a recent prevalence near 4%. HIV prevalence has declined in urban areas of Haiti by 2005 estimates, but remained constant in other areas of the Caribbean. Subtype B is responsible for 94% of infections in Haiti, Dominican Republic, and Trinidad and Tobago. In Cuba, 48% were caused by subtype B and 41% caused by recombinant forms (11, 12). With the exception of Cuba, antiretroviral treatment access is highly uneven. In Haiti and the Dominican Republic, for example, fewer than 20% of people needing antiretroviral treatment were receiving it in 2005.
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