Comprehensive, up-to-date information on HIV/AIDS treatment, prevention, and policy from the University of California San Francisco

The HIV epidemics in South and Central America have changed little in recent years. The total number of people living with HIV continues to grow to an estimated 1.4 million [1.2 million - 1.6 million] in 2009 from 1.1 million [1.0 million - 1.3 million] in 2001) due largely to the availability of antiretroviral therapy. About one third of all people living with HIV in Central and South America live in populous Brazil, where early and ongoing HIV prevention and treatment efforts have contained the epidemic. The adult HIV prevalence in Brazil has remained well under 1% for at least the past decade. Concentrated epidemics - primarily among men who have sex with men Most of the HIV epidemics in this region are concentrated in and around networks of men who have sex with men. Surveys conducted in groups of urban men who have sex with men have found HIV prevalence of at least 10% in 12 of 14 countries, including in Costa Rica. High rates of HIV infection have been found in networks of men who have sex with men. In five Central American countries, the annual HIV incidence was 5.1% among men who have sex with men, while an incidence of 3.5% has been found among men who have sex with men who attended public health clinics in Lima, Peru. Th ese rates were higher than those observed among the men who have sex with men in Europe and North America.

Social stigma, however, has kept many of these epidemics among men who have sex with men hidden and unacknowledged. Several countries, especially in Central America and in the Andes, continue to have fewer programs that address the key role of unsafe sex between men in their HIV epidemics. Fear of being stigmatized can compel many men who have sex with men to also have sexual relationships with women. In Central America, for example, more than one in five men who said that they had sex with other men reported having had sex with at least one woman in the previous six months.

Most countries have focused attention on preventing HIV transmission during paid sex, and there are indications that these efforts are paying off. High condom use rates and low HIV prevalence have been reported among female sex workers in Santiago, Chile, El Salvador, and Guatemala. Injecting drug use has been the other main route of HIV transmission in this region, especially in the southern cone of South America. It has been estimated that as many as 2 million people in Central and South America inject drugs and that more than one quarter of these might be living with HIV.