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For Lessons on Fighting AIDS, Look South

Latin American and Caribbean programs offer hope, but one expert says the global picture is still grim

FRIDAY, July 28, 2006 (HealthDay News) -- When it comes to the AIDS epidemic, sub-Saharan Africa gets the most attention, followed by North America, Europe and Asia.

But an investigation by a veteran medical reporter finds that countries in another region -- Latin America and the Caribbean -- may offer up some of the world's best role models for the fight against AIDS.

Nations like Brazil, Mexico and Peru are leading the way in embracing various levels of AIDS treatment, prevention and research, reports journalist Jon Cohen in this week's special AIDS-themed edition of Science.

"Poorer countries have greater challenges and by and large are doing worse," he said. "But there are so many exceptions."

Globally, the situation remains dire, however. In a journal commentary, Dr. Anthony Fauci -- director of the National Institute of Allergy and Infectious Diseases at the U.S. National Institutes of Health -- writes that, despite the advent of powerful AIDS drugs, "many important challenges remain, and in several of these the global effort is failing."

Fauci points out that, in 2005, the worldwide estimate of 4.1 million new HIV infections far outnumbered the 2.8 million AIDS deaths reported. Still, he writes, "we know that existing HIV treatments and prevention modalities, when appropriately applied, can be enormously effective."

And Cohen says the example of Caribbean and Latin American nations shows that countries can make real headway against HIV.

A prime example: Haiti, of the world's poorest countries, where 80 percent of people live below the poverty line. Even here, though, health workers have managed against great odds to create an effective treatment system for people with HIV.

According to Cohen, this shows that, "Even with the poorest people in the world, there's a way to get them treatment."

To gather information for the current report, Cohen visited a dozen countries in Latin America and the Caribbean -- a region with an estimated two million people living with HIV, more than the U.S. and Western Europe combined.

In some countries, HIV is mainly spread through sex between men. But in others -- especially in the Caribbean -- it's largely spread through heterosexual contact, especially via sex workers; Puerto Rico also has a big problem with infections from intravenous drug users.

While about 90,000 people die from AIDS in the region each year, in some ways it is much better off than Africa. An estimated 68 percent of the HIV-infected population in need of drug treatment are taking powerful AIDS medications known as anti-retrovirals, compared to 17 percent in sub-Saharan Africa.

However, Cohen said the figures about Latin America and the Caribbean are a bit misleading because they're influenced by the high population of HIV-positive people in the world's fifth largest country, Brazil, which has made a priority of getting AIDS drugs to those in need.

In his report, Cohen found a variety of differences between -- and even within -- various countries.

Mexico, for example, sets itself apart by being "pretty up front" about the ways that AIDS is transmitted, Cohen said. "They explicitly address the machismo in the region and the outright hatred toward gay men that often leads to violence."

It's not a routine approach. "A lot of countries play ostrich. They don't want to acknowledge that they have a lot of men having sex with men or sex workers or whatever it is."

Peru is another leader. The country has "become this magnet for research," and its scientists are launching major drug trials, according to Cohen.

"Something has gone right there," he said

Haiti's example also shows that poor people will follow the complicated AIDS drug regimens, Cohen said. "There was a fear that poor can't do it, but Haiti showed that's a lot of nonsense. Poor people are just as motivated as wealthy people to stay alive."

Not every country is worthy of praise in Cohen's report. The Dominican Republic, which borders Haiti on the island of Hispaniola, is having a much harder time fighting the epidemic than its neighbor. Critics blame that on "government disinterest and outright obstructionism," Cohen said.

And he believes that many political and religious leaders across the region are making the epidemic worse.

"The virus doesn't see borders, it doesn't have any morals, it just wants to copy itself and spread," he said. "When countries drag their feet or when they let institutions like the church prohibit things like condom promotion, or let politics prevent things like methadone [treatment] or needle exchange, the virus will take advantage of those opportunities."

Overall, Cohen's report "points out that the HIV epidemic really is local, but that there are some generalities across specific situations," said Thomas Coates, an AIDS specialist and professor of medicine at the University of California at Los Angeles.

Coates added that he is glad to see a focus on Latin America and the Caribbean. "The problems in Africa are so overwhelming that sometimes we forget about what's happening in the rest of the world."

As countries worldwide wage their wars against HIV/AIDS, research in the disease continues. In another article featured in this week's AIDS-themed issue of Science, a team of Dutch and British researchers report that primates could give scientists special insight into new treatments for AIDS.

That's because animals like chimpanzees are largely immune to AIDS-like diseases, even when they display high levels of virus in their bodies, said a group led by Jonathan Heeney at Biomedical Primate Research Centre in Rijswijk, Netherlands.

There's a catch to this line of research, though: This type of species-specific immunity probably built up over millennia on an "evolutionary timescale," the researchers say, so humans won't develop any immunity on their own any time soon.

Nevertheless, study into the mechanisms driving this resistance could still yield valuable clues that might lead to new treatments, the experts said.

More information

Learn more about anti-HIV efforts around the world at Avert.

SOURCES: Jon Cohen, journalist, Cardiff, Calif.; Thomas J. Coates, Ph.D., professor, medicine, Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles; July 28, 2006, Science
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