file	title	code_name	date	type	page_number	text
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	1	COMMUNITIES AT THE CENTRE THE RESPONSE TO HIV IN LATIN AMERICA GLOBAL AIDS UPDATE 2019
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	2	Cover photo: Activists demonstrate for the rights of transgender people at the 2018 International AIDS Conference, held in Amsterdam, the Netherlands. Credit: UNAIDS.
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	3	CONTENTS LATIN AMERICA 3 Argentina 16 Bolivia (Plurinational State of) 18 Brazil 20 Chile 22 Colombia 24 Costa Rica 26 Ecuador 28 El Salvador 30 Guatemala 32 Honduras 34 Mexico 36 Nicaragua 38 Panama 40 Paraguay 42 Peru 44 Uruguay 46 ANNEX ON METHODS 49
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	4	TITLE OF THE ARTICLE FIGURE 13.1 Self-testing in national policies, Latin America, 2018 LATIN AMERICA Yes No Source: 2019 Global AIDS Monitoring. 2 10
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	5	REGIONS IN FOCUS LATIN AMERICA AT A GLANCE Although several Progress towards Monitoring stigma Humanitarian Programmes for countries show the 90–90–90 and discrimination responses to the key populations impressive declines targets has been remains a chal- high levels of in some countries in HIV incidence, steady, but lenge. Mechanisms population mobility remain highly the number of inconsistent access for reporting, liti- in the region that dependent on new HIV infections to health services gating and tracking have arisen due to donor funding in the region and challenges to cases of human political instability that is rapidly increased by 7% patient follow-up rights violations must guarantee decreasing. between 2010 and adherence are are required. HIV services for and 2018. impeding faster migrants and progress. asylum seekers. The HIV response in Latin America is predominantly Greater focus on increasing access to testing, funded with domestic resources. However, there has improving linkage to care and supporting treatment been insufficient domestic investment in programming adherence is needed in the region in order to reach for key populations, including the expansion of the 90–90–90 testing and treatment targets by 2020. prevention services for gay men and other men The introduction of diagnostic strategies—such who have sex with men, female sex workers and as self-testing in Brazil and Mexico—is increasing transgender people. In the countries that are heavily programmatic testing yield (Figure 13.1). dependent on international donor funding, rapid decreases in such resources threaten the sustainability Although attention has been paid to HIV-related of these programmes. stigma and discrimination, it remains a challenge to the success of national HIV responses. For example, Latin America faces additional challenges, including recent policy changes related to social contracting of dramatically increasing levels of migration due to civil society organizations in Mexico could potentially sociopolitical uncertainty. HIV treatment coverage has reverse the advances made in community-based HIV plummeted in the Bolivarian Republic of Venezuela, programming, especially for key populations. Retaining and people living with HIV are migrating to other social contracting as a strategic partnership approach countries to seek access to HIV treatment and other would reinforce the national response to AIDS. health-related care. Many of these migrants pass through multiple countries, each of which must provide for their health needs and overall well-being, in addition to those of their residents. 3
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	6	LATIN AMERICA PART 1 | PART TITLE STATE OF THE EPIDEMIC FIGURE 13.2 Number of new HIV infections, An estimated 100 000 [79 000–130 000] people Latin America, 2000–2018 acquired HIV in Latin America in 2018, a 7% increase compared with 2010 (Figure 13.2). Roughly half of Percentage 160 000 the countries in the region saw increases in incidence Number of new HIV infections change in new 140 000 between 2010 and 2018, with the largest increases HIV infections since 2010 120 000 occurring in Brazil (21%), Costa Rica (21%), the Plurinational State of Bolivia (22%) and Chile (34%). +7% 100 000 80 000 At the same time, impressive declines in El Salvador (-48%), Nicaragua (-29%) and Colombia (-22%) 60 000 were observed (Figure 13.5). Forty per cent of new 40 000 infections in 2018 were among gay men and other 20 000 men who have sex with men (Figure 13.7): among 0 15 countries providing data, prevalence exceeded 20% 2000 2010 2018 in two countries and 10% in a further seven. Among TITLE OF THE ARTICLE the 13 countries providing data, HIV prevalence was New HIV infections Source: UNAIDS 2019 estimates. highest among transgender people, at 30% or more New HIV infections in three countries and more than 20% in a further FIGURE 13.3 Number of AIDS-related deaths, five (Figure 13.6). Latin America, 2000–2018 The annual number of AIDS-related deaths in the Percentage 70 000 Number of AIDS-related deaths region decreased by 14% between 2010 and 2018, change in AIDS- related deaths 60 000 with an estimated 35 000 [25 000–46 000] lives lost to since 2010 50 000 AIDS-related causes in 2018 (Figure 13.3). The region’s incidence-prevalence ratio continues to decrease, -14% 40 000 30 000 reaching 5.4% [4.1–6.8%] in 2018, but further progress is needed to reach the 3.0% epidemic transition 20 000 benchmark (Figure 13.4). 10 000 There are significant differences among countries in 0 the availability of data on key population size (Table 2000 2010 2018 13.1). Only four of eight countries | reported PART 1 data TITLE PART for more than two populations, and no countries AIDS-related deaths Source: UNAIDS 2019 estimates. provided data on people who inject drugs. Given AIDS-related deaths the high prevalence and incidence of HIV among FIGURE 13.4 Incidence-prevalence ratio, gay men and other men who have sex with men and Latin America, 2000–2018 transgender people in the region, national health information systems should be strengthened and 2018 16 expanded to collect comprehensive data about Incidence-prevalence Incidence-prevalence ratio 14 these populations. ratio 12 5.4% 10 8 [4.1–6.8%] 6 4 3 2 0 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 Incidence-prevalence Target value Source: UNAIDS 2019 estimates.Incidence: prevalence ratio Target 4
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	7	TITLE OF THE ARTICLE REGIONS IN FOCUS FIGURE 13.5 Percentage change in new HIV infections, by country, Latin America, 2010–2018 40 34 30 21 21 22 20 7 9 10 6 2 0 Per cent 0 -10 -6 -8 -12 -11 -20 -22 -30 -29 -40 -50 -48 -60 Source: UNAIDS 2019 estimates. TITLE OF THE ARTICLE FIGURE 13.6 HIV prevalence among key populations, FIGURE 13.7 Distribution of new HIV infections Latin America, 2014–2018 (aged 15–49 years), by population group, Latin America, 2018 40 Sex workers 35 3% People who inject drugs 30 3% 25 Remaining Per cent 22.2 population 20 35% 15 Gay men and 10 12.6 other men 5 3.6 who have sex 0.7 with men 1.2 0 40% Clients of sex workers Sex workers (n = 13) and sex partners of other key populations Transgender women Gay men and other men who have sex with men (n = 15) 15% 4% People who inject drugs (n = 2) Transgender people (n = 3) Source: UNAIDS special analysis, 2019. Prisoners (n = 13) Source: Global AIDS Monitoring, 2014–2018. 14 5
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	8	TITLE LATINOF THE ARTICLE AMERICA TABLE 13.1 Estimated size of key populations, Latin America, 2018 have sex with men as per cent cent of adult population (15+) Prisoners as per cent of adult Gay men and other men who Gay men and other men who per cent of adult population People who inject drugs as Transgender people as per Sex workers as per cent of National adult population of adult population (15+) People who inject drugs adult population (15+) Transgender people have sex with men population (15+) Sex workers Prisoners Country (15+) (15+) Bolivia (Plurinational 7 711 000 State of) Chile 14 538 000 42 000 0.29 Costa Rica 3 893 000 100 <0.1 Mexico 96 429 000 240 000 0.25 1 200 000 1.23 120 000 0.12 200 000 0.21 Panama 3 033 000 Peru 23 731 000 Uruguay 2 743 000 6900 0.25 25 000 0.92 1600 0.06 Venezuela 23 545 000 15 000 0.06 National population size estimate Local population size estimate Insufficient data No data The regions for which the local population size estimate refers are as follows: Costa Rica: Gran Área Metropolitana Panama: Azuero, Bocas del Toro, Chiriquí, Coclé, Comarca Ngäbe-Buglé, Panamá Centro, Panamá Este, Panamá Oeste, Panamá Norte and Veraguas Sources: Global AIDS Monitoring, 2018; United Nations, Department of Economic and Social Affairs, Population Division. World population prospects: the 2017 revision. 2018 (custom data acquired via website). REMOVING BARRIERS TO AFFORDABLE TREATMENT Equitable access to affordable medicines remains a major concern in Argentina and other upper- and middle-income countries in Latin America. Due to the income classification of these countries, they often do not benefit from voluntary licensing agreements and drug access programmes from pharmaceutical companies that would greatly reduce the prices they pay for antiretroviral medicines. In response, communities of people living with HIV have been monitoring patent applications and, with the support of legal experts, challenging patents that may block access to treatment. Success can reduce the overall costs of medicines through increased competition and the import of more affordable generic versions of drugs. Leading such efforts in Argentina is the non-profit organization Fundación Grupo Efecto Positivo (FGEP). With support from the International Treatment Preparedness Coalition, FGEP filed two patent oppositions, lobbied decision-makers, engaged in policy dialogues and supported the government’s efforts to pursue generic purchasing and encourage generic drug suppliers to enter the Argentine market. This legal, technical and advocacy campaign led to a 94% price reduction for the country’s first-line regimen––a savings of US$ 37 million for the country’s national AIDS programme (1). 5 6
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	9	REGIONS IN FOCUS THE CASCADE FROM HIV TESTING TO VIRAL SUPPRESSION The proportion of the region’s estimated 1.9 million the region) reached 94% in 2018. Uruguay has had [1.6 million–2.4 million] people living with HIV who particular success reaching women living with HIV: knew their status rose to 80% [62–>95%] in 2018, up more than 95% of women living with HIV knew their from 75% [58–>95%] in 2017 and 70% [53–89%] in 2015. status, and 95% of women on treatment had achieved Similar increases were observed in the percentage of viral suppression. Despite these achievements, viral people living with HIV accessing antiretroviral therapy suppression among adults (aged 15 and older) living (from 57% [41–72%] in 2017 to 62% [43–78%] in 2018) with HIV remained well under 50% in many countries and those who were virally suppressed (from 50% in the region (Figure 13.9). [37–62%] in 2017 to 55% [42–69%] in 2018). Reaching all three targets will require an additional 199 000 people Among the many obstacles to achieving the 90–90–90 living with HIV knowing their status, 362 000 additional targets in the region, linkage to care following people on treatment, and an additional 340 000 people diagnosis is the largest gap. Late diagnosis also living with HIV who are virally suppressed (Figure 13.8). continues to be a challenge, with over 40% of people diagnosed with a CD4 count of under 350 cells per In 2018, 80% of people living with HIV in the region mm3 in 12 of 14 reporting countries (Figure 13.10). In knew their HIV status, more than three quarters who Guatemala, 71% of people had a CD4 count of under knew their HIV status were on treatment, and nearly 350 cells per mm3 at diagnosis, and nearly half (46.9%) nine in 10 of all people on treatment were virally had advanced HIV disease (CD4 count of under 200 suppressed (Table 13.2). Although no individual country cells per mm3). More than 20% of people diagnosed in Latin America has achieved all three of the 90–90–90 in an additional five countries—and more than 30% in targets, viral suppression among people on treatment seven more—had advanced HIV disease. in Brazil (the country with the largest HIV burden in TITLE OF THE ARTICLE FIGURE 13.8 HIV testing and treatment cascade, Latin America, 2018 3 Number of people living with HIV (million) 2 Gap to reaching the first 90: Gap to reaching 199 000 the first and Gap to reaching second 90s: the three 90s: 362 000 340 000 1 80% [62–>95%] 62% 55% [43–78%] [42–69%] 0 People living with HIV People living with HIV People living with HIV who know their status on treatment who are virally suppressed Source: UNAIDS special analysis, 2019; see annex on methods for more details. 7
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	10	LATIN AMERICA PART 1 | PART TITLE TABLE 13.2 90–90–90 country scorecard, Latin America, 2018 First 90: percentage Second 90: Third 90: percentage Viral load of people living with percentage of of people living with suppression: HIV who know their people living with HIV on treatment percentage of HIV status HIV who know their who have suppressed people living with status and who are viral loads HIV who are virally on treatment suppressed All ages Women (15 years and older) Men (15 years and older) All ages Women (15 years and older) Men (15 years and older) All ages Women (15 years and older) Men (15 years and older) All ages Women (15 years and older) Men (15 years and older) Latin America 80 83 79 78 75 80 89 89 89 55 55 56 Argentina Bolivia (Plurinational State of) 74 68 76 33 30 34 Brazil 85 77 94 62 Chile 77 88 69 74 Colombia Costa Rica Ecuador 76 84 73 75 74 75 89 95 87 51 59 47 El Salvador 74 78 74 63 67 60 85 86 84 40 45 37 Guatemala 62 56 65 69 68 72 80 79 81 34 30 38 Honduras 60 71 53 85 85 84 83 81 85 42 49 38 Mexico 76 93 89 63 Nicaragua 74 74 75 40 39 40 Panama 70 56 77 76 81 74 76 83 73 41 37 42 Paraguay 71 84 65 57 52 60 79 79 80 32 34 31 Peru Uruguay 82 >95 75 70 73 68 86 >95 79 50 72 40 Venezuela (Bolivarian Republic of) 90–90–90: 90% and above 85–89% 70–84% 50–69% Less than 50% Viral load suppression: 73% and above 65–72% 40–64% 25–39% Less than 25% Source: UNAIDS special analysis, 2019. 8 4
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	11	REGIONS IN FOCUS FIGURE 13.9 Viral load suppression among adults (aged 15 years and older) living with HIV, by sex, Latin America, 2018 100 90 80 70 60 Per cent 50 40 30 20 10 0 Bolivia Ecuador El Salvador Guatemala Honduras Nicaragua Panama Paraguay Uruguay (Plurinational State of) Females Males Source: UNAIDS special analysis, 2019. Women Men TITLE OF THE ARTICLE FIGURE 13.10 Percentage of people living with HIV with a low CD4 count at initiation of antiretroviral therapy, Latin America, 2018 80 6 70 60 50 Per cent 40 30 20 10 0 CD4 <200 CD4 <350 CD4 <200 CD4 <350 Source: 2019 Global AIDS Monitoring. 9
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	12	LATIN AMERICA A COMBINATION APPROACH TO PREVENTION There is a pressing need for improved combination In addition, there are disparities in the coverage of HIV prevention in the region, particularly for key prevention services. For example, between 55.3% and populations at higher risk of HIV infection. No country 97% of transgender people reported having received at had public policies that included the delivery of all nine least two prevention services in the last three months, prevention services recommended by the World Health except in Guatemala, where only 16% of transgender Organization (WHO) for gay men and other men who people report such services (Figure 13.11). Among other have sex with men or transgender women, and only key populations, only 29.4% of sex workers in Peru—and two countries had such policies for female sex workers 26.3% of gay men and other men who have sex with men (Table 13.3). Three quarters (76%) of countries had and 42.9% of transgender people in Colombia—reported public policies for the delivery of five to eight of the the same service coverage. services to all three of these populations. PART 1 | PART TITLE FIGURE 13.11 Percentage of key populations who reported receiving at least two prevention services in the past three months, Latin America, 2016–2018 100 90 80 70 Per cent 60 50 40 30 20 10 0 Bolivia Brazil Colombia Costa Rica Guatemala Honduras Nicaragua Panama* (Plurinational State of) Sex Sexworkers workers Gaymen Gay andother menand othermen menwho whohave havesex withmen sexwith men People inject drugs who inject People who drugs Transgenderpeople Transgender people Note 1: The use of an asterisk (*) indicates that data for marked countries come from programme data (which tend to show higher values due to the use as a denominator of the number of key population members that are linked to the programme) and not from a survey. Note 2: Possible prevention services received among sex workers, gay men and other men who have sex with men and transgender people: condoms and lubricant, counselling on condom use and safe sex, and testing of sexually transmitted infections. Possible prevention services received among people who inject drugs: condoms and lubricant, counselling on condom use and safe sex, and clean needles or syringes. Source: Global AIDS Monitoring, 2016–2018. 10
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	13	No. Country A1.3 Self-testing 1 Argentina No TITLE OF THE ARTICLE REGIONS IN FOCUS 2 Bolivia (Plurinational State of) No 3 Brazil Yes 4 Chile No FIGURE 13.12 Knowledge of status among key populations, Latin America, 2016–2018 5 Colombia Yes 6 Costa Rica No 100 7 90 Ecuador No 8 80 El Salvador Yes 9 70 Guatemala No Per cent 60 10 Honduras No 50 11 Mexico Yes 40 1230 Nicaragua No 1320 Panama No 1410 Paraguay No 0 15 Peru No (Plurinational Chile El Salvador Mexico Paraguay Ecuador Nicaragua Brazil Colombia Peru Guatemala State of) 16 Uruguay No Bolivia 17 Venezuela (Bolivarian Republic of) No Source: 2019 Global AIDS Monitoring. Sex workers Sex workers Gaymen Gay men and other menwho andhave men othersex who with have sexTransgender with men people men Transgender people Note: Data shown come from surveys, which are typically conducted in areas with high prevalence and needs and may not be nationally representative. Source: Global AIDS Monitoring, 2016–2018. TABLE 13.3 Number of countries with public policies for delivery of HIV prevention services recommended by World Health Organization, by key population, Latin America Gay men and other men Female sex Transgender Latin America who have sex with men workers women HIV testing and counselling 17 17 17 Sexually transmitted infection diagnosis and treatment 17 17 17 PrEP 5 4 5 Post-exposure prophylaxis (PEP) 4 4 4 Condoms 17 16 14 Lubricants 13 12 10 Antiretroviral therapy for all 12 12 12 Peer-led community outreach activities 12 15 12 Sexual health information and education 12 11 11 Number of countries with public policies for delivery of all nine services 0 2 0 Number of countries with public policies for delivery of five to eight services 13 13 13 Number of countries with public policies for delivery of four services or less 4 2 4 Note: Number of countries in the region (n = 17) Source: HIV prevention in the spotlight: an analysis from the perspective of the health sector in Latin America and the Caribbean, 2017. Washington (DC): Pan American Health Organization, UNAIDS; 2017. 11 8 11
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	14	LATIN AMERICA ELIMINATING MOTHER-TO-CHILD TRANSMISSION Regionally, progress on eliminating mother-to-child FIGURE 13.13 Cascade of services for preventing transmission of HIV is mixed. The percentage vertical transmission, numbers of new HIV infections of pregnant women living with HIV receiving and transmission rate, Latin America, 2018 antiretroviral prophylaxis to prevent vertical transmission of HIV and protect their own health was 76% [61–95%] in 2018, and the rate of mother-to-child 76% transmission was 14% [12–17%] in 2018 (Figure 13.13). [61–95%] Number Several countries in the region are close to reaching dual elimination of mother-to-child transmission of HIV and syphilis. National programmes should include the appropriate interventions to achieve 20% Transmission [16–25%] rate: 14% the elimination of mother-to-child transmission of [12–17%] HIV, syphilis, Chagas disease and perinatal hepatitis hepatitis B (2). 0 New child infections Births to women Infants tested by eight weeks of age prevent vertical transmission Women receiving antiretrovirals to living with HIV to birth Any Any birth women to women living living with HIVwith HIV ChildrenChildren newly infected newly infected with HIVwith HIV Source: UNAIDS 2019 estimates; 2019 Global AIDS Monitoring. PART 1 | PART TITLE FIGURE 13.14 Percentage of infants receiving HIV testing in the first 4–6 weeks, Latin America, 2018 100 90 80 70 60 Per cent 50 40 30 20 10 0 Source: 2019 Global AIDS Monitoring. 12
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	15	REGIONS IN FOCUS CONFRONTING STIGMA AND DISCRIMINATION Stigma and discrimination continue to impede the HIV Women in some countries also continue to face response in many countries in the region, with 30% of high levels of physical and/or sexual violence by people surveyed in five of seven countries with recent an intimate partner: nearly 40% in the Plurinational data saying they would not purchase vegetables from State of Bolivia, 33% in Colombia, almost 11% in a vendor living with HIV (Figure 13.15). In Guatemala, Peru, and around 8% in both Guatemala and Mexico the rate was 57%. (Figure 13.16). PART 1 PART TITLE | FIGURE 13.15 Percentage of men and women aged FIGURE 13.16 Percentage of ever-married 15–49 years who would not buy vegetables from a or partnered women aged 15–49 years who shopkeeper living with HIV, Latin America, 2013–2016 experienced physical and/or sexual violence by an intimate partner in the past 12 months, Latin 70 America, most recent data, 2015–2016 60 50 45 Per cent 40 40 35 30 30 Per cent 20 25 10 20 15 0 10 Panama Paraguay Uruguay Colombia Guatemala El Salvador Mexico 5 0 (Plurinational Colombia Peru Mexico Guatemala State of) Bolivia Source: Population-based surveys, 2013–2016, countries with available data. Source: Population-based surveys, 2015–2016. Percentage of people who would not buy vegetables from a shopkeeper living with HIV DECRIMINALIZATION OF HIV IN COLOMBIA AND MEXICO Criminalization of perceived, potential or actual HIV transmission and criminalization of non-disclosure of HIV-positive status continues to slow the HIV response and violate the rights of people living with HIV in many countries. Supported by health and legal experts, networks of people living with HIV have been working hard to challenge such legislation. Two recent victories were achieved in Colombia and Mexico’s Veracruz state. In June 2019, Colombia’s Supreme Court overturned a section of the criminal code that criminalizes HIV and hepatitis B transmission. The court challenge was supported by Colombian nongovernmental organizations, international human rights organizations and United Nations agencies (3). In Veracruz, a coalition including Grupo Multi de Veracruz, HIV Justice Worldwide and the National Human Rights Commission challenged the constitutionality of an amendment to the criminal code that would impose a penalty of six months to five years in prison for anyone who “willfully” transmits HIV. Two years of sustained campaigning by the coalition brought success: in May 2018, the Supreme Court found that the amendment to the Penal Code of the State of Veracruz was invalid. The court ruled that the law violated several fundamental rights, including the rights to equality before the law, to personal freedom and to nondiscrimination (4). 13
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	16	LATIN AMERICA INVESTING TO END AN EPIDEMIC Latin American countries used domestic resources for contributions from the Government of the United 95% of the region’s HIV response financing in 2018.1 The States decreased by 56%, contributions from the availability of financial resources for HIV responses in Global Fund decreased by 42% and contributions from the region has increased by 50% since 2010, mainly due all other international sources decreased by 10%, for to a 55% increase in domestic public resources, which a total of US$ 124 million (2016 constant US dollars).2 accounted for US$ 2.4 billion in 2018 (2016 constant US dollars) (Figure 13.17). Over the same period, bilateral The funding gap for reaching the 2020 target was contributions from the Government of the United States US$ 660 million in 2018. Resource mobilization of America decreased by 62% and contributions from strategies, price reductions for commodities, the Global Fund to Fight AIDS, Tuberculosis and Malaria better resource allocation and other efficiency (the Global Fund) decreased by 44%. Contributions from gains are needed, as is greater investment in key all other donors increased by 47%. populations and social enablers. Countries that are still heavily reliant on donor funds need to develop Funding from all sources decreased in 2018 compared and implement plans for a transition to sustainable, to 2017. Domestic resources decreased by 7%, and domestically resourced HIV responses. international funding decreased by 8% overall: bilateral TITLE OF THE ARTICLE FIGURE 13.17 HIV resource availability, by source, Latin America , 2010–2018, and projected resource needs by 2020 Domestic (public and private) US$ (million) United States (bilateral) Global Fund Other international Resource needs (Fast-Track) 500 0 Source: UNAIDS 2019 resource 2010 2011 2012 2013 2014 2015 2016 2017 2018 2020 availability and needs estimates. Domestic (public and private) United States (Bilateral) Global Fund Other international Resource Needs fast-track 1 Details on the revised UNAIDS estimates for resource availability in low- and middle-income countries can be found in the Investing to End an Epidemic chapter. 2 The Global Fund disbursements to countries decreased by 20% in 2018 because most funding grants ended in 2017, hence the changes in the level of disbursements. 14
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	17	REGIONS IN FOCUS REFERENCES 1.	Othoman Mellouk, Intellectual Property and Access to Medicines Lead, International Treatment Preparedness Coalition. Personal communication, 16 May 2019. 2.	EMTCT plus. Framework for elimination of mother-to-child transmission of HIV, syphilis, hepatitis B, and Chagas. Washington (DC): Pan American Health Organization, World Health Organization; 2017 (http://iris.paho.org/xmlui/handle/123456789/34306, accessed on 6 July 2019). 3.	UNAIDS welcomes the decision of the Constitutional Court of Colombia to strike down the section of the criminal code criminalizing HIV transmission. In: UNAIDS.org [Internet]. 13 June 2019. Geneva; UNAIDS; c2019 (https://www.unaids.org/en/resources/ presscentre/pressreleaseandstatementarchive/2019/june/20190613_colombia, accessed 21 June 2019). 4.	Mexico: Supreme Court Finds Veracruz Law Criminalising “Wilful Transmission” of HIV and STIs to Be Unconstitutional. In: The Body: The HIV/AIDS Resource [Internet]. 4 May 2018. Remedy Health Media LLC; c2019 (https://www.thebody.com/article/mexicosupreme-court-finds-veracruz-law-criminalis, accessed 21 June 2019). 15
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	18	Country tables ARGENTINA COUNTRY DATA ARGENTINA EPIDEMIC ESTIMATES 2010 2015 2018 New HIV infections 6400 6500 6500 New HIV infections (all ages) [5600–7100] [5700–7300] [5800–7300] <200 <200 <100 New HIV infections (0–14) [<200– <200] [<100– <200] [<100– <200] 1800 1900 1900 New HIV infections (women, 15+) [1600–2000] [1700–2100] [1600–2100] 4400 4500 4600 New HIV infections (men, 15+) [3700–5100] [3800–5200] [3800–5200] HIV incidence per 1000 population 0.16 [0.14–0.18] 0.15 [0.13–0.17] 0.15 [0.13–0.17] AIDS-related deaths 1600 1600 1700 AIDS-related deaths (all ages) [1300–2000] [1200–2000] [1300–2100] <100 <100 <100 AIDS-related deaths (0–14) [<100– <100] [<100– <100] [<100– <100] <500 <500 <500 AIDS-related deaths (women, 15+) [<500– <500] [<500– <500] [<500– <500] 1200 1200 1300 AIDS-related deaths (men, 15+) [950–1600] [900–1600] [940–1700] People living with HIV 110 000 130 000 140 000 People living with HIV (all ages) [96 000–120 000] [120 000–140 000] [130 000–150 000] 2700 2100 1800 People living with HIV (0–14) [2500–3000] [1900–2400] [1600–2100] 33 000 40 000 45 000 People living with HIV (women, 15+) [30 000–36 000] [37 000–44 000] [41 000–48 000] 71 000 85 000 93 000 People living with HIV (men, 15+) [62 000–80 000] [75 000–96 000] [83 000–100 000] HIV prevalence (15–49) 0.4 [0.3–0.4] 0.4 [0.4–0.4] 0.4 [0.4–0.4] LAWS AND POLICIES STIGMA AND DISCRIMINATION Laws criminalizing the transmission of, non- No Percentage of women and men aged 15–49 disclosure of or exposure to HIV transmission years who report discriminatory attitudes Criminalization of sex work among consenting Any criminalization or punitive towards people living with HIV adults regulation of sex work Percentage of people living with HIV denied Criminalization of same-sex sexual acts No specific legislation health services because of their HIV status in the last 12 months Possession of drugs for personal use Drug use or possession for personal use is an or drug use and/or consumption are offence Percentage of people living with HIV who specified as criminal offences reported a health-care professional told others Neither criminalized nor about their HIV status without their consent Criminalization of transgender people prosecuted Laws or policies restricting the entry, stay and residence of people living with HIV No VIOLENCE Parental consent for adolescents to access HIV Yes, for adolescents younger than Proportion of ever-married or partnered testing 14 years women aged 15–49 years who experienced physical or sexual violence from a male Spousal consent for married women to access No intimate partner in the past 12 months sexual and reproductive health services Mandatory HIV testing for marriage, work or No residence permits or for certain groups EXPENDITURES Financing sources International: International: International: Domestic private Domestic public Total PEPFAR Global Fund all others Last available report: 2016 $1 860 000 $625 340 000 ... ... ... $627 390 000 16
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	19	EPIDEMIC TRANSITION METRICS 8 000 2 500 12% 8 000 10% Number of people Number of people Number of people 6 000 2 000 6 000 8% 1 500 Percent 4 000 6% 4 000 1 000 4% 2 000 500 2 000 2% 0 0 0% 0 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 New HIV infections Incidence:prevalence ratio New HIV infections AIDS-related deaths Target Deaths among people living with HIV Change in new Change in AIDS- Incidence: HIV infections = 2% related deaths = 3% prevalence = 5% since 2010 since 2010 ratio KEY POPULATIONS HIV COMORBIDITIES Gay men and other men People who Transgender Estimated number of incident tuberculosis 1500 Sex workers Prisoners cases among people living with HIV (2017) [890–2300] who have inject drugs people sex with men People living with HIV who started TB Estimated size of population ... ... ... ... ... ... preventive therapy (2017) HIV prevalence ... ... ... ... 2.7% Cervical cancer screening of women living Know their HIV status ... ... ... ... 43.6% with HIV (2016) Antiretroviral therapy coverage ... ... ... ... 87.4% People coinfected with HIV and hepatitis B Condom use ... ... ... ... ... virus receiving combined treatment Coverage of HIV prevention ... ... ... ... programmes People coinfected with HIV and hepatitis C ... virus starting hepatitis C treatment Avoidance of health care because of stigma and ... ... ... ... discrimination HIV PREVENTION Expenditures (0) ... ... ... Adults aged 15+ years with unsuppressed ... HIV TESTING AND TREATMENT CASCADE viral load Knowledge of HIV prevention among young 120 000 100% people aged 15–24 years ― Women ... 100 000 Number of people living with HIV Gap to reaching the 75% ― Men ... 80 000 first and second 90: Condom use at last sex with a non-marital, 60 000 27 900 50% non-cohabiting partner 40 000 ― Women ... 25% ― Men ... 20 000 Women aged 15–49 years who have their 0 0% demand for family planning satisfied by ... People living with HIV who know People living with HIV on People living with HIV who are modern methods their status treatment virally suppressed Not Men aged 15–49 years who are circumcised All ages ...% [...–...%] 61% [55–67%] ...% [...–...%] applicable 85 500 Voluntary medical male circumcisions Not Children (0–14) ...% [...–...%] 92% [84– >95%] ...% [...–...%] performed according to national standards applicable 1700 People who received PrEP at least once ... Women (15+) ...% [...–...%] 69% [63–75%] ...% [...–...%] during the reporting period 30 900 Harm reduction Men (15+) ...% [...–...%] 57% [50–63%] ...% [...–...%] 52 900 ― Use of sterile injecting equipment at ... last injection ― Needles and syringes distributed per ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ... person who injects 2010 2018 ― Coverage of opioid substitution ... Percentage of pregnant women living with HIV 94% >95% therapy accessing antiretroviral medicines [83– >95%] [85– >95%] ― Naloxone available (2019) No ...% 70.6% Early infant diagnosis [...–...%] [65.1–79.7%] ― Safe injection rooms available (2019) No 17
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	20	BOLIVIA (PLURINATIONAL STATE OF) COUNTRY DATA THE PLURINATIONAL STATE OF BOLIVIA EPIDEMIC ESTIMATES 2010 2015 2018 New HIV infections 1100 1300 1400 New HIV infections (all ages) [1000–1200] [1200–1400] [1300–1500] <100 <100 <100 New HIV infections (0–14) [<100– <200] [<100– <100] [<100– <100] <500 <500 <500 New HIV infections (women, 15+) [<500– <500] [<500– <500] [<500– <500] 720 900 930 New HIV infections (men, 15+) [630–790] [780–980] [810–1000] HIV incidence per 1000 population 0.12 [0.11–0.12] 0.13 [0.12–0.14] 0.13 [0.11–0.14] AIDS-related deaths 1600 1100 670 AIDS-related deaths (all ages) [1500–1800] [960–1200] [550–760] <200 <100 <100 AIDS-related deaths (0–14) [<100– <200] [<100– <100] [<100– <100] <500 <500 <200 AIDS-related deaths (women, 15+) [<500– <500] [<500– <500] [<200– <500] 1100 760 <500 AIDS-related deaths (men, 15+) [960–1200] [650–850] [<500–540] People living with HIV 23 000 21 000 22 000 People living with HIV (all ages) [20 000–25 000] [19 000–23 000] [20 000–24 000] 1000 790 620 People living with HIV (0–14) [990–1100] [720–850] [560–670] 6500 6300 6900 People living with HIV (women, 15+) [5800–7200] [5800–7000] [6400–7500] 15 000 14 000 15 000 People living with HIV (men, 15+) [13 000–17 000] [12 000–16 000] [13 000–17 000] HIV prevalence (15–49) 0.4 [0.3–0.4] 0.3 [0.3–0.3] 0.3 [0.3–0.3] LAWS AND POLICIES STIGMA AND DISCRIMINATION Laws criminalizing the transmission of, non- Yes Percentage of women and men aged 15–49 disclosure of or exposure to HIV transmission years who report discriminatory attitudes Criminalization of sex work among consenting Sex work is not subject to punitive towards people living with HIV adults regulations or is not criminalized Percentage of people living with HIV denied Criminalization of same-sex sexual acts No specific legislation health services because of their HIV status in the last 12 months Possession of drugs for personal use Drug use or possession for personal use is an or drug use and/or consumption are offence Percentage of people living with HIV who specified as criminal offences reported a health-care professional told others Neither criminalized nor about their HIV status without their consent Criminalization of transgender people prosecuted Laws or policies restricting the entry, stay and residence of people living with HIV No VIOLENCE Parental consent for adolescents to access HIV Yes, for adolescents younger than Proportion of ever-married or partnered 2016 testing 18 years women aged 15–49 years who experienced physical or sexual violence from a male Spousal consent for married women to access Yes intimate partner in the past 12 months 39.4 sexual and reproductive health services Mandatory HIV testing for marriage, work or No residence permits or for certain groups EXPENDITURES Financing sources International: International: International: Domestic private Domestic public Total PEPFAR Global Fund all others Last available report: 2012 $2 112 301 $4 786 726 ... $3 549 926 $97 951 $11 768 762 18
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	21	EPIDEMIC TRANSITION METRICS 5 000 2 500 25% 4 000 Number of people Number of people 4 000 Number of people 2 000 20% 3 000 3 000 1 500 15% Percent 2 000 2 000 1 000 10% 1 000 500 5% 1 000 0 0 0% 0 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 New HIV infections Incidence:prevalence ratio New HIV infections AIDS-related deaths Target Deaths among people living with HIV Change in new Change in AIDS- Incidence: HIV infections = 22% related deaths = -59% prevalence = 6% since 2010 since 2010 ratio KEY POPULATIONS HIV COMORBIDITIES Gay men and other men People who Transgender Estimated number of incident tuberculosis 560 Sex workers Prisoners cases among people living with HIV (2017) [360–800] who have inject drugs people sex with men People living with HIV who started TB Estimated size of population ... ... ... ... ... ... preventive therapy (2017) HIV prevalence ... 25.4% ... 22.6% 1.1% Cervical cancer screening of women living Know their HIV status ... ... ... 63.8% ... with HIV Antiretroviral therapy coverage 32.0% ... ... ... ... People coinfected with HIV and hepatitis B Condom use ... 66.0% ... 80.0% ... virus receiving combined treatment Coverage of HIV prevention ... 33.9% ... 55.3% programmes People coinfected with HIV and hepatitis C ... virus starting hepatitis C treatment Avoidance of health care because of stigma and ... ... ... ... discrimination HIV PREVENTION Expenditures (0) ... ... ... Adults aged 15+ years with unsuppressed 0.2% HIV TESTING AND TREATMENT CASCADE viral load Knowledge of HIV prevention among young 20 000 100% people aged 15–24 years 18 000 ― Women ... Number of people living with HIV 16 000 75% ― Men ... 14 000 Gap to 12 000 reaching the Gap to Condom use at last sex with a non-marital, first and reaching all 50% 10 000 second 90: non-cohabiting partner three 90s: 8 000 8300 9000 ― Women ... 6 000 25% ― Men ... 4 000 2 000 Women aged 15–49 years who have their 0 0% demand for family planning satisfied by ... People living with HIV who know People living with HIV on People living with HIV who are modern methods their status treatment virally suppressed Not Men aged 15–49 years who are circumcised All ages ...% [...–...%] 44% [40–48%] 33% [30–36%] applicable 9900 Voluntary medical male circumcisions Not Children (0–14) ...% [...–...%] 40% [37–43%] 37% [33–39%] performed according to national standards applicable 250 People who received PrEP at least once ... Women (15+) ...% [...–...%] 44% [41–49%] 30% [28–33%] during the reporting period 3100 Harm reduction Men (15+) ...% [...–...%] 44% [39–49%] 34% [30–37%] 6600 ― Use of sterile injecting equipment at ... last injection ― Needles and syringes distributed per ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ... person who injects 2010 2018 ― Coverage of opioid substitution ... Percentage of pregnant women living with HIV 34% >95% therapy accessing antiretroviral medicines [29–38%] [>95– >95%] ― Naloxone available (2019) No 38.0% ...% Early infant diagnosis [33.6–44.5%] [...–...%] ― Safe injection rooms available (2019) No 19
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	22	BRAZIL COUNTRY DATA BRAZIL EPIDEMIC ESTIMATES 2010 2015 2018 New HIV infections 44 000 48 000 53 000 New HIV infections (all ages) [34 000–54 000] [38 000–59 000] [42 000–65 000] ... ... ... New HIV infections (0–14) [...–...] [...–...] [...–...] ... ... ... New HIV infections (women, 15+) [...–...] [...–...] [...–...] ... ... ... New HIV infections (men, 15+) [...–...] [...–...] [...–...] HIV incidence per 1000 population 0.23 [0.18–0.28] 0.24 [0.19–0.29] 0.26 [0.2–0.31] AIDS-related deaths 15 000 16 000 15 000 AIDS-related deaths (all ages) [11 000–19 000] [12 000–21 000] [11 000–19 000] ... ... ... AIDS-related deaths (0–14) [...–...] [...–...] [...–...] ... ... ... AIDS-related deaths (women, 15+) [...–...] [...–...] [...–...] ... ... ... AIDS-related deaths (men, 15+) [...–...] [...–...] [...–...] People living with HIV 670 000 800 000 900 000 People living with HIV (all ages) [520 000–830 000] [620 000–1 000 000] [690 000–1 100 000] ... ... ... People living with HIV (0–14) [...–...] [...–...] [...–...] ... ... ... People living with HIV (women, 15+) [...–...] [...–...] [...–...] ... ... ... People living with HIV (men, 15+) [...–...] [...–...] [...–...] HIV prevalence (15–49) 0.5 [0.4–0.6] 0.5 [0.4–0.6] 0.5 [0.4–0.7] LAWS AND POLICIES STIGMA AND DISCRIMINATION Laws criminalizing the transmission of, non- No Percentage of women and men aged 15–49 disclosure of or exposure to HIV transmission years who report discriminatory attitudes Criminalization of sex work among consenting Any criminalization or punitive towards people living with HIV adults regulation of sex work Laws penalizing same-sex sexual Percentage of people living with HIV denied Criminalization of same-sex sexual acts acts have been decriminalized or health services because of their HIV status in never existed the last 12 months Possession of drugs for personal use Drug use or possession for personal use is an or drug use and/or consumption are offence Percentage of people living with HIV who specified as non-criminal offences reported a health-care professional told others Neither criminalized nor about their HIV status without their consent Criminalization of transgender people prosecuted Laws or policies restricting the entry, stay and residence of people living with HIV No VIOLENCE Parental consent for adolescents to access HIV No Proportion of ever-married or partnered testing women aged 15–49 years who experienced physical or sexual violence from a male Spousal consent for married women to access No intimate partner in the past 12 months sexual and reproductive health services Mandatory HIV testing for marriage, work or No residence permits or for certain groups EXPENDITURES Financing sources International: International: International: Domestic private Domestic public Total PEPFAR Global Fund all others Last available report: 2018 ... $699 139 356 ... ... ... $699 139 356 20
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	23	EPIDEMIC TRANSITION METRICS 70 000 25 000 20% 60 000 60 000 Number of people Number of people Number of people 20 000 15% 50 000 15 000 40 000 Percent 40 000 10% 30 000 10 000 20 000 20 000 5 000 5% 10 000 0 0 0% 0 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 New HIV infections Incidence:prevalence ratio New HIV infections AIDS-related deaths Target Deaths among people living with HIV Change in new Change in AIDS- Incidence: HIV infections = 21% related deaths = 1% prevalence = 6% since 2010 since 2010 ratio KEY POPULATIONS HIV COMORBIDITIES Gay men and 11 000 other men People who Transgender Estimated number of incident tuberculosis Sex workers Prisoners [9300 who have inject drugs people cases among people living with HIV (2017) –13 000] sex with men People living with HIV who started TB Estimated size of population ... ... ... ... ... ... preventive therapy (2017) HIV prevalence 5.3% 18.3% ... 30.0% ... Cervical cancer screening of women living Know their HIV status 52.3% 72.6% ... 76.9% ... with HIV Antiretroviral therapy coverage ... ... ... ... ... People coinfected with HIV and hepatitis B Condom use ... 64.3% ... 70.8% ... virus receiving combined treatment Coverage of HIV prevention 22.4% 29.8% ... 59.3% programmes People coinfected with HIV and hepatitis C ... virus starting hepatitis C treatment Avoidance of health care because of stigma and ... 17.3% ... ... discrimination HIV PREVENTION Expenditures (2017) $0 $0 $0 Adults aged 15+ years with unsuppressed ... HIV TESTING AND TREATMENT CASCADE viral load Knowledge of HIV prevention among young 900 000 100% people aged 15–24 years 800 000 Gap to ― Women ... Number of people living with HIV 700 000 reaching the Gap to 75% ― Men ... first 90: 600 000 43 200 reaching the Gap to first and reaching all Condom use at last sex with a non-marital, 500 000 second 90: three 90s: 50% non-cohabiting partner 400 000 135 000 102 000 300 000 ― Women ... 200 000 25% ― Men ... 100 000 Women aged 15–49 years who have their 0 0% demand for family planning satisfied by ... People living with HIV who know People living with HIV on People living with HIV who are modern methods their status treatment virally suppressed Not Men aged 15–49 years who are circumcised All ages 85% [66– >95%] 66% [51–82%] 62% [47–77%] applicable 593 000 Voluntary medical male circumcisions Not Children (0–14) ...% [...–...%] ...% [...–...%] ...% [...–...%] performed according to national standards applicable ... People who received PrEP at least once 8108 Women (15+) ...% [...–...%] ...% [...–...%] ...% [...–...%] during the reporting period (2018) ... Harm reduction Men (15+) ...% [...–...%] ...% [...–...%] ...% [...–...%] ... ― Use of sterile injecting equipment at ... last injection ― Needles and syringes distributed per ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ... person who injects 2010 2018 ― Coverage of opioid substitution ... Percentage of pregnant women living with HIV ...% ...% therapy accessing antiretroviral medicines [...–...%] [...–...%] ― Naloxone available (2019) No 21.9% ...% Early infant diagnosis [17.4–29.9%] [...–...%] ― Safe injection rooms available (2019) No 21
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	24	CHILE COUNTRY DATA CHILE EPIDEMIC ESTIMATES 2010 2015 2018 New HIV infections 3700 4600 5000 New HIV infections (all ages) [3100–4100] [3700–5000] [4000–5500] <100 <100 <100 New HIV infections (0–14) [<100– <100] [<100– <100] [<100– <100] 620 790 950 New HIV infections (women, 15+) [540–700] [700–890] [830–1100] 3100 3700 4000 New HIV infections (men, 15+) [2500–3400] [3000–4200] [3100–4500] HIV incidence per 1000 population 0.22 [0.18–0.24] 0.26 [0.21–0.29] 0.27 [0.22–0.3] AIDS-related deaths ... ... 590 AIDS-related deaths (all ages) [...–...] [...–...] [<500–770] ... ... <100 AIDS-related deaths (0–14) [...–...] [...–...] [<100– <100] ... ... <200 AIDS-related deaths (women, 15+) [...–...] [...–...] [<200– <200] ... ... <500 AIDS-related deaths (men, 15+) [...–...] [...–...] [<500–580] People living with HIV 39 000 57 000 71 000 People living with HIV (all ages) [34 000–43 000] [50 000–62 000] [63 000–78 000] <500 <500 <500 People living with HIV (0–14) [<500– <500] [<500– <500] [<500– <500] 6600 9700 12 000 People living with HIV (women, 15+) [6000–7100] [8800–10 000] [11 000–13 000] 32 000 47 000 59 000 People living with HIV (men, 15+) [28 000–36 000] [41 000–52 000] [51 000–66 000] HIV prevalence (15–49) 0.4 [0.3–0.4] 0.5 [0.4–0.5] 0.5 [0.5–0.6] LAWS AND POLICIES STIGMA AND DISCRIMINATION Laws criminalizing the transmission of, non- No Percentage of women and men aged 15–49 disclosure of or exposure to HIV transmission years who report discriminatory attitudes Criminalization of sex work among consenting Any criminalization or punitive towards people living with HIV adults regulation of sex work Laws penalizing same-sex sexual Percentage of people living with HIV denied Criminalization of same-sex sexual acts acts have been decriminalized or health services because of their HIV status in never existed the last 12 months Possession of drugs for personal use Drug use or possession for personal use is an or drug use and/or consumption are offence Percentage of people living with HIV who specified as non-criminal offences reported a health-care professional told others Neither criminalized nor about their HIV status without their consent Criminalization of transgender people prosecuted Laws or policies restricting the entry, stay and residence of people living with HIV No VIOLENCE Parental consent for adolescents to access HIV Yes, for adolescents younger than Proportion of ever-married or partnered testing 14 years women aged 15–49 years who experienced physical or sexual violence from a male Spousal consent for married women to access No intimate partner in the past 12 months sexual and reproductive health services Mandatory HIV testing for marriage, work or Yes residence permits or for certain groups EXPENDITURES Financing sources International: International: International: Domestic private Domestic public Total PEPFAR Global Fund all others Last available report: 2018 $108 369 580 $207 644 768 ... ... ... $316 014 348 22
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	25	EPIDEMIC TRANSITION METRICS 6 000 1 000 20% 6 000 5 000 Number of people Number of people Number of people 800 15% 4 000 4 000 600 Percent 3 000 10% 400 2 000 2 000 200 5% 1 000 0 0 0% 0 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 New HIV infections Incidence:prevalence ratio New HIV infections AIDS-related deaths Target Deaths among people living with HIV Change in new Change in AIDS- Incidence: HIV infections = 34% related deaths = prevalence = 7% since 2010 since 2010 ratio KEY POPULATIONS HIV COMORBIDITIES Gay men and other men People who Transgender Estimated number of incident tuberculosis 510 Sex workers Prisoners cases among people living with HIV (2017) [310–770] who have inject drugs people sex with men People living with HIV who started TB Estimated size of population ... ... ... ... 42 000 ... preventive therapy (2017) HIV prevalence 0.0% 13.9% ... ... 0.5% Cervical cancer screening of women living Know their HIV status 58.0% 62.2% ... ... ... with HIV Antiretroviral therapy coverage 79.4% 89.0% ... 92.2% 89.0% People coinfected with HIV and hepatitis B Condom use 97.0% 42.1% ... ... ... virus receiving combined treatment Coverage of HIV prevention ... ... ... ... programmes People coinfected with HIV and hepatitis C 36% virus starting hepatitis C treatment (2018) Avoidance of health care because of stigma and ... ... ... ... discrimination HIV PREVENTION Expenditures (2016) $169 593 $665 414 $0 Adults aged 15+ years with unsuppressed ... HIV TESTING AND TREATMENT CASCADE viral load Knowledge of HIV prevention among young 70 000 100% people aged 15–24 years 60 000 ― Women ... Number of people living with HIV Gap to 75% ― Men ... 50 000 reaching the 40 000 first and Condom use at last sex with a non-marital, second 90: 50% non-cohabiting partner (2016) 30 000 12 700 ― Women 26.1% 20 000 25% ― Men 49.2% 10 000 Women aged 15–49 years who have their 0 0% demand for family planning satisfied by ... People living with HIV who know People living with HIV on People living with HIV who are modern methods their status treatment virally suppressed Not Men aged 15–49 years who are circumcised All ages ...% [...–...%] 63% [56–70%] ...% [...–...%] applicable 45 100 Voluntary medical male circumcisions Not Children (0–14) ...% [...–...%] 56% [50–61%] ...% [...–...%] performed according to national standards applicable 140 People who received PrEP at least once ... Women (15+) 77% [70–83%] 53% [48–57%] ...% [...–...%] during the reporting period 6400 Harm reduction Men (15+) 88% [76– >95%] 65% [56–73%] ...% [...–...%] 38 500 ― Use of sterile injecting equipment at ... last injection ― Needles and syringes distributed per ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ... person who injects 2010 2018 ― Coverage of opioid substitution ... Percentage of pregnant women living with HIV 72% >95% therapy accessing antiretroviral medicines [65–80%] [>95– >95%] ― Naloxone available (2019) No ...% 81.2% Early infant diagnosis [...–...%] [73.7–90.1%] ― Safe injection rooms available (2019) No 23
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	26	COLOMBIA COUNTRY DATA COLOMBIA EPIDEMIC ESTIMATES 2010 2015 2018 New HIV infections 8800 7900 6900 New HIV infections (all ages) [6400–11 000] [5600–10 000] [4700–9100] 590 510 510 New HIV infections (0–14) [<500–750] [<500–630] [<500–660] 1400 1100 910 New HIV infections (women, 15+) [1000–1800] [760–1500] [630–1300] 6800 6300 5400 New HIV infections (men, 15+) [5000–8900] [4400–8400] [3700–7400] HIV incidence per 1000 population 0.19 [0.14–0.25] 0.17 [0.12–0.22] 0.14 [0.1–0.19] AIDS-related deaths ... ... ... AIDS-related deaths (all ages) [...–...] [...–...] [...–...] ... ... ... AIDS-related deaths (0–14) [...–...] [...–...] [...–...] ... ... ... AIDS-related deaths (women, 15+) [...–...] [...–...] [...–...] ... ... ... AIDS-related deaths (men, 15+) [...–...] [...–...] [...–...] People living with HIV 130 000 140 000 160 000 People living with HIV (all ages) [100 000–150 000] [120 000–170 000] [130 000–180 000] 5200 4000 3600 People living with HIV (0–14) [4500–6100] [3400–4800] [2900–4300] 26 000 29 000 31 000 People living with HIV (women, 15+) [22 000–30 000] [24 000–34 000] [26 000–36 000] 94 000 110 000 120 000 People living with HIV (men, 15+) [77 000–110 000] [91 000–130 000] [98 000–150 000] HIV prevalence (15–49) 0.4 [0.3–0.5] 0.4 [0.3–0.5] 0.4 [0.3–0.5] LAWS AND POLICIES STIGMA AND DISCRIMINATION Laws criminalizing the transmission of, non- Yes Percentage of women and men aged 15–49 2010 2015 disclosure of or exposure to HIV transmission years who report discriminatory attitudes Criminalization of sex work among consenting Sex work is not subject to punitive towards people living with HIV 44.7 37.2 adults regulations or is not criminalized (2010 refers to women only) Laws penalizing same-sex sexual Percentage of people living with HIV denied Criminalization of same-sex sexual acts acts have been decriminalized or health services because of their HIV status in never existed the last 12 months Drug use or possession for personal use is an ... offence Percentage of people living with HIV who reported a health-care professional told others Neither criminalized nor about their HIV status without their consent Criminalization of transgender people prosecuted Laws or policies restricting the entry, stay and residence of people living with HIV No VIOLENCE Parental consent for adolescents to access HIV Yes, for adolescents younger than Proportion of ever-married or partnered 2010 2015 testing 14 years women aged 15–49 years who experienced physical or sexual violence from a male Spousal consent for married women to access No intimate partner in the past 12 months 37.4 33.3 sexual and reproductive health services Mandatory HIV testing for marriage, work or No residence permits or for certain groups EXPENDITURES Financing sources International: International: International: Domestic private Domestic public Total PEPFAR Global Fund all others Last available report: 2013 $34 547 857 $84 674 170 ... ... ... $119 528 046 24
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	27	EPIDEMIC TRANSITION METRICS 20 000 1 20% 15 000 Number of people Number of people Number of people 15 000 1 15% 1 10 000 Percent 10 000 10% 0 5 000 5 000 0 5% 0 0 0% 0 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 New HIV infections Incidence:prevalence ratio New HIV infections AIDS-related deaths Target Deaths among people living with HIV Change in new Change in AIDS- Incidence: HIV infections = -22% related deaths = prevalence = 4% since 2010 since 2010 ratio KEY POPULATIONS HIV COMORBIDITIES Gay men and 2000 other men People who Transgender Estimated number of incident tuberculosis Sex workers Prisoners [1500 who have inject drugs people cases among people living with HIV (2017) –2500] sex with men People living with HIV who started TB Estimated size of population ... ... ... ... ... ... preventive therapy (2017) HIV prevalence 1.2% 17.0% 2.8% 21.4% ... Cervical cancer screening of women living Know their HIV status 90.6% 26.3% ... 42.9% ... with HIV Antiretroviral therapy coverage ... ... ... ... ... People coinfected with HIV and hepatitis B Condom use 98.3% 17.0% 35.8% ... ... virus receiving combined treatment Coverage of HIV prevention ... 38.0% ... ... programmes People coinfected with HIV and hepatitis C ... virus starting hepatitis C treatment Avoidance of health care because of stigma and ... ... ... ... discrimination HIV PREVENTION Expenditures (2016) $0 $414 142 $0 Adults aged 15+ years with unsuppressed ... HIV TESTING AND TREATMENT CASCADE viral load Knowledge of HIV prevention among young 140 000 100% people aged 15–24 years (2015) 120 000 Gap to ― Women 31.63% Number of people living with HIV reaching the 75% ― Men 28.52% 100 000 first and second 90: Condom use at last sex with a non-marital, 80 000 12 800 50% non-cohabiting partner (2015) 60 000 ― Women 42.4% 40 000 25% ― Men 70.5% 20 000 Women aged 15–49 years who have their 0 0% demand for family planning satisfied by 86.8% People living with HIV who know People living with HIV on People living with HIV who are modern methods (2015) their status treatment virally suppressed Not Men aged 15–49 years who are circumcised All ages ...% [...–...%] 73% [60–86%] ...% [...–...%] applicable 113 000 Voluntary medical male circumcisions Not Children (0–14) ...% [...–...%] 41% [32–49%] ...% [...–...%] performed according to national standards applicable 1500 People who received PrEP at least once ... Women (15+) ...% [...–...%] 77% [64–90%] ...% [...–...%] during the reporting period 23 900 Harm reduction Men (15+) ...% [...–...%] 73% [59–88%] ...% [...–...%] 87 700 ― Use of sterile injecting equipment at ... last injection ― Needles and syringes distributed per ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION 5 person who injects (2018) 2010 2018 ― Coverage of opioid substitution ... Percentage of pregnant women living with HIV 33% 21% therapy accessing antiretroviral medicines [26–40%] [17–25%] ― Naloxone available (2019) No 7.1% 30.7% Early infant diagnosis [5.8–8.9%] [26.2–37.3%] ― Safe injection rooms available (2019) No 25
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	28	COSTA RICA COUNTRY DATA COSTA RICA EPIDEMIC ESTIMATES 2010 2015 2018 New HIV infections 830 950 1000 New HIV infections (all ages) [730–920] [830–1100] [860–1200] ... ... ... New HIV infections (0–14) [...–...] [...–...] [...–...] <200 <200 <200 New HIV infections (women, 15+) [<200– <200] [<200– <200] [<200– <200] 650 770 820 New HIV infections (men, 15+) [550–740] [630–900] [660–960] HIV incidence per 1000 population 0.19 [0.16–0.21] 0.2 [0.18–0.23] 0.21 [0.18–0.24] AIDS-related deaths <500 <500 <500 AIDS-related deaths (all ages) [<200– <500] [<200– <500] [<200– <500] ... ... ... AIDS-related deaths (0–14) [...–...] [...–...] [...–...] <100 <100 <100 AIDS-related deaths (women, 15+) [<100– <100] [<100– <100] [<100– <100] <200 <200 <200 AIDS-related deaths (men, 15+) [<200– <500] [<200– <500] [<200– <500] People living with HIV 9300 13 000 15 000 People living with HIV (all ages) [8400–10 000] [11 000–14 000] [13 000–17 000] ... ... ... People living with HIV (0–14) [...–...] [...–...] [...–...] 2000 2600 2900 People living with HIV (women, 15+) [1800–2200] [2400–2900] [2700–3300] 7200 10 000 12 000 People living with HIV (men, 15+) [6300–8100] [8900–11 000] [10 000–13 000] HIV prevalence (15–49) 0.3 [0.3–0.3] 0.4 [0.3–0.4] 0.4 [0.4–0.5] LAWS AND POLICIES STIGMA AND DISCRIMINATION Laws criminalizing the transmission of, non- No, but prosecutions exist based Percentage of women and men aged 15–49 disclosure of or exposure to HIV transmission on general criminal laws years who report discriminatory attitudes Criminalization of sex work among consenting Sex work is not subject to punitive towards people living with HIV adults regulations or is not criminalized Laws penalizing same-sex sexual Percentage of people living with HIV denied 2014 Criminalization of same-sex sexual acts acts have been decriminalized or health services because of their HIV status in never existed the last 12 months 8.8 Drug use or possession for personal use is an No Percentage of people living with HIV who 2014 offence reported a health-care professional told others Neither criminalized nor about their HIV status without their consent Criminalization of transgender people 15.5 prosecuted Laws or policies restricting the entry, stay and residence of people living with HIV No VIOLENCE Parental consent for adolescents to access HIV No Proportion of ever-married or partnered testing women aged 15–49 years who experienced physical or sexual violence from a male Spousal consent for married women to access No intimate partner in the past 12 months sexual and reproductive health services Mandatory HIV testing for marriage, work or No residence permits or for certain groups EXPENDITURES Financing sources International: International: International: Domestic private Domestic public Total PEPFAR Global Fund all others Last available report: 2018 $1 628 121 $44 000 708 ... $1 935 200 $480 461 $48 044 490 26
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	29	EPIDEMIC TRANSITION METRICS 1 400 350 15% 1 500 1 200 300 Number of people Number of people Number of people 1 000 250 10% 1 000 Percent 800 200 600 150 400 100 5% 500 200 50 0 0 0% 0 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 New HIV infections Incidence:prevalence ratio New HIV infections AIDS-related deaths Target Deaths among people living with HIV Change in new Change in AIDS- Incidence: HIV infections = 21% related deaths = -4% prevalence = 7% since 2010 since 2010 ratio KEY POPULATIONS HIV COMORBIDITIES Gay men and other men People who Transgender Estimated number of incident tuberculosis 42 Sex workers Prisoners cases among people living with HIV (2017) [32–53] who have inject drugs people sex with men People living with HIV who started TB Estimated size of population ... ... ... ... 100 ... preventive therapy (2017) HIV prevalence 1.4% 15.4% ... 24.6% 0.3% Cervical cancer screening of women living Know their HIV status 100% 100% ... 100% ... with HIV Antiretroviral therapy coverage ... ... ... ... 79.8% People coinfected with HIV and hepatitis B Condom use 74.0% 39.2% ... 78.6% ... virus receiving combined treatment Coverage of HIV prevention 83.3% ... ... ... programmes People coinfected with HIV and hepatitis C ... virus starting hepatitis C treatment Avoidance of health care because of stigma and ... ... ... ... discrimination HIV PREVENTION Expenditures (2014) $0 $0 $0 Adults aged 15+ years with unsuppressed ... HIV TESTING AND TREATMENT CASCADE viral load Knowledge of HIV prevention among young 14 000 100% people aged 15–24 years 12 000 ― Women ... Number of people living with HIV 75% ― Men ... 10 000 Gap to reaching the Condom use at last sex with a non-marital, 8 000 first and 50% non-cohabiting partner 6 000 second 90: 4800 ― Women ... 4 000 25% ― Men ... 2 000 Women aged 15–49 years who have their 0 0% demand for family planning satisfied by ... People living with HIV who know People living with HIV on People living with HIV who are modern methods their status treatment virally suppressed Not Men aged 15–49 years who are circumcised All ages ...% [...–...%] 49% [44–54%] ...% [...–...%] applicable 7200 Voluntary medical male circumcisions Not Children (0–14) ...% [...–...%] ...% [...–...%] ...% [...–...%] performed according to national standards applicable ... People who received PrEP at least once ... Women (15+) ...% [...–...%] 60% [54–66%] ...% [...–...%] during the reporting period 1800 Harm reduction Men (15+) ...% [...–...%] 46% [40–52%] ...% [...–...%] 5400 ― Use of sterile injecting equipment at ... last injection ― Needles and syringes distributed per ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ... person who injects 2010 2018 ― Coverage of opioid substitution ... Percentage of pregnant women living with HIV ...% ...% therapy accessing antiretroviral medicines [...–...%] [...–...%] ― Naloxone available (2019) No ...% ...% Early infant diagnosis [...–...%] [...–...%] ― Safe injection rooms available (2019) No 27
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	30	ECUADOR COUNTRY DATA ECUADOR EPIDEMIC ESTIMATES 2010 2015 2018 New HIV infections 2500 2400 2200 New HIV infections (all ages) [1400–4600] [1300–4500] [1200–4400] <100 <100 <100 New HIV infections (0–14) [<100– <200] [<100– <200] [<100– <200] 700 690 650 New HIV infections (women, 15+) [<500–1300] [<500–1300] [<500–1200] 1700 1700 1500 New HIV infections (men, 15+) [990–3300] [890–3100] [800–3100] HIV incidence per 1000 population 0.17 [0.1–0.32] 0.15 [0.08–0.29] 0.13 [0.07–0.27] AIDS-related deaths 1100 1100 620 AIDS-related deaths (all ages) [520–2200] [520–2400] [<500–1500] <100 <100 <100 AIDS-related deaths (0–14) [<100– <100] [<100– <100] [<100– <100] <500 <200 <200 AIDS-related deaths (women, 15+) [<200– <500] [<100– <500] [<100– <500] 790 980 <500 AIDS-related deaths (men, 15+) [<500–1600] [<500–2000] [<500–1100] People living with HIV 34 000 40 000 44 000 People living with HIV (all ages) [22 000–57 000] [27 000–65 000] [29 000–71 000] 640 660 660 People living with HIV (0–14) [<500–1100] [<500–1100] [<500–1200] 9000 11 000 13 000 People living with HIV (women, 15+) [6100–15 000] [7700–18 000] [8700–20 000] 24 000 28 000 30 000 People living with HIV (men, 15+) [16 000–41 000] [18 000–46 000] [20 000–50 000] HIV prevalence (15–49) 0.4 [0.2–0.6] 0.4 [0.2–0.6] 0.4 [0.2–0.6] LAWS AND POLICIES STIGMA AND DISCRIMINATION Laws criminalizing the transmission of, non- Yes Percentage of women and men aged 15–49 disclosure of or exposure to HIV transmission years who report discriminatory attitudes Criminalization of sex work among consenting Sex work is not subject to punitive towards people living with HIV adults regulations or is not criminalized Laws penalizing same-sex sexual Percentage of people living with HIV denied Criminalization of same-sex sexual acts acts have been decriminalized or health services because of their HIV status in never existed the last 12 months Drug use or possession for personal use is an No Percentage of people living with HIV who offence reported a health-care professional told others Neither criminalized nor about their HIV status without their consent Criminalization of transgender people prosecuted Laws or policies restricting the entry, stay and residence of people living with HIV No VIOLENCE Parental consent for adolescents to access HIV No Proportion of ever-married or partnered testing women aged 15–49 years who experienced physical or sexual violence from a male Spousal consent for married women to access No intimate partner in the past 12 months sexual and reproductive health services Mandatory HIV testing for marriage, work or No residence permits or for certain groups EXPENDITURES Financing sources International: International: International: Domestic private Domestic public Total PEPFAR Global Fund all others Last available report: 2018 $305 994 $14 807 266 ... $501 000 ... $15 614 260 28
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	31	EPIDEMIC TRANSITION METRICS 6 000 3 500 20% 3 000 5 000 3 000 Number of people Number of people Number of people 2 500 15% 4 000 2 000 Percent 2 000 3 000 10% 1 500 2 000 1 000 1 000 5% 1 000 500 0 0 0% 0 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 New HIV infections Incidence:prevalence ratio New HIV infections AIDS-related deaths Target Deaths among people living with HIV Change in new Change in AIDS- Incidence: HIV infections = -12% related deaths = -44% prevalence = 5% since 2010 since 2010 ratio KEY POPULATIONS HIV COMORBIDITIES Gay men and other men People who Transgender Estimated number of incident tuberculosis 950 Sex workers Prisoners cases among people living with HIV (2017) [720–1200] who have inject drugs people sex with men People living with HIV who started TB Estimated size of population ... ... ... ... ... ... preventive therapy (2017) HIV prevalence ... 16.5% ... 34.8% 1.3% Cervical cancer screening of women living Know their HIV status ... 56.3% ... 60.4% ... with HIV Antiretroviral therapy coverage ... ... ... ... 89.7% People coinfected with HIV and hepatitis B Condom use 69.7% 77.0% ... 94.0% ... virus receiving combined treatment Coverage of HIV prevention ... ... ... ... programmes People coinfected with HIV and hepatitis C ... virus starting hepatitis C treatment Avoidance of health care because of stigma and ... ... ... ... discrimination HIV PREVENTION Expenditures (2017) $0 $0 $0 Adults aged 15+ years with unsuppressed 0.2% HIV TESTING AND TREATMENT CASCADE viral load Knowledge of HIV prevention among young 45 000 100% people aged 15–24 years 40 000 ― Women ... Number of people living with HIV 35 000 Gap to reaching the 75% ― Men ... 30 000 first 90: Gap to 6000 reaching the Gap to Condom use at last sex with a non-marital, 25 000 reaching all 50% first and non-cohabiting partner 20 000 second 90: three 90s: 10 400 9600 ― Women ... 15 000 10 000 25% ― Men ... 5 000 Women aged 15–49 years who have their 0 0% demand for family planning satisfied by ... People living with HIV who know People living with HIV on People living with HIV who are modern methods their status treatment virally suppressed Not Men aged 15–49 years who are circumcised All ages 76% [51– >95%] 57% [38–93%] 51% [34–83%] applicable 25 100 Voluntary medical male circumcisions Not Children (0–14) 92% [60– >95%] 82% [54– >95%] 75% [49– >95%] performed according to national standards applicable 540 People who received PrEP at least once ... Women (15+) 84% [56– >95%] 62% [42– >95%] 59% [40–93%] during the reporting period 8100 Harm reduction Men (15+) 73% [48– >95%] 55% [36–90%] 47% [31–78%] 16 500 ― Use of sterile injecting equipment at ... last injection ― Needles and syringes distributed per ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ... person who injects 2010 2018 ― Coverage of opioid substitution ... Percentage of pregnant women living with HIV 78% >95% therapy accessing antiretroviral medicines [50– >95%] [68– >95%] ― Naloxone available (2019) No 1.5% ...% Early infant diagnosis [<1–2.3%] [...–...%] ― Safe injection rooms available (2019) No 29
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	32	EL SALVADOR COUNTRY DATA EL SALVADOR EPIDEMIC ESTIMATES 2010 2015 2018 New HIV infections 1400 900 700 New HIV infections (all ages) [1000–1700] [670–1100] [530–870] <200 <100 <100 New HIV infections (0–14) [<100– <200] [<100– <200] [<100– <100] <500 <500 <500 New HIV infections (women, 15+) [<500–500] [<500– <500] [<200– <500] 840 560 <500 New HIV infections (men, 15+) [610–1100] [<500–710] [<500–550] HIV incidence per 1000 population 0.22 [0.17–0.27] 0.14 [0.11–0.18] 0.11 [0.08–0.14] AIDS-related deaths <500 620 700 AIDS-related deaths (all ages) [<500–730] [<500–920] [<500–1000] <100 <100 <100 AIDS-related deaths (0–14) [<100– <200] [<100– <100] [<100– <100] <200 <200 <200 AIDS-related deaths (women, 15+) [<100– <500] [<100– <200] [<100– <500] <500 <500 <500 AIDS-related deaths (men, 15+) [<200– <500] [<500–700] [<500–720] People living with HIV 26 000 26 000 25 000 People living with HIV (all ages) [20 000–31 000] [21 000–31 000] [21 000–30 000] 770 680 610 People living with HIV (0–14) [600–970] [540–850] [<500–740] 8400 9100 9100 People living with HIV (women, 15+) [6600–10 000] [7300–11 000] [7400–11 000] 16 000 16 000 16 000 People living with HIV (men, 15+) [13 000–20 000] [13 000–19 000] [13 000–18 000] HIV prevalence (15–49) 0.7 [0.6–0.9] 0.6 [0.5–0.7] 0.6 [0.5–0.7] LAWS AND POLICIES STIGMA AND DISCRIMINATION Laws criminalizing the transmission of, non- Yes Percentage of women aged 15–49 years who 2014 disclosure of or exposure to HIV transmission report discriminatory attitudes towards people Criminalization of sex work among consenting Any criminalization or punitive living with HIV 33.1 adults regulation of sex work Laws penalizing same-sex sexual Percentage of people living with HIV denied Criminalization of same-sex sexual acts acts have been decriminalized or health services because of their HIV status in never existed the last 12 months Possession of drugs for personal use Drug use or possession for personal use is an or drug use and/or consumption are offence Percentage of people living with HIV who specified as criminal offences reported a health-care professional told others Neither criminalized nor about their HIV status without their consent Criminalization of transgender people prosecuted Laws or policies restricting the entry, stay and residence of people living with HIV No VIOLENCE Parental consent for adolescents to access HIV No Proportion of ever-married or partnered testing women aged 15–49 years who experienced physical or sexual violence from a male Spousal consent for married women to access No intimate partner in the past 12 months sexual and reproductive health services Mandatory HIV testing for marriage, work or No residence permits or for certain groups EXPENDITURES Financing sources International: International: International: Domestic private Domestic public Total PEPFAR Global Fund all others Last available report: 2018 $3 194 118 $36 850 429 $2 206 076 $5 744 405 $1 293 236 $49 288 264 30
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	33	EPIDEMIC TRANSITION METRICS 3 500 1 400 20% 3 000 3 000 1 200 Number of people Number of people Number of people 2 500 1 000 15% 2 000 Percent 2 000 800 10% 1 500 600 1 000 400 1 000 5% 500 200 0 0 0% 0 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 New HIV infections Incidence:prevalence ratio New HIV infections AIDS-related deaths Target Deaths among people living with HIV Change in new Change in AIDS- Incidence: HIV infections = -48% related deaths = 41% prevalence = 3% since 2010 since 2010 ratio KEY POPULATIONS HIV COMORBIDITIES Gay men and other men People who Transgender Estimated number of incident tuberculosis 220 Sex workers Prisoners cases among people living with HIV (2017) [140–310] who have inject drugs people sex with men People living with HIV who started TB Estimated size of population ... ... ... ... ... 95.4% preventive therapy (2017) HIV prevalence 2.2% 12.0% ... 15.3% 0.1% Cervical cancer screening of women living Know their HIV status 89.5% 77.3% ... 74.4% ... with HIV Antiretroviral therapy coverage ... ... ... ... ... People coinfected with HIV and hepatitis B Condom use 91.4% 52.6% ... 75.7% ... virus receiving combined treatment Coverage of HIV prevention ... ... ... ... programmes People coinfected with HIV and hepatitis C ... virus starting hepatitis C treatment Avoidance of health care because of stigma and ... ... ... ... discrimination HIV PREVENTION Expenditures (2017) $877 771 $1 390 322 $0 Adults aged 15+ years with unsuppressed 0.3% HIV TESTING AND TREATMENT CASCADE viral load Knowledge of HIV prevention among young 25 000 100% people aged 15–24 years (2014) ― Women 31.1% Gap to Number of people living with HIV 20 000 reaching the 75% ― Men 33.9% first 90: Gap to 15 000 3900 Gap to Condom use at last sex with a non-marital, reaching the first and reaching all 50% non-cohabiting partner 10 000 second 90: three 90s: 8700 8400 ― Women ... 25% ― Men ... 5 000 Women aged 15–49 years who have their 0 0% demand for family planning satisfied by ... People living with HIV who know People living with HIV on People living with HIV who are modern methods their status treatment virally suppressed Not Men aged 15–49 years who are circumcised All ages 74% [61–87%] 47% [39–55%] 40% [33–46%] applicable 11 900 Voluntary medical male circumcisions Not Children (0–14) 36% [28–44%] 24% [19–30%] 21% [17–26%] performed according to national standards applicable 150 People who received PrEP at least once ... Women (15+) 78% [64–92%] 52% [43–62%] 45% [37–53%] during the reporting period 4800 Harm reduction Men (15+) 74% [60–86%] 44% [36–52%] 37% [31–43%] 6900 ― Use of sterile injecting equipment at ... last injection ― Needles and syringes distributed per ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ... person who injects 2010 2018 ― Coverage of opioid substitution ... Percentage of pregnant women living with HIV 24% 40% therapy accessing antiretroviral medicines [19–29%] [33–46%] ― Naloxone available (2019) No 26.7% 37.1% Early infant diagnosis [22.1–33.5%] [32.3–44.3%] ― Safe injection rooms available (2019) No 31
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	34	GUATEMALA COUNTRY DATA GUATEMALA EPIDEMIC ESTIMATES 2010 2015 2018 New HIV infections 2200 2100 2300 New HIV infections (all ages) [2100–2300] [2000–2200] [2200–2400] <500 <500 <500 New HIV infections (0–14) [<500– <500] [<500– <500] [<200– <500] 860 790 870 New HIV infections (women, 15+) [830–910] [760–830] [830–920] 990 1100 1200 New HIV infections (men, 15+) [890–1100] [960–1100] [1100–1300] HIV incidence per 1000 population 0.15 [0.15–0.16] 0.13 [0.12–0.14] 0.14 [0.13–0.14] AIDS-related deaths 1700 2200 2200 AIDS-related deaths (all ages) [1500–1900] [2000–2400] [2000–2400] <500 <200 <200 AIDS-related deaths (0–14) [<500– <500] [<200– <200] [<200– <200] 680 740 940 AIDS-related deaths (women, 15+) [610–780] [650–850] [860–1000] 750 1300 1100 AIDS-related deaths (men, 15+) [610–890] [1100–1400] [960–1200] People living with HIV 49 000 48 000 47 000 People living with HIV (all ages) [44 000–53 000] [44 000–52 000] [43 000–51 000] 3200 2400 2000 People living with HIV (0–14) [3000–3400] [2200–2600] [1800–2200] 19 000 19 000 19 000 People living with HIV (women, 15+) [17 000–20 000] [18 000–21 000] [18 000–21 000] 27 000 26 000 26 000 People living with HIV (men, 15+) [24 000–30 000] [24 000–29 000] [24 000–28 000] HIV prevalence (15–49) 0.6 [0.5–0.6] 0.4 [0.4–0.5] 0.4 [0.3–0.4] LAWS AND POLICIES STIGMA AND DISCRIMINATION Laws criminalizing the transmission of, non- Yes Percentage of women and men aged 15–49 2015 disclosure of or exposure to HIV transmission years who report discriminatory attitudes Criminalization of sex work among consenting Any criminalization or punitive towards people living with HIV 57.3 adults regulation of sex work Laws penalizing same-sex sexual Percentage of people living with HIV denied Criminalization of same-sex sexual acts acts have been decriminalized or health services because of their HIV status in never existed the last 12 months Possession of drugs for personal use Drug use or possession for personal use is an or drug use and/or consumption are offence Percentage of people living with HIV who specified as criminal offences reported a health-care professional told others Neither criminalized nor about their HIV status without their consent Criminalization of transgender people prosecuted Laws or policies restricting the entry, stay and residence of people living with HIV No VIOLENCE Parental consent for adolescents to access HIV Yes, for adolescents younger than Proportion of ever-married or partnered 2015 testing 18 years women aged 15–49 years who experienced physical or sexual violence from a male Spousal consent for married women to access No intimate partner in the past 12 months 8.5 sexual and reproductive health services Mandatory HIV testing for marriage, work or Yes residence permits or for certain groups EXPENDITURES Financing sources International: International: International: Domestic private Domestic public Total PEPFAR Global Fund all others Last available report: 2018 $9413 $18 101 609 $3 727 389 $1 960 361 $637 253 $24 436 024 32
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	35	EPIDEMIC TRANSITION METRICS 7 000 3 500 15% 6 000 6 000 3 000 Number of people Number of people Number of people 5 000 2 500 10% 4 000 Percent 4 000 2 000 3 000 1 500 2 000 1 000 5% 2 000 1 000 500 0 0 0% 0 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 New HIV infections Incidence:prevalence ratio New HIV infections AIDS-related deaths Target Deaths among people living with HIV Change in new Change in AIDS- Incidence: HIV infections = 6% related deaths = 30% prevalence = 5% since 2010 since 2010 ratio KEY POPULATIONS HIV COMORBIDITIES Gay men and other men People who Transgender Estimated number of incident tuberculosis 330 Sex workers Prisoners cases among people living with HIV (2017) [250–410] who have inject drugs people sex with men People living with HIV who started TB Estimated size of population ... ... ... ... ... 27.8% preventive therapy (2017) HIV prevalence 1.0% 9.0% ... 22.2% 0.7% Women who tested positive for HIV among Know their HIV status 85.9% 77.9% ... 92.2% those screened for cervical cancer 11.1% (programme data) (2018) Antiretroviral therapy coverage 3.9% 28.6% ... 9.2% 30.6% People coinfected with HIV and hepatitis B Condom use 97.4% 69.3% ... 66.2% 48.2% virus receiving combined treatment (2018) Coverage of HIV prevention 29.0% 26.0% ... 16.0% programmes People coinfected with HIV and hepatitis C 28.6% virus starting hepatitis C treatment (2018) Avoidance of health care because of stigma and ... ... ... ... discrimination HIV PREVENTION Expenditures (2016) $401 175 $2 697 379 $0 Adults aged 15+ years with unsuppressed 0.3% HIV TESTING AND TREATMENT CASCADE viral load Knowledge of HIV prevention among young 45 000 100% people aged 15–24 years (2015) 40 000 ― Women 22.2% Number of people living with HIV 35 000 Gap to 75% ― Men 21.9% reaching the 30 000 first 90: Gap to 13 000 reaching the Gap to Condom use at last sex with a non-marital, 25 000 first and reaching all 50% non-cohabiting partner (2015) 20 000 second 90: three 90s: 15 000 17 900 18 200 ― Women 19.9% 10 000 25% ― Men 45.3% 5 000 Women aged 15–49 years who have their 0 0% demand for family planning satisfied by 66.2% People living with HIV who know People living with HIV on People living with HIV who are modern methods (2015) their status treatment virally suppressed Men aged 15–49 years who are circumcised Not All ages 62% [57–68%] 43% [40–47%] 34% [32–37%] (2015) applicable 20 200 Voluntary medical male circumcisions Not Children (0–14) 88% [80–95%] 36% [33–39%] 25% [23–27%] performed according to national standards applicable 730 People who received PrEP at least once 45 Women (15+) 56% [52–61%] 38% [35–42%] 30% [28–33%] during the reporting period (2018) 7300 Harm reduction Men (15+) 65% [59–71%] 47% [43–52%] 38% [35–42%] 12 200 ― Use of sterile injecting equipment at ... last injection ― Needles and syringes distributed per ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ... person who injects 2010 2018 ― Coverage of opioid substitution ... Percentage of pregnant women living with HIV 26% 34% therapy accessing antiretroviral medicines [23–29%] [31–38%] ― Naloxone available (2019) No ...% 23.5% Early infant diagnosis [...–...%] [21.5–25.9%] ― Safe injection rooms available (2019) No 33
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	36	HONDURAS COUNTRY DATA HONDURAS EPIDEMIC ESTIMATES 2010 2015 2018 New HIV infections 740 770 800 New HIV infections (all ages) [500–1000] [<500–1100] [<500–1100] <200 <100 <100 New HIV infections (0–14) [<100– <200] [<100– <200] [<100– <100] <200 <500 <500 New HIV infections (women, 15+) [<200– <500] [<200– <500] [<200– <500] <500 <500 510 New HIV infections (men, 15+) [<500–620] [<500–690] [<500–740] HIV incidence per 1000 population 0.09 [0.06–0.13] 0.09 [0.05–0.13] 0.09 [0.05–0.12] AIDS-related deaths 1400 1000 780 AIDS-related deaths (all ages) [990–1800] [730–1400] [540–1100] <100 <100 <100 AIDS-related deaths (0–14) [<100– <200] [<100– <100] [<100– <100] <500 <500 <500 AIDS-related deaths (women, 15+) [<200– <500] [<200– <500] [<200– <500] 1000 720 510 AIDS-related deaths (men, 15+) [740–1300] [510–970] [<500–720] People living with HIV 26 000 24 000 23 000 People living with HIV (all ages) [21 000–32 000] [19 000–29 000] [18 000–28 000] 1600 1100 890 People living with HIV (0–14) [1300–1900] [930–1300] [710–1100] 8900 8800 8900 People living with HIV (women, 15+) [7300–11 000] [7300–11 000] [7200–11 000] 16 000 14 000 13 000 People living with HIV (men, 15+) [12 000–19 000] [11 000–17 000] [10 000–17 000] HIV prevalence (15–49) 0.5 [0.4–0.6] 0.4 [0.3–0.5] 0.3 [0.3–0.4] LAWS AND POLICIES STIGMA AND DISCRIMINATION Laws criminalizing the transmission of, non- Yes Percentage of women and men aged 15–49 disclosure of or exposure to HIV transmission years who report discriminatory attitudes Criminalization of sex work among consenting Sex work is not subject to punitive towards people living with HIV adults regulations or is not criminalized Laws penalizing same-sex sexual Percentage of people living with HIV denied 2013 Criminalization of same-sex sexual acts acts have been decriminalized or health services because of their HIV status in never existed the last 12 months 4.1 Possession of drugs for personal use Drug use or possession for personal use is an or drug use and/or consumption are 2013 offence Percentage of people living with HIV who specified as criminal offences reported a health-care professional told others Neither criminalized nor about their HIV status without their consent Criminalization of transgender people 9.9 prosecuted Laws or policies restricting the entry, stay and residence of people living with HIV No VIOLENCE Parental consent for adolescents to access HIV Yes, for adolescents younger than Proportion of ever-married or partnered testing 18 years women aged 15–49 years who experienced physical or sexual violence from a male Spousal consent for married women to access No intimate partner in the past 12 months sexual and reproductive health services Mandatory HIV testing for marriage, work or Yes residence permits or for certain groups EXPENDITURES Financing sources International: International: International: Domestic private Domestic public Total PEPFAR Global Fund all others Last available report: 2013 $3 692 374 $15 784 431 $4 855 998 $8 468 368 $3 177 785 $36 713 777 34
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	37	EPIDEMIC TRANSITION METRICS 2 500 5 000 6% 4 000 5% Number of people Number of people 2 000 Number of people 4 000 3 000 4% 1 500 3 000 Percent 3% 2 000 1 000 2 000 2% 500 1 000 1 000 1% 0 0 0% 0 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 New HIV infections Incidence:prevalence ratio New HIV infections AIDS-related deaths Target Deaths among people living with HIV Change in new Change in AIDS- Incidence: HIV infections = 7% related deaths = -43% prevalence = 3% since 2010 since 2010 ratio KEY POPULATIONS HIV COMORBIDITIES Gay men and other men People who Transgender Estimated number of incident tuberculosis 240 Sex workers Prisoners cases among people living with HIV (2017) [160–350] who have inject drugs people sex with men People living with HIV who started TB Estimated size of population ... ... ... ... ... 45.3% preventive therapy (2017) HIV prevalence 2.0% 8.4% ... 8.2% 1.7% Women who tested positive for HIV among Know their HIV status ... ... ... ... those screened for cervical cancer 13.5% (programme data) (2018) Antiretroviral therapy coverage ... ... ... ... ... People coinfected with HIV and hepatitis B Condom use 72.9% 24.7% ... 41.2% 100% virus receiving combined treatment (2018) Coverage of HIV prevention ... 70.6% ... 83.0% programmes People coinfected with HIV and hepatitis C 33.3% virus starting hepatitis C treatment (2018) Avoidance of health care because of stigma and ... ... ... ... discrimination HIV PREVENTION Expenditures (0) ... ... ... Adults aged 15+ years with unsuppressed 0.2% HIV TESTING AND TREATMENT CASCADE viral load Knowledge of HIV prevention among young 25 000 100% people aged 15–24 years ― Women ... Number of people living with HIV 20 000 75% ― Men ... Gap to 15 000 reaching the Gap to Condom use at last sex with a non-marital, first 90: reaching the Gap to 50% non-cohabiting partner 7000 first and reaching all 10 000 second 90: three 90s: ― Women ... 7100 7200 25% ― Men ... 5 000 Women aged 15–49 years who have their 0 0% demand for family planning satisfied by ... People living with HIV who know People living with HIV on People living with HIV who are modern methods their status treatment virally suppressed Not Men aged 15–49 years who are circumcised All ages 60% [47–72%] 50% [40–61%] 42% [33–51%] applicable 11 700 Voluntary medical male circumcisions Not Children (0–14) 52% [42–63%] 41% [33–49%] 37% [30–44%] performed according to national standards applicable 360 People who received PrEP at least once ... Women (15+) 71% [57–84%] 61% [49–72%] 49% [40–58%] during the reporting period 5400 Harm reduction Men (15+) 53% [40–65%] 44% [34–55%] 38% [29–47%] 5900 ― Use of sterile injecting equipment at ... last injection ― Needles and syringes distributed per ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ... person who injects 2010 2018 ― Coverage of opioid substitution ... Percentage of pregnant women living with HIV 49% 59% therapy accessing antiretroviral medicines [40–59%] [48–72%] ― Naloxone available (2019) No 65.1% 44.5% Early infant diagnosis [54.6–79.4%] [36.4–53.9%] ― Safe injection rooms available (2019) No 35
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	38	MEXICO COUNTRY DATA MEXICO EPIDEMIC ESTIMATES 2010 2015 2018 New HIV infections 11 000 11 000 11 000 New HIV infections (all ages) [8800–13 000] [8400–14 000] [7600–14 000] <500 <200 <200 New HIV infections (0–14) [<500– <500] [<200– <500] [<200– <500] 1500 1400 1400 New HIV infections (women, 15+) [1100–1800] [1100–1800] [970–1900] 9200 9600 9300 New HIV infections (men, 15+) [7300–11 000] [7200–12 000] [6500–12 000] HIV incidence per 1000 population 0.09 [0.08–0.11] 0.09 [0.07–0.11] 0.08 [0.06–0.11] AIDS-related deaths ... ... ... AIDS-related deaths (all ages) [...–...] [...–...] [...–...] ... ... ... AIDS-related deaths (0–14) [...–...] [...–...] [...–...] ... ... ... AIDS-related deaths (women, 15+) [...–...] [...–...] [...–...] ... ... ... AIDS-related deaths (men, 15+) [...–...] [...–...] [...–...] People living with HIV 180 000 210 000 230 000 People living with HIV (all ages) [150 000–210 000] [180 000–240 000] [200 000–270 000] 2600 2500 2300 People living with HIV (0–14) [2200–3100] [2100–3000] [1900–2600] 28 000 33 000 37 000 People living with HIV (women, 15+) [24 000–33 000] [29 000–38 000] [32 000–42 000] 150 000 180 000 190 000 People living with HIV (men, 15+) [130 000–170 000] [150 000–200 000] [170 000–220 000] HIV prevalence (15–49) 0.2 [0.2–0.3] 0.2 [0.2–0.3] 0.2 [0.2–0.3] LAWS AND POLICIES STIGMA AND DISCRIMINATION Laws criminalizing the transmission of, non- No, but prosecutions exist based Percentage of women aged 15–49 years who 2015 disclosure of or exposure to HIV transmission on general criminal laws report discriminatory attitudes towards people Criminalization of sex work among consenting Issue is determined/differs at living with HIV 15.4 adults subnational level Percentage of people living with HIV denied Criminalization of same-sex sexual acts No specific legislation health services because of their HIV status in the last 12 months Drug use or possession for personal use is an The law allows possession of a offence certain amount of drugs Percentage of people living with HIV who reported a health-care professional told others Neither criminalized nor about their HIV status without their consent Criminalization of transgender people prosecuted Laws or policies restricting the entry, stay and residence of people living with HIV No VIOLENCE Parental consent for adolescents to access HIV Yes, for adolescents younger than Proportion of ever-married or partnered 2011 2016 testing 18 years women aged 15–49 years who experienced physical or sexual violence from a male Spousal consent for married women to access No intimate partner in the past 12 months 6.5 8.1 sexual and reproductive health services Mandatory HIV testing for marriage, work or No residence permits or for certain groups EXPENDITURES Financing sources International: International: International: Domestic private Domestic public Total PEPFAR Global Fund all others Last available report: 2015 $67 939 646 $867 060 986 ... ... $1 190 948 $936 191 579 36
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	39	EPIDEMIC TRANSITION METRICS 20 000 1 20% 12 500 Number of people Number of people Number of people 15 000 1 15% 12 000 1 Percent 11 500 10 000 10% 0 11 000 5 000 0 5% 10 500 0 0 0% 10 000 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 New HIV infections Incidence:prevalence ratio New HIV infections AIDS-related deaths Target Deaths among people living with HIV Change in new Change in AIDS- Incidence: HIV infections = 0% related deaths = prevalence = 5% since 2010 since 2010 ratio KEY POPULATIONS HIV COMORBIDITIES Gay men and 3500 other men Estimated number of incident tuberculosis People who Transgender [2700 Sex workers Prisoners cases among people living with HIV (2017) who have sex inject drugs people –4500] with men People living with HIV who started TB Estimated size of population 240 000 1 200 000 ... 120 000 200 000 2.3% preventive therapy (2017) HIV prevalence 1.0% 12.6% 4.3% 8.7% 0.7% Cervical cancer screening of women living Know their HIV status 65.8% 39.8% ... 62.3% ... with HIV Antiretroviral therapy coverage ... ... ... ... ... People coinfected with HIV and hepatitis B Condom use 84.4% 65.3% ... 74.9% ... virus receiving combined treatment Coverage of HIV prevention ... ... ... ... programmes People coinfected with HIV and hepatitis C ... virus starting hepatitis C treatment Avoidance of health care because of stigma and ... ... ... ... discrimination HIV PREVENTION Expenditures (2015) $2 896 831 $12 296 685 $1 744 656 Adults aged 15+ years with unsuppressed ... HIV TESTING AND TREATMENT CASCADE viral load Knowledge of HIV prevention among young 250 000 100% people aged 15–24 years (2015) ― Women 31.3% Number of people living with HIV 200 000 Gap to 75% ― Men ... reaching the Gap to 150 000 first 90: reaching the Gap to first and Condom use at last sex with a non-marital, 32 900 reaching all second 90: three 90s: 50% non-cohabiting partner 100 000 24 900 24 400 ― Women ... 25% ― Men ... 50 000 Women aged 15–49 years who have their 0 0% demand for family planning satisfied by ... People living with HIV who know People living with HIV on People living with HIV who are modern methods their status treatment virally suppressed Not Men aged 15–49 years who are circumcised All ages 76% [65–86%] 70% [60–80%] 63% [53–71%] applicable 165 000 Voluntary medical male circumcisions Not Children (0–14) ...% [...–...%] ...% [...–...%] ...% [...–...%] performed according to national standards applicable ... People who received PrEP at least once ... Women (15+) ...% [...–...%] ...% [...–...%] ...% [...–...%] during the reporting period ... Harm reduction Men (15+) ...% [...–...%] ...% [...–...%] ...% [...–...%] ... ― Use of sterile injecting equipment at ... last injection ― Needles and syringes distributed per ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION 6 person who injects (2018) 2010 2018 ― Coverage of opioid substitution 9.3% Percentage of pregnant women living with HIV ...% ...% therapy (2018) accessing antiretroviral medicines [...–...%] [...–...%] ― Naloxone available (2019) No ...% ...% Early infant diagnosis [...–...%] [...–...%] ― Safe injection rooms available (2019) No 37
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	40	NICARAGUA COUNTRY DATA NICARAGUA EPIDEMIC ESTIMATES 2010 2015 2018 New HIV infections 580 <500 <500 New HIV infections (all ages) [<500–800] [<500–680] [<500–620] <100 <100 <100 New HIV infections (0–14) [<100– <100] [<100– <100] [<100– <100] <200 <200 <200 New HIV infections (women, 15+) [<200– <500] [<100– <200] [<100– <200] <500 <500 <500 New HIV infections (men, 15+) [<500– <500] [<500– <500] [<200– <500] HIV incidence per 1000 population 0.1 [0.08–0.14] 0.08 [0.05–0.11] 0.07 [0.04–0.1] AIDS-related deaths <500 <500 <200 AIDS-related deaths (all ages) [<200– <500] [<200– <500] [<200– <500] <100 <100 <100 AIDS-related deaths (0–14) [<100– <100] [<100– <100] [<100– <100] <100 <100 <100 AIDS-related deaths (women, 15+) [<100– <200] [<100– <100] [<100– <100] <200 <200 <200 AIDS-related deaths (men, 15+) [<100– <500] [<100– <500] [<100– <200] People living with HIV 7900 8900 9400 People living with HIV (all ages) [6500–10 000] [7200–12 000] [7600–12 000] <500 <500 <500 People living with HIV (0–14) [<200– <500] [<200– <500] [<200– <500] 2500 2900 3000 People living with HIV (women, 15+) [2000–3200] [2300–3800] [2500–3900] 5200 5800 6100 People living with HIV (men, 15+) [4100–6600] [4600–7400] [5000–7900] HIV prevalence (15–49) 0.2 [0.2–0.3] 0.2 [0.2–0.3] 0.2 [0.2–0.3] LAWS AND POLICIES STIGMA AND DISCRIMINATION Laws criminalizing the transmission of, non- Yes Percentage of women and men aged 15–49 disclosure of or exposure to HIV transmission years who report discriminatory attitudes Criminalization of sex work among consenting Sex work is not subject to punitive towards people living with HIV adults regulations or is not criminalized Percentage of people living with HIV denied 2013 Criminalization of same-sex sexual acts No specific legislation health services because of their HIV status in the last 12 months 4 Possession of drugs for personal use Drug use or possession for personal use is an or drug use and/or consumption are 2013 offence Percentage of people living with HIV who specified as non-criminal offences reported a health-care professional told others Neither criminalized nor about their HIV status without their consent Criminalization of transgender people 8.1 prosecuted Laws or policies restricting the entry, stay and residence of people living with HIV No VIOLENCE Parental consent for adolescents to access HIV No Proportion of ever-married or partnered testing women aged 15–49 years who experienced physical or sexual violence from a male Spousal consent for married women to access No intimate partner in the past 12 months sexual and reproductive health services Mandatory HIV testing for marriage, work or No residence permits or for certain groups EXPENDITURES Financing sources International: International: International: Domestic private Domestic public Total PEPFAR Global Fund all others Last available report: 2010 $1 150 592 $9 682 304 ... $9 155 592 $2 793 096 $24 894 867 38
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	41	EPIDEMIC TRANSITION METRICS 1 500 500 50% 1 000 Number of people Number of people Number of people 400 40% 800 1 000 300 30% Percent 600 200 20% 400 500 100 10% 200 0 0 0% 0 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 New HIV infections Incidence:prevalence ratio New HIV infections AIDS-related deaths Target Deaths among people living with HIV Change in new Change in AIDS- Incidence: HIV infections = -29% related deaths = -31% prevalence = 4% since 2010 since 2010 ratio KEY POPULATIONS HIV COMORBIDITIES Gay men and other men People who Transgender Estimated number of incident tuberculosis 140 Sex workers Prisoners cases among people living with HIV (2017) [88–200] who have inject drugs people sex with men People living with HIV who started TB Estimated size of population ... ... ... ... ... 21.3% preventive therapy (2017) HIV prevalence 2.6% 8.6% ... 8.1% 0.3% Cervical cancer screening of women living Know their HIV status 83.0% 95.8% ... 93.5% ... with HIV Antiretroviral therapy coverage ... ... ... ... ... People coinfected with HIV and hepatitis B Condom use 92.1% 55.1% ... 60.4% 100% virus receiving combined treatment (2018) Coverage of HIV prevention 88.4% 70.8% ... 87.4% programmes People coinfected with HIV and hepatitis C 100% virus starting hepatitis C treatment (2018) Avoidance of health care because of stigma and ... ... ... ... discrimination HIV PREVENTION Expenditures (0) ... ... ... Adults aged 15+ years with unsuppressed 0.1% HIV TESTING AND TREATMENT CASCADE viral load Knowledge of HIV prevention among young 8 000 100% people aged 15–24 years 7 000 ― Women ... Number of people living with HIV Gap to 6 000 75% ― Men ... reaching the first and Gap to 5 000 second 90: reaching all Condom use at last sex with a non-marital, 4 000 2600 three 90s: 50% non-cohabiting partner 3100 3 000 ― Women ... 2 000 25% ― Men ... 1 000 Women aged 15–49 years who have their 0 0% demand for family planning satisfied by ... People living with HIV who know People living with HIV on People living with HIV who are modern methods their status treatment virally suppressed Not Men aged 15–49 years who are circumcised All ages ...% [...–...%] 53% [43–68%] 40% [32–51%] applicable 5000 Voluntary medical male circumcisions Not Children (0–14) ...% [...–...%] 55% [41–76%] 31% [24–43%] performed according to national standards applicable 120 People who received PrEP at least once ... Women (15+) ...% [...–...%] 54% [44–68%] 39% [32–50%] during the reporting period 1600 Harm reduction Men (15+) ...% [...–...%] 53% [43–68%] 40% [32–51%] 3200 ― Use of sterile injecting equipment at ... last injection ― Needles and syringes distributed per ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ... person who injects 2010 2018 ― Coverage of opioid substitution ... Percentage of pregnant women living with HIV 60% 90% therapy accessing antiretroviral medicines [48–80%] [73– >95%] ― Naloxone available (2019) No 38.7% 77.2% Early infant diagnosis [29.1–48.7%] [60.3– >95%] ― Safe injection rooms available (2019) No 39
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	42	PANAMA COUNTRY DATA PANAMA EPIDEMIC ESTIMATES 2010 2015 2018 New HIV infections 1400 1400 1300 New HIV infections (all ages) [1300–1500] [1300–1600] [1100–1400] <100 <100 <100 New HIV infections (0–14) [<100– <100] [<100– <100] [<100– <100] <500 <500 <500 New HIV infections (women, 15+) [<500– <500] [<500– <500] [<500– <500] 980 980 900 New HIV infections (men, 15+) [840–1100] [830–1100] [750–1000] HIV incidence per 1000 population 0.4 [0.36–0.44] 0.37 [0.32–0.4] 0.32 [0.28–0.36] AIDS-related deaths <500 550 <500 AIDS-related deaths (all ages) [<500–570] [<500–650] [<500–530] <100 <100 <100 AIDS-related deaths (0–14) [<100– <100] [<100– <100] [<100– <100] <200 <200 <200 AIDS-related deaths (women, 15+) [<200– <200] [<200– <500] [<200– <200] <500 <500 <500 AIDS-related deaths (men, 15+) [<500– <500] [<500– <500] [<500– <500] People living with HIV 20 000 24 000 26 000 People living with HIV (all ages) [18 000–22 000] [22 000–26 000] [24 000–29 000] <500 <500 <500 People living with HIV (0–14) [<500– <500] [<500– <500] [<500– <500] 5900 7200 8000 People living with HIV (women, 15+) [5300–6400] [6500–7900] [7200–8700] 14 000 17 000 18 000 People living with HIV (men, 15+) [12 000–15 000] [15 000–19 000] [16 000–20 000] HIV prevalence (15–49) 0.8 [0.8–0.9] 0.9 [0.8–1] 0.9 [0.8–1] LAWS AND POLICIES STIGMA AND DISCRIMINATION Laws criminalizing the transmission of, non- Yes Percentage of women aged 15–49 years who 2013 disclosure of or exposure to HIV transmission report discriminatory attitudes towards people Criminalization of sex work among consenting Sex work is not subject to punitive living with HIV 36.5 adults regulations or is not criminalized Percentage of people living with HIV denied Criminalization of same-sex sexual acts No specific legislation health services because of their HIV status in the last 12 months Drug use or possession for personal use is an The law allows possession of a offence certain amount of drugs Percentage of people living with HIV who reported a health-care professional told others Neither criminalized nor about their HIV status without their consent Criminalization of transgender people prosecuted Laws or policies restricting the entry, stay and residence of people living with HIV No VIOLENCE Parental consent for adolescents to access HIV Yes, for adolescents younger than Proportion of ever-married or partnered testing 16 years women aged 15–49 years who experienced physical or sexual violence from a male Spousal consent for married women to access No intimate partner in the past 12 months sexual and reproductive health services Mandatory HIV testing for marriage, work or Yes residence permits or for certain groups EXPENDITURES Financing sources International: International: International: Domestic private Domestic public Total PEPFAR Global Fund all others Last available report: 2012 $25 136 198 $19 286 886 $2 020 143 $919 786 $472 003 $47 835 016 40
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	43	EPIDEMIC TRANSITION METRICS 2 000 800 15% 2 000 Number of people Number of people Number of people 1 500 600 1 500 10% Percent 1 000 400 1 000 5% 500 200 500 0 0 0% 0 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 New HIV infections Incidence:prevalence ratio New HIV infections AIDS-related deaths Target Deaths among people living with HIV Change in new Change in AIDS- Incidence: HIV infections = -8% related deaths = -9% prevalence = 5% since 2010 since 2010 ratio KEY POPULATIONS HIV COMORBIDITIES Gay men and other men People who Transgender Estimated number of incident tuberculosis 400 Sex workers Prisoners cases among people living with HIV (2017) [310–510] who have inject drugs people sex with men People living with HIV who started TB Estimated size of population ... ... ... ... ... 11.2% preventive therapy (2017) HIV prevalence 0.6% 6.7% ... 29.6% 1.1% Cervical cancer screening of women living Know their HIV status 96.9% 99.2% ... 95.9% ... with HIV Antiretroviral therapy coverage ... 93.7% ... ... 92.4% People coinfected with HIV and hepatitis B Condom use 97.0% 80.6% ... 80.0% ... virus receiving combined treatment Coverage of HIV prevention 99.0% 97.9% ... 97.0% programmes People coinfected with HIV and hepatitis C ... virus starting hepatitis C treatment Avoidance of health care because of stigma and ... ... ... ... discrimination HIV PREVENTION Expenditures (0) ... ... ... Adults aged 15+ years with unsuppressed 0.5% HIV TESTING AND TREATMENT CASCADE viral load Knowledge of HIV prevention among young 25 000 100% people aged 15–24 years Gap to ― Women ... Number of people living with HIV 20 000 reaching the 75% ― Men ... first 90: Gap to 15 000 5200 reaching the first and Gap to Condom use at last sex with a non-marital, reaching all 50% non-cohabiting partner second 90: three 90s: 10 000 7300 8600 ― Women ... 25% ― Men ... 5 000 Women aged 15–49 years who have their 0 0% demand for family planning satisfied by ... People living with HIV who know People living with HIV on People living with HIV who are modern methods their status treatment virally suppressed Not Men aged 15–49 years who are circumcised All ages 70% [64–77%] 54% [48–59%] 41% [37–45%] applicable 14 200 Voluntary medical male circumcisions Not Children (0–14) 81% [73–90%] 76% [69–84%] 58% [52–64%] performed according to national standards applicable 200 People who received PrEP at least once ... Women (15+) 56% [50–61%] 45% [41–49%] 37% [34–41%] during the reporting period 3600 Harm reduction Men (15+) 77% [68–86%] 57% [50–64%] 42% [37–47%] 10 400 ― Use of sterile injecting equipment at ... last injection ― Needles and syringes distributed per ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ... person who injects 2010 2018 ― Coverage of opioid substitution ... Percentage of pregnant women living with HIV 80% 92% therapy accessing antiretroviral medicines [71–91%] [83– >95%] ― Naloxone available (2019) No 48.4% 90.1% Early infant diagnosis [42.9–55.0%] [82.4– >95%] ― Safe injection rooms available (2019) No 41
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	44	PARAGUAY COUNTRY DATA PARAGUAY EPIDEMIC ESTIMATES 2010 2015 2018 New HIV infections 1200 1200 1100 New HIV infections (all ages) [850–1900] [810–1900] [690–1700] <100 <100 <100 New HIV infections (0–14) [<100– <200] [<100– <200] [<100– <100] <500 <500 <500 New HIV infections (women, 15+) [<500–530] [<500–510] [<200– <500] 820 830 750 New HIV infections (men, 15+) [580–1400] [560–1300] [<500–1200] HIV incidence per 1000 population 0.2 [0.14–0.31] 0.18 [0.12–0.29] 0.16 [0.1–0.25] AIDS-related deaths 790 810 720 AIDS-related deaths (all ages) [540–1200] [530–1300] [<500–1200] <100 <100 <100 AIDS-related deaths (0–14) [<100– <100] [<100– <100] [<100– <100] <200 <200 <200 AIDS-related deaths (women, 15+) [<200– <500] [<200– <500] [<200– <500] 550 590 <500 AIDS-related deaths (men, 15+) [<500–810] [<500–980] [<500–850] People living with HIV 20 000 21 000 21 000 People living with HIV (all ages) [14 000–27 000] [16 000–30 000] [16 000–31 000] <500 <500 <500 People living with HIV (0–14) [<500–660] [<500–680] [<500–640] 5700 6200 6400 People living with HIV (women, 15+) [4300–8000] [4700–8800] [4900–9000] 14 000 14 000 14 000 People living with HIV (men, 15+) [10 000–19 000] [11 000–20 000] [11 000–21 000] HIV prevalence (15–49) 0.5 [0.4–0.8] 0.5 [0.4–0.7] 0.5 [0.3–0.7] LAWS AND POLICIES STIGMA AND DISCRIMINATION Laws criminalizing the transmission of, non- No, but prosecutions exist based Percentage of women aged 15–49 years who 2016 disclosure of or exposure to HIV transmission on general criminal laws report discriminatory attitudes towards people Criminalization of sex work among consenting Sex work is not subject to punitive living with HIV 35 adults regulations or is not criminalized Laws penalizing same-sex sexual Percentage of people living with HIV denied 2016 Criminalization of same-sex sexual acts acts have been decriminalized or health services because of their HIV status in never existed the last 12 months 16.5 Possession of drugs for personal use Drug use or possession for personal use is an or drug use and/or consumption are 2016 offence Percentage of people living with HIV who specified as criminal offences reported a health-care professional told others Neither criminalized nor about their HIV status without their consent Criminalization of transgender people 19.8 prosecuted Laws or policies restricting the entry, stay and residence of people living with HIV Yes VIOLENCE Parental consent for adolescents to access HIV No Proportion of ever-married or partnered testing women aged 15–49 years who experienced physical or sexual violence from a male Spousal consent for married women to access No intimate partner in the past 12 months sexual and reproductive health services Mandatory HIV testing for marriage, work or Yes residence permits or for certain groups EXPENDITURES Financing sources International: International: International: Domestic private Domestic public Total PEPFAR Global Fund all others Last available report: 2013 $1 133 010 $10 841 743 ... $2 932 872 $22 020 $14 941 352 42
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	45	EPIDEMIC TRANSITION METRICS 5 000 2 000 30% 2 500 25% Number of people Number of people 4 000 Number of people 1 500 2 000 20% 3 000 Percent 1 500 1 000 15% 2 000 1 000 10% 1 000 500 5% 500 0 0 0% 0 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 New HIV infections Incidence:prevalence ratio New HIV infections AIDS-related deaths Target Deaths among people living with HIV Change in new Change in AIDS- Incidence: HIV infections = -11% related deaths = -10% prevalence = 5% since 2010 since 2010 ratio KEY POPULATIONS HIV COMORBIDITIES Gay men and other men People who Transgender Estimated number of incident tuberculosis 260 Sex workers Prisoners cases among people living with HIV (2017) [220–300] who have inject drugs people sex with men People living with HIV who started TB Estimated size of population ... ... ... ... ... 9.8% preventive therapy (2017) HIV prevalence 1.3% 20.7% ... 23.0% ... Cervical cancer screening of women living Know their HIV status 78.8% 80.3% ... 86.9% ... with HIV Antiretroviral therapy coverage ... 26.1% ... ... ... People coinfected with HIV and hepatitis B Condom use 96.0% 66.8% ... 54.3% 96.5% virus receiving combined treatment (2017) Coverage of HIV prevention ... ... ... ... programmes People coinfected with HIV and hepatitis C ... virus starting hepatitis C treatment Avoidance of health care because of stigma and 5.0% 16.6% ... 6.3% discrimination HIV PREVENTION Expenditures (0) ... ... ... Adults aged 15+ years with unsuppressed 0.3% HIV TESTING AND TREATMENT CASCADE viral load Knowledge of HIV prevention among young 25 000 100% people aged 15–24 years (2016) ― Women 27.5% Number of people living with HIV 20 000 75% ― Men ... Gap to 15 000 reaching the Condom use at last sex with a non-marital, first 90: Gap to 50% non-cohabiting partner 4100 reaching the Gap to 10 000 first and reaching all ― Women ... second 90: three 90s: 25% ― Men ... 5 000 8600 8700 Women aged 15–49 years who have their 0 0% demand for family planning satisfied by ... People living with HIV who know People living with HIV on People living with HIV who are modern methods their status treatment virally suppressed Not Men aged 15–49 years who are circumcised All ages 71% [54– >95%] 40% [31–58%] 32% [25–46%] applicable 8500 Voluntary medical male circumcisions Not Children (0–14) 75% [50– >95%] 43% [28–68%] 26% [17–41%] performed according to national standards applicable 170 People who received PrEP at least once ... Women (15+) 84% [64– >95%] 43% [33–61%] 34% [26–48%] during the reporting period 2800 Harm reduction Men (15+) 65% [49–94%] 39% [29–57%] 31% [24–45%] 5600 ― Use of sterile injecting equipment at ... last injection ― Needles and syringes distributed per ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ... person who injects 2010 2018 ― Coverage of opioid substitution ... Percentage of pregnant women living with HIV 43% 88% therapy accessing antiretroviral medicines [28–67%] [60– >95%] ― Naloxone available (2019) No 24.9% 59.8% Early infant diagnosis [15.8–38.5%] [39.9–87.5%] ― Safe injection rooms available (2019) No 43
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	46	PERU COUNTRY DATA PERU EPIDEMIC ESTIMATES 2010 2015 2018 New HIV infections 3500 3500 3300 New HIV infections (all ages) [2200–5900] [2100–5800] [1900–5800] <200 <200 <200 New HIV infections (0–14) [<200– <500] [<100– <500] [<100– <500] 690 710 700 New HIV infections (women, 15+) [<500–1100] [<500–1200] [<500–1200] 2600 2600 2500 New HIV infections (men, 15+) [1600–4400] [1600–4400] [1500–4400] HIV incidence per 1000 population 0.12 [0.08–0.2] 0.11 [0.07–0.19] 0.1 [0.06–0.18] AIDS-related deaths 2100 1300 1000 AIDS-related deaths (all ages) [1400–3300] [790–2400] [650–1900] <200 <100 <100 AIDS-related deaths (0–14) [<100– <500] [<100– <200] [<100– <200] <500 <200 <200 AIDS-related deaths (women, 15+) [<200– <500] [<100– <500] [<200– <500] 1700 1100 790 AIDS-related deaths (men, 15+) [1100–2600] [630–2100] [<500–1500] People living with HIV 65 000 74 000 79 000 People living with HIV (all ages) [49 000–91 000] [56 000–100 000] [58 000–110 000] 1900 1600 1600 People living with HIV (0–14) [1500–2600] [1200–2300] [1100–2300] 14 000 17 000 18 000 People living with HIV (women, 15+) [11 000–19 000] [13 000–23 000] [13 000–25 000] 49 000 56 000 59 000 People living with HIV (men, 15+) [37 000–69 000] [42 000–78 000] [43 000–84 000] HIV prevalence (15–49) 0.3 [0.3–0.5] 0.3 [0.2–0.4] 0.3 [0.2–0.4] LAWS AND POLICIES STIGMA AND DISCRIMINATION Laws criminalizing the transmission of, non- No, but prosecutions exist based Percentage of women and men aged 15–49 disclosure of or exposure to HIV transmission on general criminal laws years who report discriminatory attitudes Criminalization of sex work among consenting towards people living with HIV ... adults Laws penalizing same-sex sexual Percentage of people living with HIV denied Criminalization of same-sex sexual acts acts have been decriminalized or health services because of their HIV status in never existed the last 12 months Drug use or possession for personal use is an ... offence Percentage of people living with HIV who reported a health-care professional told others about their HIV status without their consent Criminalization of transgender people ... Laws or policies restricting the entry, stay and residence of people living with HIV No VIOLENCE Parental consent for adolescents to access HIV Yes, for adolescents younger than Proportion of ever-married or partnered 2010 2016 testing 18 years women aged 15–49 years who experienced physical or sexual violence from a male Spousal consent for married women to access No intimate partner in the past 12 months 13.9 10.8 sexual and reproductive health services Mandatory HIV testing for marriage, work or Yes residence permits or for certain groups EXPENDITURES Financing sources International: International: International: Domestic private Domestic public Total PEPFAR Global Fund all others Last available report: 2014 ... $78 148 248 ... ... ... $78 148 248 44
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	47	EPIDEMIC TRANSITION METRICS 8 000 8 000 12% 6 000 10% Number of people Number of people Number of people 6 000 6 000 8% 4 000 Percent 4 000 4 000 6% 4% 2 000 2 000 2 000 2% 0 0 0% 0 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 New HIV infections Incidence:prevalence ratio New HIV infections AIDS-related deaths Target Deaths among people living with HIV Change in new Change in AIDS- Incidence: HIV infections = -6% related deaths = -50% prevalence = 4% since 2010 since 2010 ratio KEY POPULATIONS HIV COMORBIDITIES Gay men and 1800 other men People who Transgender Estimated number of incident tuberculosis Sex workers Prisoners [1400 who have inject drugs people cases among people living with HIV (2017) –2300] sex with men People living with HIV who started TB Estimated size of population ... ... ... ... ... 16.1% preventive therapy (2017) HIV prevalence 0.7% 3.0% ... 2.3% 0.5% Cervical cancer screening of women living Know their HIV status 29.4% ... ... ... ... with HIV Antiretroviral therapy coverage ... ... ... ... 81.1% People coinfected with HIV and hepatitis B Condom use 90.5% ... ... ... 100% virus receiving combined treatment (2018) Coverage of HIV prevention ... ... ... ... programmes People coinfected with HIV and hepatitis C ... virus starting hepatitis C treatment Avoidance of health care because of stigma and ... ... ... ... discrimination HIV PREVENTION Expenditures (0) ... ... ... Adults aged 15+ years with unsuppressed ... HIV TESTING AND TREATMENT CASCADE viral load Knowledge of HIV prevention among young 70 000 100% people aged 15–24 years (2016) 60 000 Gap to ― Women 75.3% Number of people living with HIV reaching the 75% ― Men 0% 50 000 first and second 90: 40 000 6000 Condom use at last sex with a non-marital, 50% non-cohabiting partner 30 000 ― Women ... 20 000 25% ― Men ... 10 000 Women aged 15–49 years who have their 0 0% demand for family planning satisfied by 39% People living with HIV who know People living with HIV on People living with HIV who are modern methods (2017) their status treatment virally suppressed Not Men aged 15–49 years who are circumcised All ages ...% [...–...%] 73% [54– >95%] ...% [...–...%] applicable 57 800 Voluntary medical male circumcisions Not Children (0–14) ...% [...–...%] 48% [34–70%] ...% [...–...%] performed according to national standards applicable 740 People who received PrEP at least once 544 Women (15+) ...% [...–...%] 78% [58– >95%] ...% [...–...%] during the reporting period (2018) 14 100 Harm reduction Men (15+) ...% [...–...%] 73% [53– >95%] ...% [...–...%] 43 000 ― Use of sterile injecting equipment at ... last injection ― Needles and syringes distributed per ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ... person who injects 2010 2018 ― Coverage of opioid substitution ... Percentage of pregnant women living with HIV 41% 85% therapy accessing antiretroviral medicines [33–56%] [67– >95%] ― Naloxone available (2019) ... ...% 82.2% Early infant diagnosis [...–...%] [62.1– >95%] ― Safe injection rooms available (2019) ... 45
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	48	URUGUAY COUNTRY DATA URUGUAY EPIDEMIC ESTIMATES 2010 2015 2018 New HIV infections 810 810 890 New HIV infections (all ages) [510–1100] [<500–1300] [<500–1600] <100 <100 <100 New HIV infections (0–14) [<100– <100] [<100– <100] [<100– <100] <500 <500 <500 New HIV infections (women, 15+) [<200– <500] [<200– <500] [<100– <500] 570 590 670 New HIV infections (men, 15+) [<500–810] [<500–970] [<500–1200] HIV incidence per 1000 population 0.24 [0.15–0.34] 0.24 [0.12–0.39] 0.26 [0.11–0.47] AIDS-related deaths <500 <200 <200 AIDS-related deaths (all ages) [<200– <500] [<100– <500] [<100– <500] <100 <100 <100 AIDS-related deaths (0–14) [<100– <100] [<100– <100] [<100– <100] <100 <100 <100 AIDS-related deaths (women, 15+) [<100– <100] [<100– <100] [<100– <100] <500 <200 <200 AIDS-related deaths (men, 15+) [<200– <500] [<100– <200] [<100– <500] People living with HIV 9600 12 000 14 000 People living with HIV (all ages) [8000–11 000] [9300–15 000] [9900–19 000] <200 <200 <200 People living with HIV (0–14) [<200– <200] [<200– <200] [<100– <200] 2800 3600 4000 People living with HIV (women, 15+) [2400–3200] [2800–4500] [3000–5300] 6700 8600 9900 People living with HIV (men, 15+) [5300–8000] [6300–11 000] [6700–13 000] HIV prevalence (15–49) 0.5 [0.4–0.5] 0.5 [0.4–0.7] 0.6 [0.4–0.8] LAWS AND POLICIES STIGMA AND DISCRIMINATION Laws criminalizing the transmission of, non- No Percentage of women aged 15–49 years who 2013 disclosure of or exposure to HIV transmission report discriminatory attitudes towards people Criminalization of sex work among consenting Sex work is not subject to punitive living with HIV 12.7 adults regulations or is not criminalized Laws penalizing same-sex sexual Percentage of people living with HIV denied Criminalization of same-sex sexual acts acts have been decriminalized or health services because of their HIV status in never existed the last 12 months Drug use or possession for personal use is an No Percentage of people living with HIV who offence reported a health-care professional told others Neither criminalized nor about their HIV status without their consent Criminalization of transgender people prosecuted Laws or policies restricting the entry, stay and residence of people living with HIV No VIOLENCE Parental consent for adolescents to access HIV No Proportion of ever-married or partnered testing women aged 15–49 years who experienced physical or sexual violence from a male Spousal consent for married women to access No intimate partner in the past 12 months sexual and reproductive health services Mandatory HIV testing for marriage, work or Yes residence permits or for certain groups EXPENDITURES Financing sources International: International: International: Domestic private Domestic public Total PEPFAR Global Fund all others Last available report: 2007 $6 543 398 $6 851 169 ... ... $291 464 $14 077 809 46
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	49	EPIDEMIC TRANSITION METRICS 2 000 600 20% 1 000 Number of people 500 Number of people Number of people 1 500 15% 800 400 Percent 600 1 000 300 10% 200 400 500 5% 100 200 0 0 0% 0 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 New HIV infections Incidence:prevalence ratio New HIV infections AIDS-related deaths Target Deaths among people living with HIV Change in new Change in AIDS- Incidence: HIV infections = 9% related deaths = -35% prevalence = 6% since 2010 since 2010 ratio KEY POPULATIONS HIV COMORBIDITIES Gay men and other men People who Transgender Estimated number of incident tuberculosis 170 Sex workers Prisoners cases among people living with HIV (2017) [140–190] who have inject drugs people sex with men People living with HIV who started TB Estimated size of population 6900 25 000 ... 1600 ... ... preventive therapy (2017) HIV prevalence 1.0% 8.5% ... ... 1.3% Cervical cancer screening of women living Know their HIV status ... ... ... ... ... with HIV Antiretroviral therapy coverage ... ... ... ... ... People coinfected with HIV and hepatitis B Condom use ... ... ... ... 100% virus receiving combined treatment (2018) Coverage of HIV prevention ... ... ... ... programmes People coinfected with HIV and hepatitis C 9.6% virus starting hepatitis C treatment (2018) Avoidance of health care because of stigma and ... ... ... ... discrimination HIV PREVENTION Expenditures (0) ... ... ... Adults aged 15+ years with unsuppressed 0.3% HIV TESTING AND TREATMENT CASCADE viral load Knowledge of HIV prevention among young 14 000 100% people aged 15–24 years 12 000 Gap to ― Women ... Number of people living with HIV reaching the 75% 10 000 ― Men ... first 90: Gap to 1100 reaching the Gap to 8 000 Condom use at last sex with a non-marital, first and reaching all second 90: 50% non-cohabiting partner three 90s: 6 000 3300 3300 ― Women ... 4 000 25% ― Men ... 2 000 Women aged 15–49 years who have their 0 0% demand for family planning satisfied by ... People living with HIV who know People living with HIV on People living with HIV who are modern methods their status treatment virally suppressed Not Men aged 15–49 years who are circumcised All ages 82% [58– >95%] 58% [41–76%] 50% [35–65%] applicable 8100 Voluntary medical male circumcisions Not Children (0–14) 64% [47–90%] 64% [47–90%] 64% [47–90%] performed according to national standards applicable 80 People who received PrEP at least once 54 Women (15+) >95% [73– >95%] 73% [54– >95%] 72% [53– >95%] during the reporting period (2018) 2900 Harm reduction Men (15+) 75% [51– >95%] 51% [35–69%] 40% [27–55%] 5100 ― Use of sterile injecting equipment at ... last injection ― Needles and syringes distributed per ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ... person who injects 2010 2018 ― Coverage of opioid substitution ... Percentage of pregnant women living with HIV >95% >95% therapy accessing antiretroviral medicines [89– >95%] [71– >95%] ― Naloxone available (2019) No 66.1% 75.0% Early infant diagnosis [55.0–80.0%] [56.4– >95%] ― Safe injection rooms available (2019) No 47
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	50	
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	51	ANNEX ON METHODS
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	52	METHODS FOR DERIVING UNAIDS HIV ESTIMATES 50
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	53	REGIONS IN FOCUS METHODS FOR DERIVING UNAIDS HIV ESTIMATES INTRODUCTION UNAIDS annually provides revised global, regional AIDS-related causes in any country: doing so would and country-specific modelled estimates using the require regularly testing every person for HIV and best available epidemiological and programmatic data investigating all deaths, which is logistically impossible to track the HIV epidemic. Modelled estimates are and ethically problematic. Modelled estimates—and required because it is impossible to count the exact the lower and upper bounds around these estimates— number of people living with HIV, people who are provide a scientifically appropriate way of describing newly infected with HIV or people who have died from HIV epidemic levels and trends. PARTNERSHIPS IN DEVELOPING METHODS FOR UNAIDS ESTIMATES Country teams use UNAIDS-supported software to The software used to produce the estimates is develop estimates annually. The country teams are Spectrum, which is developed by Avenir Health, primarily comprised of demographers, epidemiologists, and the Estimates and Projections Package, which is monitoring and evaluation specialists, and technical developed by the East–West Center.1 The UNAIDS partners. Reference Group on Estimates, Modelling and Projections provides technical guidance on the development of the HIV component of the software.2 1 More information on Avenir Health can be found at www.avenirhealth.org. The East–West Center website can be found at www.eastwestcenter.org. 2 For more on the UNAIDS Reference Group on Estimates, Modelling and Projections, please visit www.epidem.org. 51
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	54	METHODS FOR DERIVING UNAIDS HIV ESTIMATES A BRIEF DESCRIPTION OF METHODS USED BY UNAIDS TO CREATE ESTIMATES3 For countries where HIV transmission is high enough rural–urban estimates and trends are then aggregated to sustain an epidemic in the general population, to obtain national estimates. available epidemiological data typically consist of HIV prevalence results from pregnant women attending In the remaining countries, where HIV transmission antenatal clinics and from nationally representative occurs largely among key populations at higher population-based surveys. Many countries have risk of HIV and the epidemic can be described as historically conducted HIV sentinel surveillance among low-level, the estimates are derived from either women attending antenatal clinics, which requires surveillance among key populations and the general, collecting data from a selection of clinics for a few low-risk population, or from HIV case reporting months every few years. More recently, a number data, depending on which data are most reliable in of countries have stopped conducting sentinel a particular country. In countries with high-quality surveillance among pregnant women and are now HIV surveillance data among the key populations, using the data from the routine HIV tests conducted the data from repeated HIV prevalence studies that when pregnant women attend antenatal clinics and are are focused on key populations are used to derive tested for HIV. These data avoid the need to conduct national estimates and trends. Estimates of the size of a separate surveillance effort, and they provide a key populations are increasingly derived empirically complete set of data from all clinics across the country in each country; when studies are not available, they instead of samples from specific sites. are derived based on regional values and consensus among experts. Other data sources—including HIV The trends from pregnant women at antenatal clinics, case reporting data, population-based surveys and whether done through surveillance or routine data, surveillance among pregnant women—are used to can be used to inform estimates of national prevalence estimate the HIV prevalence in the general, low-risk trends, whereas data from population-based surveys— population. The HIV prevalence curves and numbers of which are conducted less frequently but have broader people on antiretroviral therapy are then used to derive geographical coverage and also include men—are national HIV incidence trends. more useful for informing estimates of national HIV prevalence levels. Data from these surveys also For most countries in western and central Europe and contribute to estimating age- and sex-specific HIV North America—and many countries in Latin America, prevalence and incidence levels and trends. For a the Caribbean, and the Middle East and North Africa few countries in sub-Saharan Africa that have not that have insufficient HIV surveillance or survey data, conducted population-based surveys, HIV prevalence but that have robust disease reporting systems— levels are adjusted based on comparisons of antenatal HIV case reporting and AIDS-related mortality data clinic surveillance and population-based survey data from vital registration systems are directly used to from other countries in the region. HIV prevalence inform trends and levels in national HIV prevalence trends and numbers of people on antiretroviral therapy and incidence. These methods also allow countries are then used to derive an estimate of HIV incidence to take into account evidence of underreporting or trends. reporting delays in HIV case report data, as well as the misclassification of deaths from AIDS-related causes. Historically, countries with high HIV transmission have produced separate HIV prevalence and incidence In all countries where UNAIDS supports the trends for rural and urban areas when there are well- development of estimates, assumptions about the established geographical differences in prevalence. effectiveness of HIV programme scale-up and patterns To better describe and account for further geographical of HIV transmission and disease progression are used heterogeneity, an increasing number of countries have to obtain the following age- and sex-specific estimates produced subnational estimates (e.g., at the level of of people living with HIV, people newly infected with the province or state) that, in some cases, also account HIV, people dying from AIDS-related illness and other for rural and urban differences. These subnational or important indicators (including treatment programme coverage statistics). These assumptions are based on 3 A full description of the methods used for the 2019 estimates is available in the July 2019 supplement of the journal AIDS. 52
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	55	REGIONS IN FOCUS systematic literature reviews and analyses of raw study Final country-submitted files containing the modelled data by scientific experts. Demographic population outputs are reviewed at UNAIDS to ensure that the data, including fertility estimates, are derived from the results are comparable across regions and countries United Nations Population Division’s World Population and over time. Prospects 2017 data files. In 2019, sub-national estimates were created and Selected inputs into the model—including the number used by more than 25 countries for internal planning of people on antiretroviral therapy and the number purposes. The methods for producing robust of women accessing services for the prevention sub-national estimates varies by country and depends of mother-to-child transmission of HIV by type of primarily on the availability of sub-national data. regimen—are reviewed and validated in partnership Four methods were used (Mathematical modelling, with the United Nations Children’s Fund (UNICEF), the Model-based geo-statistics, small area estimation and World Health Organization (WHO), the Government of direct estimates from prevalence surveys) to derive the United States of America, the Global Fund to Fight the sub-national estimates. The methods to generate AIDS, Tuberculosis and Malaria, and other partners. robust sub-national estimates are still being refined. UNCERTAINTY BOUNDS AROUND UNAIDS ESTIMATES The estimation software calculates uncertainty bounds deaths observed will contribute to determining the around each estimate. These bounds define the range precision of the estimate. within which the true value lies (if it can be measured). Narrow bounds indicate that an estimate is precise, The assumptions required to arrive at the estimate while wide bounds indicate greater uncertainty also contribute to the extent of the ranges around regarding the estimate. the estimates: in brief, the more assumptions, the wider the uncertainty range, since each assumption In countries using HIV surveillance data, the quantity introduces additional uncertainties. For example, the and source of the data available partly determine the ranges around the estimates of adult HIV prevalence precision of the estimates: countries with more HIV are smaller than those around the estimates of HIV surveillance data have smaller ranges than countries incidence among children, which require additional with less surveillance data or smaller sample sizes. data on prevalence among pregnant women and the Countries in which a national population-based survey probability of mother-to-child HIV transmission that has been conducted generally have smaller ranges have their own additional uncertainty. around estimates than countries where such surveys have not been conducted. Countries producing UNAIDS is confident that the actual numbers of people subnational estimates at the provincial level have wider living with HIV, people who are newly infected with HIV ranges. In countries using HIV case reporting and AIDS- or people who have died from AIDS-related causes lie related mortality data, the number of years of data and within the reported ranges. Over time, more and better the magnitude of the cases reported or AIDS-related data from countries will steadily reduce uncertainty. IMPROVEMENTS INCLUDED IN THE 2019 UNAIDS ESTIMATES MODEL Country teams create new Spectrum files every year. HIV incidence. Due to these improvements to the model The files may differ from one year to the next for two and the addition of new data to create the estimates, reasons. First, new surveillance and programme data are the results from previous years cannot be compared with entered into the model; this can change HIV prevalence the results from this year. A full historical set of estimates and incidence trends over time or antiretroviral therapy are created each year, however, enabling a description of coverage rates, including for past years. Second, trends over time. improvements are incorporated into the model based on the latest available science and statistical methods, Between the 2018 estimates and the 2019 estimates, which leads to the creation of more accurate trends in the following changes were applied to the model 53
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	56	METHODS FOR DERIVING UNAIDS HIV ESTIMATES under the guidance of the UNAIDS Reference Group even after controlling for temporal changes in baseline on Estimates, Modelling and Projections and based on CD4 count and treatment duration. A temporal the latest scientific evidence. reduction in mortality was included in the model as estimated from the IeDEA cohort data. New incidence estimation model for generalized epidemics IeDEA data were also reanalysed for Latin America, North America, and Asia and the Pacific with improved In 2019, a new model (R-hybrid) was introduced that assumptions about mortality among those lost to uses an improved function to estimate the rate of HIV follow-up. This resulted in substantially lower mortality infection during different phases of the HIV epidemic. rates than previously estimated. In countries with high- For estimating infections early in the epidemic, when quality mortality data, on- and off-treatment mortality data were relatively sparse, the new model has a simple were adjusted to match AIDS-related deaths. An option structure that follows the consistent pattern across to specify allocation of treatment disproportionately countries of exponential growth, peak and decline. to either those with low CD4 counts or according to For more recent years the model has more flexibility eligibility criteria was introduced to better match the to follow the increased amount of data to shape the low number of AIDS-related mortality data observed in trends in new infections. This new model improves the western and central Europe. fit to existing prevalence data, especially for recent routine testing data from antenatal clinics. Fertility among women living with HIV The previous incidence estimation model used in The 2019 Spectrum model included updated generalized epidemics assumed HIV prevalence parameters about the fertility of women living with HIV stabilized at the last observed value. The impact who were not receiving antiretroviral therapy. The new of adopting the R-hybrid model will be minimal in parameters led to higher fertility among women living countries with substantial historical surveillance data with HIV early in the epidemic, before treatment and recent surveys, but in countries with few data was provided to HIV-positive pregnant women. This points early in the epidemic or in recent years, the adjustment increased historical estimates of children R-hybrid model should improve the fit to available data. living with HIV. Mortality among people not receiving In the 2019 model, HIV prevalence data from routine treatment testing among pregnant women at antenatal clinics were used to calibrate the estimated births to women Assumptions of the risk of mortality among people living with HIV. This increased the estimates in some not receiving treatment were reduced based on high countries and decreased the values in others. There quality vital registration data where fewer AIDS-related is still some work to be done to ensure the country deaths among the untreated HIV positive adults were programme data used for this calibration are robust. recorded than predicted by Spectrum. Breastfeeding among women living with HIV The impact of this change is lower mortality rates among people not receiving treatment and fewer New analysis of survey data done in early 2019 AIDS-related deaths overall. found that women who were living with HV before widespread HIV testing and treatment had shorter Mortality among people receiving breastfeeding duration. The model previously assumed antiretroviral therapy that women who did not know their HIV status had similar breastfeeding patterns as women who were Previously, the model assumed that mortality rates HIV-negative. following antiretroviral therapy initiation are constant over time, conditional on age, sex, baseline CD4 count In 2019, eight high-burden countries in eastern and duration on treatment. However, recent studies southern Africa with household surveys from the early have shown that these rates have declined over time, 2000s adjusted the breastfeeding duration among 54
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	57	REGIONS IN FOCUS undiagnosed women living with HIV to reflect the new Changes to case surveillance and vital analysis. The impact of this change is reduced mother– registration model to–child transmission during breastfeeding. The age range of requested model inputs of new Probability of mother-to-child transmission diagnoses, CD4 count at diagnosis and AIDS-related mortality was changed from all ages to 15 years and Analysis conducted for the UNAIDS Reference Group older. It was recommended that AIDS-related death on Estimates, Modelling and Projections found minor estimates (adjusted for incomplete reporting and updated transmission probabilities based on the latest misclassification) rather than raw AIDS-related deaths published literature about the impact of different from the vital registration system be used in the fitting antiretroviral regimens on mother-to-child transmission. process. A new function was added to estimate new This had minimal impact on the child HIV estimates. diagnosis based on age, sex and year. Also, a new r-logistic fitting approach was added. Complementing Updated age at initiation of antiretroviral this new model is another function that provides the therapy for children user with the ability to determine which model best fits the inputs. The average age of children starting antiretroviral therapy has changed over the years as children are Surveillance data entered into the model diagnosed earlier. Data from the IeDEA and CIPHER networks provide data on the average age of children In 2018, Nigeria conducted a large household survey to starting antiretroviral therapy in multiple regions improve the precision of the estimate of HIV prevalence around the world. These data are available for each in the country. The Nigeria AIDS Indicator and Impact calendar year from 2002 through 2016. The most recent Survey (NAIIS) found lower HIV prevalence than update of these data suggested an increase in the previous household surveys. The new survey estimates proportion of children under two years of age starting were included in the Nigeria Spectrum models and on treatment and a small reduction to the proportion previous survey data were removed, resulting in a shift of children older than 10 years of age starting on in HIV prevalence to a lower level over the full history treatment. This has a small impact on both the number of the epidemic. This change also shifted the estimated of children living with HIV and on AIDS-related deaths prevalence in western and central Africa to slightly among children. lower levels. Retention on treatment of pregnant women At the global level, trends in new HIV infections, AIDS- related deaths and people living with HIV are similar Many countries do not have robust data available to previous estimates, although there are shifts within on the retention of women on treatment during regions. The number of AIDS-related deaths has shifted pregnancy. An analysis conducted for the UNAIDS downward in all regions due to changes in the models. Reference Group on Estimates, Modelling and New HIV infections are slightly flatter than estimated Projections suggested that at the time of delivery, in 2018 in Asia and the Pacific and in eastern Europe only 80% of women were retained on treatment. This and central Asia. Lower estimates of people living with estimate was used as a default value for women already HIV in western and central Africa were offset by higher on treatment before the pregnancy and for those estimates in Asia and the Pacific. women who started treatment during the pregnancy. Most of the high-burden countries in eastern and More detailed information on revisions to the 2019 southern Africa updated this assumption to reflect model and Spectrum generally can be found at available data. Previously, the default assumption was www.epidem.org. that 75% of women were retained on treatment at delivery before the pregnancy. 55
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	58	METHODS FOR DERIVING UNAIDS HIV ESTIMATES PUBLICATION OF COUNTRY-SPECIFIC ESTIMATES UNAIDS aims to publish estimates for all countries With regard to reporting incidence trends, if there are with populations of 250 000 or more ((according not enough historical data to state with confidence to the United Nations Population Division 2017 whether a decline in incidence has occurred, UNAIDS World Population Prospects). For the countries with will only publish data for the most recent year. This populations of 250 000 or more that did not submit is done to prevent users from making inaccurate estimates, UNAIDS developed estimates using the inferences about trends. Specifically, incidence Spectrum software based on published or otherwise trends are not published if there are fewer than four available information. These estimates contributed to data points for the key population or if there have regional and global totals but were not published as been no data for the past four years for countries country-specific estimates. using repeated survey or routine testing data. Trends prior to 2000 are not published for countries using In countries with low-level epidemics, the number of case surveillance models if there are no early case pregnant women living with HIV is difficult to estimate. surveillance or mortality data available. Many women living with HIV in these countries are sex workers or people who use drugs—or they are the Finally, UNAIDS does not publish country estimates sexual partners of people who use drugs or gay men when further data or analyses are needed to and other men who have sex with men—making them produce justifiable estimates. More information on likely to have different fertility levels than the general the UNAIDS estimates and the individual Spectrum population. UNAIDS does not present estimates of files for most countries can be found in the UNAIDS mother-to-child HIV transmission, including estimates website. Data from the estimates can be found related to children in some countries that have in the AIDSinfo section of the UNAIDS website concentrated epidemics, unless adequate data are (http://aidsinfo.unaids.org). available to validate these estimates. UNAIDS also does not publish estimates related to children for countries where the estimated number of pregnant women living with HIV is less than 50. 56
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	59	REGIONS IN FOCUS METHODS FOR DERIVING THE 90–90–90 TARGETS INTRODUCTION Since 2015, UNAIDS has reported estimates of global, `` Indicator 3 (the third 90): The percentage of people regional and country-specific progress against the living with HIV on treatment who have suppressed 90–90–90 targets. Progress toward these targets is viral loads. monitored using three basic indicators: Indicators 2 and 3 can also be expressed as a `` Indicator 1 (the first 90): The percentage of people percentage of all people living with HIV. When numbers living with HIV who know their HIV status. or coverage of the treatment target are expressed relative to the total number of people living with `` Indicator 2 (the second 90): The percentage of HIV, this is called “the HIV testing and treatment people living with HIV who know their status and are cascade.”––therapy Annual estimates of antiretroviral accessing treatment. therapy coverage among people living with HIV are available from the time when treatment was first introduced in countries. DATA SOURCES FOR CONSTRUCTING COUNTRY MEASURES Country-level progress against the 90–90–90 targets A description of the target-related indicators that was constructed using reported data from Spectrum, countries report against is provided in the UNAIDS the Global AIDS Monitoring tool and (for selected 2019 Global AIDS Monitoring guidelines (1). Data countries in western and central Europe)) the Dublin sources are also briefly described. A summary of the Declaration monitoring process. Estimates are number of countries that are publicly reporting on each published for all people and separately, by sex, for measure is provided in Table 18.1, organized by region. children (0 to 14 years) and for adults (15 years and older). Upper and lower ranges of uncertainty for The final set of country measures of progress against country-level estimates were calculated from the range the 90–90–90 targets for 2015 through 2018 are of estimated numbers of people living with HIV. This available at http://aidsinfo.unaids.org. Not all countries range may not fully capture uncertainty in the reported were able to report against all three prongs of the estimates. 90–90–90 targets: complete treatment cascades are published for 60 countries in 2018, up from 23 in 2015. 57
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	60	METHODS FOR DERIVING THE 90–90–90 TARGETS Estimates of people living with HIV the measure also may be overestimated if people are reported to the system or included on a register more All progress measures in this report are based on than once and these duplicates are not detected. UNAIDS global, regional and country-specific modelled Similarly, if people die or emigrate but are not removed estimates from Spectrum of the numbers of people from the system, the number of people living with HIV living with HIV. Estimates of people living with HIV who are reported to know their HIV status also will be in 2018 were available for 170 of 193 countries and overstated. territories and published for 137. Estimates of people living with HIV are developed for all countries with For 28 countries in eastern and southern Africa and populations above 250 000. western and central Africa, estimates of the numbers of people living with HIV who knew their status were More details about how UNAIDS derives estimates and derived using a new UNAIDS-supported mathematical uncertainty bounds around the number of people living model called the First 90 model. This model uses with HIV can be found in Part 1 of this annex. Published population-based survey and HIV testing service country estimates of people living with HIV (available program data—together with country-specific HIV http://aidsinfo.unaids.org)the ) represent 79% of the epidemic parameters from the standard UNAIDS total global estimated number of people living with HIV Spectrum model—to produce outputs of knowledge in 2018. of HIV status for adults, by sex. More details on the modelling approach are available in a forthcoming Knowledge of HIV status among people article (currently in press) (2). living with HIV Knowledge of HIV status from the First 90 model Estimates of the number of people living with HIV who for eastern and southern Africa and western and know their status were derived using the most recent central Africa has a number of strengths compared HIV surveillance, programme data and nationally with UNAIDS’ previously recommended approach to representative population-based survey data, and from estimating knowledge of status relying on population modelled 2018 estimates for 102 countries. Where data survey data and programme treatment coverage data. were available separately for children (aged 0–14 years) Most importantly, the new model differentiates in the and adults (aged 15 years and older, by sex), the age- population survey data those who are aware of their HIV and sex-specific measures were first calculated and status and those who likely seroconverted after their last then aggregated to produce a national measure. HIV-negative test based on national incidence trends. This approach constrains the upper bound of the For 74 countries in 2018—primarily outside of eastern proportion of people living with HIV ever tested in the and southern Africa and western and central Africa— survey who likely knew their HIV status at the time of the the number of people living with HIV who knew survey, thus producing a more accurate estimate of the their HIV status is based on HIV surveillance case first 90. Results of the proportion of people who know notification data, programme registers or modelled their HIV status from the model are also available by sex, estimates derived from case surveillance data. If assuming male-to-female testing ratios have remained the estimate from these sources was lower than the relatively constant over time. Estimates of knowledge of number of people accessing antiretroviral therapy, status by sex for adults are also available since 2010. the reported value was excluded. For countries using HIV surveillance or programme data, a country should An important model limitation, similar to the previously have included this measure only if the HIV surveillance recommended approach, is that caution should be system had been functioning since at least 2013 and used in interpreting results when the last population- people who have died, emigrated or who otherwise based survey was conducted more than five years have been lost to follow-up are removed. ago or if there are concerns about the accuracy of self-reported testing history in the survey. Model Although HIV surveillance systems, including those results also are only for those aged 15 years and older. based on programme registers, can be a reasonably UNAIDS continues to recommend that countries robust source of data to estimate the number of conservatively estimate knowledge of status among people living with HIV who know their status, biases children as the proportion of children living with HIV in the reported numbers may still exist. For example, on treatment (unless other information from case a country’s measure of the knowledge of status may surveillance data are available). Additional strengths be underestimated if not all people diagnosed are and limitations of the model are described in the reported to the surveillance system in a timely manner; forthcoming article referenced earlier in this section. 58
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	61	REGIONS IN FOCUS People accessing antiretroviral therapy People who have achieved viral suppression Global and regional measures of antiretroviral therapy Progress towards the viral suppression target among numbers are abstracted from country-reported people on treatment and as a proportion of all programme data through the UNAIDS-supported people living with HIV was derived from data reported Spectrum software, the Global AIDS Monitoring in Spectrum and through the online Global AIDS reporting tool, and the Dublin Declaration reporting Monitoring reporting tool and the Dublin Declaration process. In 2018, 143 countries had publicly available reporting process. For the purposes of reporting, the estimates of the number of people on treatment, threshold for suppression is a viral load of less than representing 85% of all people on treatment. For the 1000 copies per ml, although some countries may small number of countries where reported numbers set lower thresholds or require persons to achieve an of people on treatment are not available in selected undetectable viral load. This guidance also specifies years—primarily in western and central Europe and only a person’s last test result from the reporting year North America, and inin China, India and the Russian be submitted, so the reported number suppressed Federation—estimates of the number of people on among those tested should represent people and not treatment are developed either in consultation with the tests performed. public health agency responsible for monitoring the national treatment programme or based on published UNAIDS2019 Global AIDS Monitoring guidelines were sources. revised from those of 2018 to clarify that countries should report viral load suppression outcomes, In partnership with UNICEF, WHO, the Government of regardless of testing coverage. However, viral load the United States, the Global Fund and other partners testing results will only be published in countries where that support treatment service delivery in countries, access to testing is for all or nearly all (>90%) people UNAIDS annually reviews and validates treatment on treatment or nationally representative (typically numbers reported by countries through Global AIDS 50–90% testing coverage). Table 1 shows the increase Monitoring and Spectrum. UNAIDS staff also provide in the number of countries able to report on viral load technical assistance and training to country public suppression compared to previous years. In 2015, only health and clinical officers to ensure the quality of the 26 countries had reliable estimates; in 2018, there were treatment data reported. Nevertheless, this measure 76 countries with reported data. may overestimate the number of people on treatment if people who transfer from one facility to another are For countries with nationally representative but not reported by both facilities. Similarly, coverage may be universally accessible access to treatment, the estimate overestimated if people who have died, disengaged of viral suppression among those tested (i.e., the from care or emigrated are not identified and removed third 90) was multiplied by the number of people on from treatment registries. Treatment numbers also may treatment to obtain overall viral suppression levels in be underestimated if not all clinics report the numbers the country. Countries where testing coverage was 90% on treatment completely or in a timely manner. or higher reported only the number suppressed among all people on treatment. In 2016, UNAIDS completed a triangulation of data to verify the UNAIDS global estimate of people accessing A number of challenges exist in using country-reported antiretroviral therapy at the end of 2015. Since early data to monitor the viral load suppression target. 2017, UNAIDS and other international partners First, routine viral load testing may not be offered have supported more than 15 countries, primarily in at all treatment facilities, and those facilities that do sub-Saharan Africa, to verify that the number of people offer it may not be representative of the care available reported to be currently on treatment is accurate. at facilities without viral load testing. By assuming For more details about how confident UNAIDS is in that the percentage of people suppressed among reported treatment numbers, please see How many those accessing viral load testing is representative of people living with HIV access treatment?4 all people on treatment countries that do not have complete access to testing, the measure may be overestimated or underestimated (depending on the characteristics of the reporting clinics). 4 The document is available at http://www.unaids.org/en/resources/documents/2016/how-many-people-living-with-HIV-access- treatment. 59
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	62	METHODS FOR DERIVING THE 90–90–90 TARGETS TABLE 1 Data availability for constructing UNAIDS measures of progress against the 90–90–90 treatment targets Western Eastern and Eastern Middle Western Asia Europe central and Latin East and and and the Caribbean and Europe Global southern America North central Pacific central and Africa Africa Africa Asia North America Number of 38 16 16 21 17 20 25 40 193 countries Number of countries in 28 10 16 20 17 19 24 36 170 UNAIDS global estimates Number of 2015 20 9 12 20 16 15 24 23 139 countries with 2016 20 9 12 20 16 15 24 24 140 publicly available data on estimates 2017 20 9 12 20 16 15 24 23 139 of people living with HIV 2018 20 9 12 20 16 15 24 21 137 Number of 2015 8 6 7 20 6 6 18 9 80 countries 2016 9 6 8 20 8 6 18 18 93 with publicly available data 2017 12 7 9 20 8 6 18 18 98 on knowledge of HIV status 2018 15 6 12 20 9 9 18 13 102 2015 20 9 13 20 16 15 24 21 138 Number of countries 2016 20 9 13 20 16 15 24 23 140 with publicly available data on 2017 21 9 13 20 16 15 24 24 142 treatment 2018 22 9 14 20 16 17 24 21 143 Number of 2015 5 0 5 3 4 4 1 4 26 countries with 2016 5 2 5 8 7 4 1 13 45 publicly available data on people 2017 7 4 8 7 8 6 3 12 55 with suppressed viral load 2018 9 7 11 13 11 9 6 10 76 Source: UNAIDS special analysis, 2019. Another challenge in measuring the accuracy of viral performed because of suspected treatment failure, the load suppression estimates is that UNAIDS guidance number of people virally suppressed in these countries requests routine (i.e., annual) viral load testing results will be underestimated. UNAIDS validates country only for people who are on treatment and eligible submissions for quality, but it is not always possible for testing. If people newly initiated on treatment to identify cases where both routine and other types achieve viral suppression but have not yet been offered of testing are occurring. Finally, UNAIDS guidance viral load testing, they will be incorrectly counted as recommends reporting viral load test results only for not suppressed, and the resulting viral suppression people on antiretroviral therapy; persons who are not estimate will be understated. UNAIDS also requests on treatment and naturally suppress the virus will not countries to only report results from routine viral be included in this measure. load testing: if countries report test results primarily 60
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	63	REGIONS IN FOCUS METHODS FOR CONSTRUCTION THE 90–90–90 TREATMENT TARGET AT THE REGIONAL AND GLOBAL LEVELS All programme data submitted to UNAIDS were coverage among people living with HIV and the second validated by UNAIDS and its partners prior to and third 90s. Upper and lower ranges of uncertainty publication. Country-submitted data that did not for the 90s do not capture uncertainty in the reported meet the required validation checks for quality either or missing programme data on the numbers of people at the indicator level or across the treatment cascade who know their HIV status or the number of people on were not included in the composite regional or global treatment who are virally suppressed. measures. As in previous years, results of global and regional To estimate regional and global progress against the progress towards the 90–90–90 treatment target 90–90–90 targets, UNAIDS imputed missing country presented in this report supersede all previously data for the first and third 90 targets using a Bayesian published estimates. The new approach to modelling hierarchical model with uncertainty based on regional the global and regional estimates of the first and third trends, sex differences and country-specific data for 90s builds on the previous UNAIDS approach, which those countries reporting data for some but not all was to calculate missing -data for countries using the years. Additional details on the modelling approach are ratio of knowledge of status and treatment for the first available in a forthcoming article (4). The proportion of 90 and the ratio of the number of people suppressed data on knowledge of status and viral load suppression among those on treatment in the region for countries that was imputed by region from 2015 to 2018 are where data were available. One of the benefits of the shown in Table 18.2. new approach is that it can use reported data when they are available to estimate trends in and across the Due to large differences in the proportion of people region. Also, it is now possible to measure progress virally suppressed in western and central Europe and separately among adults by sex. the United States for the years in which data were available, sub-regional estimates for North America and As with the previous approach, one primary drawback western and central Europe were separately calculated to the model is that it is difficult to quantify the extent and then combined to estimate the western and central to which progress in countries that reported data to Europe and North America regional results at large. UNAIDS is similar to that of countries without data Upper and lower ranges of uncertainty around the in the region. This is particularly true for viral load global and regional estimates of the HIV testing and suppression estimates, where reported data in some treatment cascade are provided that reflect uncertainty regions—especially in 2015 and 2016—are limited. in the number of people living with HIV and uncertainty For example, no countries in the Caribbean in 2015 (from missing country data) in the number of people were able to meet the threshold coverage of 50% who know their HIV status and the number of people testing coverage for reporting estimates of viral load who are virally suppressed. Based on reports from data suppression. In Asia and the Pacific, national-level quality reviews prior to 2017, uncertainty from possible estimates of viral load suppression are not available in overreporting or underreporting of treatment numbers any year for India and prior to 2018 for China. As access of 0.88 and 1.04 for the lower and upper bounds, to viral load testing improves over time, the accuracy of respectively, was added to the bounds of treatment the estimates of the third 90 will improve. 61
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	64	METHODS FOR DERIVING THE 90–90–90 TARGETS TABLE 2 Proportion of imputed data used to estimate the regional and global measures of the percentage of people living with HIV who know their HIV status and the percentage of people living with HIV on treatment who are virally suppressed Estimates of people living with People living with HIV on treatment HIV where knowledge of status is where viral suppression is imputed (%) imputed (%) 2015 2016 2017 2018 2015 2016 2017 2018 Asia and the Pacific 12 8 10 51 83 84 85 56 Caribbean 7 5 5 18 100 96 63 51 Eastern Europe and central Asia 65 69 68 5 77 76 75 4 Eastern and southern Africa 0 0 0 0 58 33 46 21 Latin America 24 21 20 22 33 29 28 28 Middle East and North Africa 21 25 19 28 63 63 46 37 Western and central Africa 2 2 0 2 99 99 98 47 Western and central Europe and North 29 4 82 95 33 6 87 98 America Global 8 6 10 15 62 46 60 35 Source: UNAIDS special analysis, 2019. 62
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	65	REGIONS IN FOCUS DATA ON KEY POPULATIONS DISTRIBUTION OF NEW HIV INFECTIONS BY SUBPOPULATION The distribution of new HIV infections among Control (ECDC) and WHO Regional Office for Europe subpopulations globally and by region was estimated HIV/AIDS surveillance in Europe 2017–2018 data (4). based on data for 177 countries using five data sources. The proportions of new diagnoses for each region in Europe (western, central and eastern) were applied to For countries that model their HIV epidemic based on UNAIDS estimates of new infections in each country data from subpopulations, including key populations, for people who inject drugs, gay men and other men the numbers of new infections were extracted from who have sex with men, and transgender people. Spectrum 2019 files. This source provided data for Data for sex workers were not available from the sex workers from 59 countries, for people who inject ECDC report. New HIV infections in China, India, the drugs from 37 countries, for gay men and other men Russian Federation and the United States were taken who have sex with men from 61 countries, and for from the most recent available national reports of transgender people from 19 countries (all of which were new diagnoses. located in Latin America, the Caribbean and Asia and the Pacific). Additionally, 22 countries (mostly from Asia New HIV infections among countries without a direct and the Pacific) had data from clients of sex workers. data source were calculated from regional benchmarks. The benchmarks were set by the median proportion The second source was mode of transmission studies of new infections in the specific subpopulation in all conducted in countries between 2006 and 2012. The available countries in the same region. The majority proportions of new infections estimated for each of these countries were located in sub-Saharan Africa. subpopulation, calculated by modes of transmission There were 112 countries that used benchmark values analyses, were multiplied by the number of total new for the sex work estimate, 92 countries for the people gender-specific adult infections (among those aged who inject drugs estimate, 69 countries for the gay men 15–49 years) to derive an estimated number of new and other men who have sex with men estimate, and infections by subpopulation. This source provided data 82 countries for the transgender people estimate. for sex workers from 18 countries, for people who inject drugs from 25 countries, and for gay men and other The calculated proportions of infections for each key men who have sex with men from 22 countries. population include the sex partners of members of key populations. New infections among sex partners New HIV infections for European countries with neither of key populations were estimated using the number of the aforementioned data sources were derived of sex partners and transmission probabilities from from the European Centre for Disease Prevention and the literature. 63
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	66	DATA ON KEY POPULATIONS QUALITY OF POPULATION SIZE ESTIMATES The regional sections of this report include tables on `` “Local population size estimate” refers to estimates the estimated size of key populations. These data that are empirically derived using one of the before are based on values reported through Global AIDS mentioned methods but only for a subnational Monitoring in 2018. A comprehensive review of the group of sites that are insufficient for national data was conducted during this reporting round and extrapolation. therefore estimates should not be compared with data presented in previous UNAIDS’ reports. As a result of `` “Insufficient data” refers either to estimates this process, the estimates reported can be categorized derived from: expert opinions, Delphi, wisdom of as follows: crowds, programmatic results or registry, regional benchmarks or unknown methods or estimates `` “National population size estimate” refers to derived prior to 2010. Estimates may or may not estimates that are empirically derived using one of be national. the following methods: multiplier, capture-recapture, mapping/enumeration, network scale up method (NSUM) or population-based survey, or respondent driven sampling–successive sampling (RDS-SS). Estimates had to be national or a combination of multiple sites with a clear approach to extrapolating to a national estimate. 64
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	67	REGIONS IN FOCUS REFERENCES 1. Global AIDS monitoring 2019: indicators for monitoring the 2016 United Nations Political Declaration on HIV and AIDS. Geneva: UNAIDS; 2017 (https://www.unaids.org/sites/default/files/media_asset/global-aids-monitoring_en.pdf, accessed 7 July 2019). 2. Maheu-Giroux M, Marsh K, Doyle C, Godin A, Delauney CL, Johnson LF et al. National HIV testing and diagnosis coverage in sub- Saharan Africa: a new modeling tool for estimating the “first 90” from program and survey data. AIDS. 2019. [in press] 3. Johnston LG, Sabin ML, Prybylski D, Sabin K, McFarland W, Baral S et al. Policy and practice: the importance of assessing self- reported HIV status in bio-behavioural surveys. Bull World Health Organ. 2016;94:605-12. 4. HIV infection and AIDS. Annual epidemiological report for 2017. Stockholm: European Centre for Disease Prevention and Control (ECDC); 2019 ((https://ecdc.europa.eu/sites/portal/files/documents/AER_for_2017-hiv-infection-aids_1.pdf, accessed 7 July 2019). 65
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	68	
latin_america_pdf/2019-global-AIDS-update_latin-america_en.pdf	Communities at the centre : the response to HIV in Latin America : Global AIDS update 2019	UNAIDS/JC2956/Latin America	2019	Documents and Publications	69	Copyright: © 2019 Joint United Nations Programme on HIV/AIDS (UNAIDS) All rights reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of UNAIDS concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. UNAIDS does not warrant that the information published in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. UNAIDS/JC2956/Latin America
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latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	1	GLOBAL AIDS UPDATE 2018 MILES TO GO THE RESPONSE TO HIV IN LATIN AMERICA
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	2	
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	3	Contents Latin America 2 Argentina 10 Bolivia (Plurinational State of) 12 Brazil 14 Chile 16 Colombia 18 Costa Rica 20 Ecuador 22 El Salvador 24 Guatemala 26 Honduras 28 Mexico 30 Nicaragua 32 Panama 34 Paraguay 36 Peru 38 Uruguay 40 Annex on methods 43
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	4	Latin America Countries with a national human rights institution that includes sexual AT A GLANCE orientation in its human rights work, Latin America, 2017 The region is approaching the 90–90–90 testing and treatment targets. Closing the remaining gaps requires community-led 1 services that more effectively reach key populations. Prevention needs reinvigoration, especially for young people 2 within key populations. Wider availability of pre-exposure prophylaxis (PrEP) for people at high risk of HIV 3 infection could add momentum to prevention efforts. Yes No Source: National Commitment and Policy Instrument, 2018. Despite significant progress related to the HIV and legal and Antiretroviral therapy coverage has been relatively high policy environment for lesbian, and AIDS-related mortality relatively low in Latin America gay, bisexual, transgender and for many years. However, little progress has been made intersex (LGBTI) people, stigma towards the region’s 2020 HIV prevention milestone, and 4 and violence still obstruct their there is evidence of rising incidence of HIV among young access to HIV services. people within key populations. Brazil is playing a key leadership role in the reinvigoration of HIV prevention, but political commitment in the region is inconsistent. Apart from Argentina, Brazil, Latin America has made notable progress in Chile, Colombia, Mexico and safeguarding the human rights of LGBTI people. National Uruguay, HIV programmes and regional networks of key populations and people focused on key populations living with HIV are monitoring human rights abuses. are too dependent on donor National and local governments have established 5 funding, which threatens their mechanisms for addressing human rights issues. sustainability. Sixteen countries in the region have national human rights institutions that include sexual orientation in their mandate. 2
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	5	EPIDEMIC TRANSITION MEASURES Number of new HIV infections, Latin America, 2000–2017 Number of AIDS-related deaths, Latin America, 2000–2017 160 000 70 000 Number of new HIV infections Number of AIDS-related deaths 140 000 60 000 Percentage 120 000 Percentage change in new change in 50 000 HIV infections 100 000 AIDS-related 40 000 since 2010 = 80 000 deaths since -1% 2010 = 30 000 60 000 -12% 40 000 20 000 20 000 10 000 0 0 2000 2010 2017 2000 2010 2017 Source: UNAIDS 2018 estimates. Source: UNAIDS 2018 estimates. Incidence:prevalence ratio, Latin America, 1990–2017 Number of new HIV infections and deaths among the HIV population, Latin America, 1990–2017 0.30 160 000 Incidence:prevalence ratio the HIV population and deaths among 2017 Number of new 0.24 120 000 HIV infections incidence:prevalence ratio= 0.18 0.06 80 000 0.12 40 000 [0.04–0.07] 0.06 0 0.00 1990 1993 1996 1999 2002 2005 2008 2011 2014 2017 1990 1993 1996 1999 2002 2005 2008 2011 2014 2017 Target value New HIV infections Deaths among the HIV population Source: UNAIDS 2018 estimates. Source: UNAIDS 2018 estimates. The region’s strong performance along the 90–90–90 continuum of services saw deaths from AIDS-related illness decline by 12% from 2010 to 2017. Although there has been little change in the number of new HIV infections in Latin America over the last 15 years, high treatment coverage and low AIDS-related mortality has driven a gradual decline in the region’s incidence:prevalence ratio, which was 0.06 [0.04–0.07] in 2017. Gay men and other men who have sex with men accounted for 41% of HIV infections in 2017, and key populations and their sexual partners represented more than three quarters of new infections overall. Distribution of new HIV infections, by population group, Distribution of new HIV infections and AIDS-related deaths by country, Latin Latin America, 2017 America, 2017 NEW HIV INFECTIONS AIDS-RELATED DEATHS 3% 3% 6% 5% 23% 22% 28% 3% 37% 41% 2% 48% 6% 14% 2% 24% 1% 11% 2% 3% 6% 2% 3% 5% Sex workers Transgender women Argentina Brazil Ecuador Guatemala Honduras Mexico People who inject drugs Clients of sex workers and Panama Peru Rest of the region other sexual partners of key Gay men and other men populations who have sex with men Rest of population† † Individuals in this category did not report any HIV-related risk behaviour. Source: UNAIDS 2018 estimates. Source: UNAIDS special analysis, 2018. 3
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	6	4 Peru Chile Brazil Sources: Mexico Panama Ecuador Uruguay end of 2018. Paraguay Honduras Colombia Country Argentina Nicaragua Costa Rica Guatemala El Salvador Bolivia (Plurinational State of) Venezuela (Bolivarian Republic of) Criminalized and/or prosecuted Criminalization of transgender Neither criminalized nor prosecuted people Data not available Any criminalization or punitive regulation of sex work Criminalization of sex work Sex work is not subject to punitive regulations or is not criminalized f a g q Issue is determined/differs at subnational level Data not available Death penalty Criminalization of same-sex Imprisonment (14 years–life, up to 14 years) or no penalty specified l b b b b m sexual acts Laws penalizing same-sex sexual acts have been decriminalized or never existed, or no specific legislation Data not available Compulsory detention for drug offences Drug use or possession for Possession of drugs for personal use is specified as a criminal offence or drug use or consumption is a specific offence in law f r s e h n o p d personal use an offence Possession of drugs for personal use is specified as a non-criminal offence Data not available Yes, for adolescents younger than 18 Yes, for adolescents younger than 14 and 16 Parental consent for adolescents Yes, for adolescents younger than 12 k to access HIV testing No Data not available Yes Spousal consent for married LAWS AND POLICIES SCORECARD No women to access SRH services Data not available National Commitment and Policy Instrument, 2017 and 2018; supplemented by additional sources where noted (see references at end of chapter). Yes Laws criminalizing the No, but prosecutions exist based on general criminal laws i c transmission of, non-disclosure of No or exposure to HIV transmission Data not available Yes Laws or policies restricting the No entry, stay and residence of Data not available people living with HIV Yes Mandatory HIV testing for j No marriage, work or residence Data not available permits or for certain groups Note: Data on laws restricting the entry, stay and residence of people living with HIV are currently undergoing a global review that will involve country validation. An update is expected by the
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	7	STIGMA AND DISCRIMINATION Percentage of men and women aged 15–49 years who would not buy Percentage of ever-married or partnered women aged 15–49 years vegetables from a shopkeeper living with HIV, Latin America, most who experienced physical and/or sexual violence by an intimate recent data, 2012–2016 partner in the past 12 months, countries with available data, Latin America, 2000–2016 Guatemala Peru* 50 Ecuador Panama* 45 Colombia* El Salvador* 40 Mexico* 35 Uruguay* 30 0 10 20 30 40 50 60 70 80 90 100 Per cent Per cent 25 *Female respondents only. Source: Population-based surveys, 2012–2016. 20 15 Percentage of people living with HIV who experienced discrimination 10 in health-care settings, countries with available data, Latin America, 2013–2016 5 60 0 50 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 40 Per cent 30 Colombia Mexico Peru Guatemala Honduras Nicaragua 20 Source: Population-based surveys, 2000–2016. 		 10 0 Paraguay Costa Rica Honduras Nicaragua Basic misunderstandings about HIV persist. In Denied health services because of their HIV status at least once in the past 12 months several Latin American countries, for example, at Health-care professional ever told other people least one third of men and women (aged 15–49 about their HIV status without their consent years) said they would not buy vegetables from Source: People Living with HIV Stigma Index surveys, 2013–2016. a shopkeeper who is living with HIV (1). Widely varying levels of discrimination at health-care facilities are reported by people living with HIV in the region (2). In Paraguay, 17% of people Percentage of key populations who reported having avoided health- living with HIV said they had been denied health care services, HIV care and HIV treatment in the past 12 months due to stigma and discrimination, Paraguay, 2017 services because of their HIV status within the last 12 months, and 20% said that health-care 25 professionals had revealed their HIV status to others without consent. In Nicaragua, these 20 transgressions were much less frequent at 4% and 8%, respectively. 15 Per cent 10 Intimate partner violence is a major issue in several countries in the region. In Colombia 5 and Nicaragua, more than one in three women reported being physically or sexually assaulted by 0 a partner in the previous 12 months, compared Health care HIV care HIV treatment with about one in 10 women in Guatemala, Female sex workers Gay men and other men who have sex with men Mexico and Peru (3). Violence is also a common Transgender persons threat faced by LGBTI people in the region (4). Source: Integrated biological and behavioural surveys, 2016–2017. 5
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	8	COMBINATION HIV PREVENTION Availability of PrEP, Latin America, 2017 HIV prevalence among transgender people and gay men and other men who have sex with men is extremely high in several countries. HIV prevention efforts should be focused on key populations. Regional prevention targets have been endorsed by all countries in the region and by prominent civil society organizations. However, financial investment in the five pillars of primary prevention remains insufficient and PrEP is underutilized. Brazil is at the vanguard of the rejuvenation of HIV prevention in Latin America. With 35% of the total population of the region and 47% of new infections in 2017, Brazil is the only country in the region where PrEP is available through the public sector. The country’s Ministry of Health aims to provide PrEP to more than 50 000 sex workers, gay men and other men who have sex with men, and transgender people over the next five years. In Chile, Costa Rica, Guatemala, Mexico and Uruguay, PrEP can be obtained through private health-care providers, the Internet or research projects. Through private providers, the Internet and/or research Through public facilities PrEP not available Data not available *Female respondents only. Source: 2017 and 2018 National Commitments and Policy Instrument. HIV prevalence among key populations, countries with available data, Latin America, 2015–2017 50 45 40 35 30 Per cent 25 20 15 10 5 0 Brazil Chile Colombia Paraguay Costa Rica Guatemala Nicaragua El Salvador Honduras Bolivia (Plurinational State of) Panama Argentina Ecuador Mexico Uruguay Peru Female sex workers Gay men and other men who have sex with men Transgender persons Prisoners Source: 2018 Global AIDS Monitoring. 6
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	9	HIV TESTING AND TREATMENT HIV testing and treatment cascade, Latin America, 2017 2.0 1.8 1.6 Gap to reaching the first 90: 235 000 Number of people living with HIV (million) Gap to reaching 1.4 the first and second 90s: Gap to reaching 362 000 all three 90s: 1.2 381 000 1.0 0.8 0.6 0.4 77% 61% 52% 0.2 [54–95%] [43–79%] [36–68%] 0.0 People living with HIV People living with HIV People living with HIV who know their status on treatment who are virally suppressed Source: UNAIDS special analysis, 2018; see annex on methods for more details Among the 1.8 million [1.5–2.3 million] people living with HIV in Latin America at the end of 2017, 77% [54– >95%] were aware of their HIV status, the same as in 2016. The gap to achieving the first 90 of the 90–90–90 targets in 2017 was 235 000 people living with HIV. About 1.1 million [992 000–1 200 000] people in the region were accessing antiretroviral therapy in 2017, which represents 61% [43–79%] of all people living with HIV. The gap to achieving the first and second 90s of the 90–90–90 targets in 2017 was 362 000 people living with HIV. The estimated percentage of people living with HIV who achieved viral suppression increased from 45% [31–59%] in 2016 to 52% [36–68%] in 2017. The gap to achieving all three 90s in 2017 was the viral suppression of an additional 381 000 people living with HIV. The costs of antiretroviral medicines and other HIV commodities in the region remain an issue. Since most countries in South America are classified as middle-income, they have limited access to the price reductions available to low-income countries. In the Bolivarian Republic of Venezuela, the economic crisis is making it difficult to procure and distribute medical commodities, including for HIV testing and treatment. Shortages of antiretroviral medicines, supplies to treat opportunistic infections and condoms are common. 7
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	10	ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION Cascade of services for preventing vertical transmission and The rate of mother-to-child transmission of transmission rate, Latin America, 2017 HIV in Latin America was 11.4% [9.8–14.3%] in 2017, one of the lowest in the world (and down 25 000 from 16.2% [13.9–20.4%] in 2010). This largely reflects the strength of programmes in Brazil and Mexico—two countries that are home to 62% of 20 000 73% people living with HIV in the region. Almost 75% women living with HIV [50–90%] Number of births to [58–90%] of pregnant women living with HIV in 15 000 46% 2017 received antiretroviral prophylaxis to prevent [37–59%] vertical transmission of HIV and protect their own 10 000 health. In addition, almost half (46%; [37–59%]) Transmission rate of infants exposed to HIV received early infant 11.4% 5000 [9.8–14.3%] diagnosis, a crucial intervention for early initiation of treatment. 0 Births to Women Infants New child women receiving tested infections living with antiretrovirals to by 8 weeks HIV prevent vertical of age transmission Source: UNAIDS 2018 estimates; 2018 Global AIDS Monitoring. INVESTMENT 3500 HIV resource availability by source, 2000–2017, and projected resource needs by 2020, Latin America 3000 2500 US$ (million) 2000 1500 1000 500 0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Domestic (public and private) United States (bilateral) Global Fund to Fight AIDS, Tubercolosis and Malaria Other international Resource needs (Fast-Track) *Estimates for low- and middle-income countries per 2015 World Bank income level classification. All figures are expressed in constant 2016 US dollars. Source: UNAIDS 2018 resource availability and needs estimates. More than 95% of the HIV response in Latin America is funded from domestic resources, and total funding available for the HIV response in the region has nearly doubled over the last decade. Domestic resources increased by 189% since 2006, and international resources decreased by 11.6%. An additional US$ 293 million, a 9.3% increase, will be needed to reach the region’s 2020 funding target. However, HIV programme and impact data suggest that additional efficiency and effectiveness measures will be needed to ensure that these resources are sufficient to reach the region’s 2020 milestone for the reduction of HIV infections. 8
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	11	References 1. Population-based surveys, 2012–2016. 2. People Living with HIV Stigma Index surveys, 2013–2016. 3. Population-based surveys, 2000–2016. 		 4. Violence against LGBTI persons. Inter-American Commission on Human Rights; 2015 (http://www.oas.org/en/iachr/reports/pdfs/ violencelgbtipersons.pdf). Additional sources for the laws and policies scorecard a. Sexual Rights Initiative database [database]. Sexual Rights Initiative; c2016 (http://sexualrightsdatabase.org/map/21/Adult%20sex%20work). b. State-sponsored homophobia. A world survey of sexual orientation laws: criminalisation, protection and recognition. ILGA; 2017 (https://ilga. org/downloads/2017/ILGA_State_Sponsored_Homophobia_2017_WEB.pdf). c. Bernard EJ, Cameron S. Advancing HIV justice 2. Building momentum in global advocacy against HIV criminalisation. Brighton and Amsterdam: HIV Justice Network, GNP+; 2016 (https://www.scribd.com/doc/312008825/Advancing-HIV-Justice-2-Building-momentum-in- global-advocacy-against-HIV-criminalisation). d. Republic of Guatemala. Codigo Penal (Decreto No. 17–72). Article 307 (http://www.un.org/depts/los/LEGISLATIONANDTREATIES/ PDFFILES/GTM_codigo_penal.pdf). e. Eastern Republic of Uruguay. Decreto Ley N°14294. Article 31 (http://www.infodrogas.gub.uy/html/marco_legal/documentos/02- DecretoLey14294.pdf). f. Codigo organico integral penal, 2014. Quito: Ministerio de Justicia, Derechos Humanos y Cultos; 2014 (https://www.justicia.gob.ec/wp- content/uploads/2014/05/c%C3%B3digo_org%C3%A1nico_integral_penal_-_coip_ed._sdn-mjdhc.pdf). g. Decreto Legislativo N°635 Codigo Penal. Décimo segundo edición official. Article 153. Lima: Ministerio de Justicia y Derechos Humanos; 2016 (http://spij.minjus.gob.pe/content/publicaciones_oficiales/img/CODIGOPENAL.pdf). h. Decreto Legislativo N°635 Codigo Penal. Décimo segundo edición official. Article 299. Lima: Ministerio de Justicia y Derechos Humanos; 2016 (http://spij.minjus.gob.pe/content/publicaciones_oficiales/img/CODIGOPENAL.pdf). i. Republic of Peru. Codio Penal del Peru. Principios Generales. Article 289. (https://www.unifr.ch/ddp1/derechopenal/ legislacion/l_20080616_75.pdf). j. Republic of Chile. Establece Normas Relativas al Virus de Inmuno Deficiencia Humana y Crea Bonificación Fiscal para Enfermedades Catastróficas: Ley N° 19.779. Article 5 (https://www.leychile.cl/Navegar?idNorma=192511). k. Proteger e cuidar da saude de adolescentes na Atenção Básica. Brasilia: Ministério da Saúde; 2017 (http://bvsms.saude.gov.br/bvs/ publicacoes/proteger_cuidar_adolescentes_atencao_basica.pdf). l. Republic of Chile. Modifica el Codigo Penal, El Codigo de Procedimiento Penal y Otros Cuerpos Legalese en Materias Relativas al Delito de Violacion: Ley N° 19.617. Article 365. (https://www.leychile.cl/Navegar?idNorma=138814&idParte=8346393&idVersion=1999-07-12). m. Republic of Columbia. Communication Nº 17 of 28 April of 2016 of the Colombian Constitutional Court (http://www.corteconstitucional.gov. co/comunicados/No.%2017%20comunicado%2028%20de%20abril%20de%202016.pdf). n. Republic of Columbia. Penal Code. Article 376 (http://www.alcaldiabogota.gov.co/sisjur/normas/Norma1.jsp?i=6388). o. Republic of Honduras. Ley Sobre uso Indebido y Trafico Ilicito de Drogas y Sustancias Psicotropicas (Decreto Número 126–89). Article 11 (http://www.poderjudicial.gob.hn/CEDIJ/Leyes/Documents/LeyUsoIndebidoTraficoIlicitoDeDrogasYSubstanciasPsicotropicas.pdf). p. United Mexican States. 479 Ley General de Salud 2013. Articles 477–9 (http://www.conadic.salud.gob.mx/pdfs/Ley_general_de_salud.pdf). q. Republic of Nicaragua. Penal Code amended by Law No. 641, 2007. Article 178 (https://www.poderjudicial.gob.ni/pjupload/noticia_reciente/ CP_641.pdf). r. Republic of Nicaragua. Ley de Reforma y Adiciones a la Ley N° 177: Ley de Estupefacientes, Sicotropicos y Sustancias Controladas, 1999. Article 67 (https://www.poderjudicial.gob.ni/pjupload/comjib/LEY_177.pdf). s. Republic of Panama. Código Penal de la República de Panamá, modified by Law 14 of 2000. Article 320 (https://www.oas.org/juridico/mla/ sp/pan/sp_pan-int-text-cp.pdf). 9
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	12	ARGENTINA COUNTRY DATA EPIDEMIC ESTIMATES 2005 2010 2017 New HIV infections 5600 6000 6500 New HIV infections (all ages) [4900–6200] [5200–6700] [5600–7200] <200 <100 <100 New HIV infections (0–14) [<200– <200] [<100– <100] [<100– <100] 1600 1700 1900 New HIV infections (women, 15+) [1400–1800] [1500–1900] [1700–2100] 3900 4200 4500 New HIV infections (men, 15+) [3200–4400] [3400–4700] [3700–5100] HIV incidence per 1000 population 0.15 [0.13–0.16] 0.15 [0.13–0.16] 0.15 [0.13–0.17] AIDS-related deaths 1900 1900 2000 AIDS-related deaths (all ages) [1400–2400] [1400–2300] [1400–2600] <100 <100 <100 AIDS-related deaths (0–14) [<100– <100] [<100– <100] [<100– <100] <500 <500 <500 AIDS-related deaths (women, 15+) [<500–660] [<500–560] [<500–630] 1300 1400 1500 AIDS-related deaths (men, 15+) [950–1700] [1000–1800] [1000–2000] People living with HIV 76 000 94 000 120 000 People living with HIV (all ages) [67 000–85 000] [85 000–100 000] [110 000–130 000] 1200 1100 850 People living with HIV (0–14) [1000–1500] [950–1400] [770–960] 23 000 29 000 39 000 People living with HIV (women, 15+) [21 000–26 000] [27 000–33 000] [35 000–42 000] 52 000 64 000 82 000 People living with HIV (men, 15+) [44 000–58 000] [56 000–72 000] [73 000–92 000] LAWS AND POLICIES STIGMA AND DISCRIMINATION Laws criminalizing the transmission of, non- No disclosure of or exposure to HIV transmission Percentage of women and men aged 15–49 years who report discriminatory attitudes Other punitive regulation of sex towards people living with HIV Criminalization of sex work work Laws penalizing same-sex sexual Percentage of people living with HIV denied Criminalization of same-sex sexual acts acts have been decriminalized or health services because of their HIV status in never existed the last 12 months Possession of drugs for personal Drug use or possession for personal use is an use is specified as a criminal offence Percentage of people living with HIV who offence reported a health-care professional told others Neither criminalized nor about their HIV status without their consent Criminalization of transgender people prosecuted Laws or policies restricting the entry, stay and residence of people living with HIV No VIOLENCE Parental consent for adolescents to access HIV Yes, for adolescents younger than Proportion of ever-married or partnered testing 14 years women aged 15–49 years who experienced physical or sexual violence from a male Spousal consent for married women to access No intimate partner in the past 12 months sexual and reproductive health services Mandatory HIV testing for marriage, work or Yes residence permits or for certain groups EXPENDITURES Financing sources International: Global International: Domestic private Domestic public International: PEPFAR Total Fund all others Last available report: 2012 ... US$ 178 870 021 ... ... ... US$ 179 007 273 10
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	13	EPIDEMIC TRANSITION METRICS 8 000 3 000 0.4 8 000 N umber of people N umber of people N umber of people 2 500 6 000 0.3 6 000 2 000 Rate 4 000 1 500 0.2 4 000 1 000 2 000 0.1 2 000 500 0 0 0 0 2000 2005 2010 2015 2000 2005 2010 2015 1990 2000 2010 2000 2005 2010 2015 N ew H IV infections Incidence:prevalence ratio N ew H IV infections A ID S-related deaths D eaths among people Targ et living with HIV Change in new Change in AIDS- Incidence: HIV infections = 8% related deaths = 5% prevalence = 0.05 since 2010 since 2010 ratio KEY POPULATIONS HIV COMORBIDITIES Gay men and Sex other men People who Transgender Estimated number of incident tuberculosis 590 Prisoners workers who have inject drugs people cases among people living with HIV (2016) [380–850] sex with men Estimated size of population 74 896 205 596 ... ... ... Proportion of people living with HIV newly enrolled in HIV care with active tuberculosis ... HIV prevalence ... 11.4% ... ... 2.7% (2016) Know their HIV status ... ... ... ... Women who tested positive for HIV among those screened for cervical cancer 43.6% Antiretroviral therapy coverage ... ... ... ... 87.4% (programme data) (2016) Condom use ... ... ... ... Proportion of people coinfected with HIV and Coverage of HIV prevention hepatitis B virus receiving combined ... ... ... ... ... treatment programmes Avoidance of health care Proportion of people coinfected with HIV and because of stigma and ... ... ... ... hepatitis C virus starting hepatitis C ... discrimination treatment HIV TESTING AND TREATMENT CASCADE HIV PREVENTION 120 000 100% Knowledge of HIV prevention among young people aged 15–24 years 100 000 Number of people living with HIV Gap to ― Women ... reaching the 75% Gap to 80 000 first 90: reaching the ― Men ... 18802 second 90: 60 000 50% 18313 Condom use at last higher-risk sex (with a non-marital, non-cohabiting partner) 40 000 25% ― Women ... 20 000 ― Men ... 0 0% People living with HIV who know People living with HIV on People living with HIV who are Women aged 15–49 years who have their their status treatment virally suppressed demand for family planning satisfied by ... modern methods 75% 66% ...% All ages [67–83%] [60–73%] [...–...%] Not Men aged 15–49 years who are circumcised ...% >95% ...% applicable Children (0–14) [...–...%] [>95– >95%] [...–...%] Male circumcisions performed according to Not ...% 75% ...% Women (15+) national standards applicable [...–...%] [68–82%] [...–...%] ...% 61% ...% People who received PrEP at least once Men (15+) ... [...–...%] [54–68%] [...–...%] during the reporting period (2017) Is antiretroviral therapy provided in community settings (such as Harm reduction outside health facilities) for people who are stable on antiretroviral No ― Use of sterile injecting equipment at therapy? ... last injection ― Needles and syringes distributed per ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ... person who injects 2010 2017 ― Coverage of opioid substitution ... Percentage of pregnant women living with HIV 90% 90% therapy accessing antiretroviral medicines [79– >95%] [78– >95%] ― Naloxone available (2016) No ...% 66% Early infant diagnosis [...–...%] [60–77%] ― Safe injection rooms available (2016) No 11
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	14	BOLIVIA (PLURINATIONAL STATE OF) COUNTRY DATA EPIDEMIC ESTIMATES 2005 2010 2017 New HIV infections 1700 1500 1500 New HIV infections (all ages) [1200–2400] [870–2300] [760–2800] <100 <100 <100 New HIV infections (0–14) [<100– <200] [<100– <100] [<100– <100] <500 <500 <500 New HIV infections (women, 15+) [<500–700] [<500–640] [<500–760] 1200 1000 1000 New HIV infections (men, 15+) [790–1600] [590–1500] [530–2000] HIV incidence per 1000 population 0.19 [0.14–0.27] 0.15 [0.09–0.23] 0.14 [0.07–0.26] AIDS-related deaths 570 800 730 AIDS-related deaths (all ages) [<500–800] [570–1100] [<500–1200] <100 <100 <100 AIDS-related deaths (0–14) [<100– <100] [<100– <100] [<100– <100] <200 <500 <200 AIDS-related deaths (women, 15+) [<100– <200] [<200– <500] [<100– <500] <500 540 520 AIDS-related deaths (men, 15+) [<500–540] [<500–770] [<500–870] People living with HIV 14 000 17 000 21 000 People living with HIV (all ages) [11 000–18 000] [13 000–23 000] [13 000–31 000] <500 <500 <500 People living with HIV (0–14) [<500– <500] [<500–520] [<500– <500] 3900 5100 6300 People living with HIV (women, 15+) [3100–5100] [3600–6800] [4200–9400] 9400 12 000 14 000 People living with HIV (men, 15+) [7200–12 000] [8400–16 000] [8900–21 000] LAWS AND POLICIES STIGMA AND DISCRIMINATION Laws criminalizing the transmission of, non- Yes disclosure of or exposure to HIV transmission Percentage of women and men aged 15–49 years who report discriminatory attitudes towards people living with HIV Criminalization of sex work Partial criminalization of sex work Percentage of people living with HIV denied Criminalization of same-sex sexual acts No specific legislation health services because of their HIV status in the last 12 months Drug use or possession for personal use is an Drug use or consumption is a offence specific offence in law Percentage of people living with HIV who reported a health-care professional told others Neither criminalized nor about their HIV status without their consent Criminalization of transgender people prosecuted Laws or policies restricting the entry, stay and residence of people living with HIV No VIOLENCE Parental consent for adolescents to access HIV Yes, for adolescents younger than Proportion of ever-married or partnered testing 18 years women aged 15–49 years who experienced physical or sexual violence from a male Spousal consent for married women to access No intimate partner in the past 12 months sexual and reproductive health services Mandatory HIV testing for marriage, work or Yes residence permits or for certain groups EXPENDITURES Financing sources International: Global International: Domestic private Domestic public International: PEPFAR Total Fund all others Last available report: 2012 US$ 2 112 301 US$ 4 786 726 ... US$ 3 549 926 US$ 97 951 US$ 11 768 762 12
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	15	EPIDEMIC TRANSITION METRICS 3 000 1 400 1 2 000 N umber of people N umber of people 2 500 1 200 N umber of people 0.8 1 000 1 500 2 000 800 0.6 Rate 1 500 1 000 600 0.4 1 000 400 0.2 500 500 200 0 0 0 0 2000 2005 2010 2015 2000 2005 2010 2015 1990 2000 2010 2000 2005 2010 2015 N ew H IV infections Incidence:prevalence ratio N ew H IV infections A ID S-related deaths D eaths among people Targ et living with HIV Change in new Change in AIDS- Incidence: HIV infections = -2% related deaths = -10% prevalence = 0.07 since 2010 since 2010 ratio KEY POPULATIONS HIV COMORBIDITIES Gay men and Sex other men People who Transgender Estimated number of incident tuberculosis 500 Prisoners workers who have inject drugs people cases among people living with HIV (2016) [320–710] sex with men Estimated size of population 13 130 29 490 ... 833 ... Proportion of people living with HIV newly enrolled in HIV care with active tuberculosis ... HIV prevalence 4.3% 25.4% ... ... ... (2016) Know their HIV status ... ... ... ... Cervical cancer screening of women living ... Antiretroviral therapy coverage ... ... ... ... ... with HIV Condom use 95.7% 57.8% ... ... Proportion of people coinfected with HIV and Coverage of HIV prevention hepatitis B virus receiving combined ... ... ... ... ... treatment programmes Avoidance of health care Proportion of people coinfected with HIV and because of stigma and ... ... ... ... hepatitis C virus starting hepatitis C ... discrimination treatment HIV TESTING AND TREATMENT CASCADE HIV PREVENTION 20 000 100% Knowledge of HIV prevention among young 18 000 people aged 15–24 years Number of people living with HIV 16 000 Gap to reaching the 75% ― Women ... 14 000 first 90: 12 000 3033 ― Men ... Gap to 10 000 reaching the 50% Condom use at last higher-risk sex (with a 8 000 second 90: Gap to reaching non-marital, non-cohabiting partner) 9261 6 000 the third 90: 25% 4 000 10457 ― Women ... 2 000 ― Men ... 0 0% People living with HIV who know People living with HIV on People living with HIV who are Women aged 15–49 years who have their their status treatment virally suppressed demand for family planning satisfied by ... modern methods 75% 36% 23% All ages [49– >95%] [24–55%] [15–34%] Not Men aged 15–49 years who are circumcised >95% 62% 56% applicable Children (0–14) [74– >95%] [42–88%] [38–79%] Male circumcisions performed according to Not 83% 41% 25% Women (15+) national standards applicable [56– >95%] [28–61%] [17–37%] 71% 34% 21% People who received PrEP at least once Men (15+) ... [45– >95%] [21–51%] [13–32%] during the reporting period (2017) Is antiretroviral therapy provided in community settings (such as Harm reduction outside health facilities) for people who are stable on antiretroviral No ― Use of sterile injecting equipment at therapy? ... last injection ― Needles and syringes distributed per ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ... person who injects 2010 2017 ― Coverage of opioid substitution ... Percentage of pregnant women living with HIV 41% 90% therapy accessing antiretroviral medicines [28–55%] [63– >95%] ― Naloxone available (2016) No 46% 40% Early infant diagnosis [34–67%] [28–57%] ― Safe injection rooms available (2016) No 13
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	16	BRAZIL COUNTRY DATA EPIDEMIC ESTIMATES 2005 2010 2017 New HIV infections 45 000 47 000 48 000 New HIV infections (all ages) [33 000–58 000] [34 000–60 000] [35 000–63 000] 2200 1300 720 New HIV infections (0–14) [1600–3000] [<500–2300] [520–1500] 16 000 14 000 15 000 New HIV infections (women, 15+) [11 000–20 000] [10 000–19 000] [10 000–19 000] 28 000 31 000 33 000 New HIV infections (men, 15+) [19 000–36 000] [22 000–42 000] [23 000–45 000] HIV incidence per 1000 population 0.25 [0.18–0.32] 0.24 [0.17–0.31] 0.24 [0.17–0.31] AIDS-related deaths 14 000 14 000 14 000 AIDS-related deaths (all ages) [9900–18 000] [9900–19 000] [9400–18 000] 1400 660 680 AIDS-related deaths (0–14) [1000–1900] [<500–1600] [<500–1300] 4700 5000 4600 AIDS-related deaths (women, 15+) [3100–6400] [3300–6800] [3200–6100] 7700 8500 8400 AIDS-related deaths (men, 15+) [5600–10 000] [5900–11 000] [5800–11 000] People living with HIV 490 000 640 000 860 000 People living with HIV (all ages) [360 000–630 000] [480 000–830 000] [630 000–1 100 000] 12 000 13 000 13 000 People living with HIV (0–14) [8600–15 000] [9200–17 000] [7100–17 000] 190 000 230 000 300 000 People living with HIV (women, 15+) [130 000–240 000] [170 000–310 000] [220 000–400 000] 290 000 400 000 550 000 People living with HIV (men, 15+) [220 000–380 000] [290 000–520 000] [390 000–730 000] LAWS AND POLICIES STIGMA AND DISCRIMINATION Laws criminalizing the transmission of, non- No disclosure of or exposure to HIV transmission Percentage of women and men aged 15–49 years who report discriminatory attitudes Other punitive regulation of sex towards people living with HIV Criminalization of sex work work Percentage of people living with HIV denied Criminalization of same-sex sexual acts No specific legislation health services because of their HIV status in the last 12 months Drug use or possession for personal use is an Drug use or consumption is a offence specific offence in law Percentage of people living with HIV who reported a health-care professional told others Neither criminalized nor about their HIV status without their consent Criminalization of transgender people prosecuted Laws or policies restricting the entry, stay and residence of people living with HIV No VIOLENCE Parental consent for adolescents to access HIV Yes, for adolescents younger than Proportion of ever-married or partnered testing 12 years women aged 15–49 years who experienced physical or sexual violence from a male Spousal consent for married women to access No intimate partner in the past 12 months sexual and reproductive health services Mandatory HIV testing for marriage, work or No residence permits or for certain groups EXPENDITURES Financing sources International: Global International: Domestic private Domestic public International: PEPFAR Total Fund all others Last available report: 2017 ... US$ 771 909 014 ... ... ... US$ 771 909 014 14
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	17	EPIDEMIC TRANSITION METRICS 70 000 25 000 0.3 60 000 N umber of people 60 000 N umber of people N umber of people 20 000 0.25 50 000 0.2 40 000 40 000 15 000 Rate 0.15 30 000 10 000 20 000 0.1 20 000 10 000 5 000 0.05 0 0 0 0 2000 2005 2010 2015 2000 2005 2010 2015 1990 2000 2010 2000 2005 2010 2015 N ew H IV infections Incidence:prevalence ratio N ew H IV infections A ID S-related deaths D eaths among people Targ et living with HIV Change in new Change in AIDS- Incidence: HIV infections = 3% related deaths = -3% prevalence = 0.06 since 2010 since 2010 ratio KEY POPULATIONS HIV COMORBIDITIES Gay men and 11 000 Sex other men People who Transgender Estimated number of incident tuberculosis Prisoners [9100 workers who have inject drugs people cases among people living with HIV (2016) sex with men –13 000] Estimated size of population ... ... 227 253 ... 607 731 Proportion of people living with HIV newly enrolled in HIV care with active tuberculosis ... HIV prevalence 5.3% ... ... ... ... (2016) Know their HIV status 52.3% 72.6% ... 76.9% Cervical cancer screening of women living ... Antiretroviral therapy coverage ... ... ... ... ... with HIV Condom use ... 64.3% 40.8% ... Proportion of people coinfected with HIV and Coverage of HIV prevention hepatitis B virus receiving combined ... 22.4% 29.8% ... 22.4% treatment programmes Avoidance of health care Proportion of people coinfected with HIV and because of stigma and 12.1% 62.7% ... ... hepatitis C virus starting hepatitis C ... discrimination treatment HIV TESTING AND TREATMENT CASCADE HIV PREVENTION 900 000 100% Knowledge of HIV prevention among young people aged 15–24 years 800 000 Number of people living with HIV 700 000 Gap to ― Women ... reaching the 75% 600 000 first 90: Gap to ― Men ... 500 000 55289 reaching the Gap to second 90: reaching 50% 400 000 Condom use at last higher-risk sex (with a 145627 the third 90: non-marital, non-cohabiting partner) 300 000 124191 200 000 25% ― Women ... 100 000 ― Men ... 0 0% People living with HIV who know People living with HIV on People living with HIV who are Women aged 15–49 years who have their their status treatment virally suppressed demand for family planning satisfied by ... modern methods 84% 64% 59% All ages [61– >95%] [47–82%] [43–75%] Not Men aged 15–49 years who are circumcised ...% 45% 35% applicable Children (0–14) [...–...%] [26–62%] [20–49%] Male circumcisions performed according to Not ...% 65% ...% Women (15+) national standards applicable [...–...%] [47–86%] [...–...%] ...% 64% ...% People who received PrEP at least once Men (15+) ... [...–...%] [46–84%] [...–...%] during the reporting period (2017) Is antiretroviral therapy provided in community settings (such as Harm reduction outside health facilities) for people who are stable on antiretroviral No ― Use of sterile injecting equipment at therapy? 54.3% last injection (2016) ― Needles and syringes distributed per ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ... person who injects 2010 2017 ― Coverage of opioid substitution ... Percentage of pregnant women living with HIV 58% 85% therapy accessing antiretroviral medicines [42–77%] [61– >95%] ― Naloxone available (2016) No 25% 45% Early infant diagnosis [19–35%] [35–63%] ― Safe injection rooms available (2016) No 15
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	18	CHILE COUNTRY DATA EPIDEMIC ESTIMATES 2005 2010 2017 New HIV infections 2200 3200 6000 New HIV infections (all ages) [1900–2500] [2700–3600] [4800–7100] <100 <100 <100 New HIV infections (0–14) [<100– <100] [<100– <100] [<100– <100] 640 930 1700 New HIV infections (women, 15+) [550–740] [820–1100] [1400–2100] 1500 2300 4200 New HIV infections (men, 15+) [1300–1800] [1800–2700] [3200–5200] HIV incidence per 1000 population 0.14 [0.12–0.16] 0.19 [0.16–0.22] 0.33 [0.27–0.39] AIDS-related deaths ... ... ... AIDS-related deaths (all ages) [...–...] [...–...] [...–...] ... ... ... AIDS-related deaths (0–14) [...–...] [...–...] [...–...] ... ... ... AIDS-related deaths (women, 15+) [...–...] [...–...] [...–...] ... ... ... AIDS-related deaths (men, 15+) [...–...] [...–...] [...–...] People living with HIV 28 000 39 000 67 000 People living with HIV (all ages) [24 000–31 000] [34 000–44 000] [58 000–76 000] <200 <500 <500 People living with HIV (0–14) [<200– <500] [<200– <500] [<200– <500] 7500 11 000 17 000 People living with HIV (women, 15+) [6800–8500] [9500–12 000] [15 000–19 000] 20 000 28 000 49 000 People living with HIV (men, 15+) [17 000–23 000] [24 000–32 000] [42 000–57 000] LAWS AND POLICIES STIGMA AND DISCRIMINATION Laws criminalizing the transmission of, non- No disclosure of or exposure to HIV transmission Percentage of women and men aged 15–49 years who report discriminatory attitudes Sex work is not subject to punitive towards people living with HIV Criminalization of sex work regulations or is not criminalized Laws penalizing same-sex sexual Percentage of people living with HIV denied Criminalization of same-sex sexual acts acts have been decriminalized or health services because of their HIV status in never existed the last 12 months Possession of drugs for personal Drug use or possession for personal use is an use is specified as a non-criminal offence Percentage of people living with HIV who offence reported a health-care professional told others Neither criminalized nor about their HIV status without their consent Criminalization of transgender people prosecuted Laws or policies restricting the entry, stay and residence of people living with HIV No VIOLENCE Parental consent for adolescents to access HIV Yes, for adolescents younger than Proportion of ever-married or partnered testing 14 years women aged 15–49 years who experienced physical or sexual violence from a male Spousal consent for married women to access No intimate partner in the past 12 months sexual and reproductive health services Mandatory HIV testing for marriage, work or No residence permits or for certain groups EXPENDITURES Financing sources International: Global International: Domestic private Domestic public International: PEPFAR Total Fund all others Last available report: 2016 US$ 65 865 282 US$ 118 838 480 ... US$ 43 383 ... US$ 184 816 554 16
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	19	EPIDEMIC TRANSITION METRICS 8 000 1 0.3 8 000 N umber of people N umber of people N umber of people 1 0.25 6 000 6 000 0.2 1 Rate 4 000 0.15 4 000 0 0.1 2 000 0 2 000 0.05 0 0 0 0 2000 2005 2010 2015 2000 2005 2010 2015 1990 2000 2010 2000 2005 2010 2015 N ew H IV infections Incidence:prevalence ratio N ew H IV infections A ID S-related deaths D eaths among people Targ et living with HIV Change in new Change in AIDS- Incidence: HIV infections = 85% related deaths = prevalence = 0.09 since 2010 since 2010 ratio KEY POPULATIONS HIV COMORBIDITIES Gay men and Sex other men People who Transgender Estimated number of incident tuberculosis 470 Prisoners workers who have inject drugs people cases among people living with HIV (2016) [280–700] sex with men Estimated size of population ... ... ... ... 42 874 Proportion of people living with HIV newly enrolled in HIV care with active tuberculosis ... HIV prevalence 1.1% 13.9% ... ... 0.4% (2016) Know their HIV status ... 78% ... ... Cervical cancer screening of women living ... Antiretroviral therapy coverage 82.5% 89% ... 84.7% 85.8% with HIV Condom use 92.7% 55.8% ... ... Proportion of people coinfected with HIV and Coverage of HIV prevention hepatitis B virus receiving combined ... ... ... ... ... treatment programmes Avoidance of health care Proportion of people coinfected with HIV and because of stigma and ... ... ... ... hepatitis C virus starting hepatitis C ... discrimination treatment HIV TESTING AND TREATMENT CASCADE HIV PREVENTION 70 000 100% Knowledge of HIV prevention among young people aged 15–24 years 60 000 Number of people living with HIV 75% ― Women ... 50 000 Gap to reaching the ― Men ... Gap to 40 000 first 90: reaching the Gap to 13057 50% second 90: reaching Condom use at last higher-risk sex (with a 30 000 14982 the third 90: non-marital, non-cohabiting partner) (2016) 20 000 13269 25% ― Women 26.1% 10 000 ― Men 49.2% 0 0% People living with HIV who know People living with HIV on People living with HIV who are Women aged 15–49 years who have their their status treatment virally suppressed demand for family planning satisfied by ... modern methods 70% 59% 53% All ages [61–81%] [51–67%] [46–61%] Not Men aged 15–49 years who are circumcised >95% 65% 59% applicable Children (0–14) [>95– >95%] [53–80%] [48–73%] Male circumcisions performed according to Not 40% 32% 28% Women (15+) national standards applicable [35–45%] [28–36%] [25–31%] 81% 68% 62% People who received PrEP at least once Men (15+) ... [69–93%] [58–78%] [53–72%] during the reporting period (2017) Is antiretroviral therapy provided in community settings (such as Harm reduction outside health facilities) for people who are stable on antiretroviral No ― Use of sterile injecting equipment at therapy? ... last injection ― Needles and syringes distributed per ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ... person who injects 2010 2017 ― Coverage of opioid substitution ... Percentage of pregnant women living with HIV 57% >95% therapy accessing antiretroviral medicines [50–64%] [86– >95%] ― Naloxone available (2016) No ...% 85% Early infant diagnosis [...–...%] [76– >95%] ― Safe injection rooms available (2016) No 17
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	20	COLOMBIA COUNTRY DATA EPIDEMIC ESTIMATES 2005 2010 2017 New HIV infections ... ... ... New HIV infections (all ages) [...–...] [...–...] [...–...] ... ... ... New HIV infections (0–14) [...–...] [...–...] [...–...] ... ... ... New HIV infections (women, 15+) [...–...] [...–...] [...–...] ... ... ... New HIV infections (men, 15+) [...–...] [...–...] [...–...] HIV incidence per 1000 population ... [...–...] ... [...–...] ... [...–...] AIDS-related deaths 9200 9500 4400 AIDS-related deaths (all ages) [7500–11 000] [7900–12 000] [3100–6100] 540 <500 <200 AIDS-related deaths (0–14) [<500–650] [<500– <500] [<200– <500] 3100 3000 1400 AIDS-related deaths (women, 15+) [2600–3700] [2600–3700] [1100–1900] 5600 6200 2800 AIDS-related deaths (men, 15+) [4500–6900] [5000–7700] [1900–4000] People living with HIV 140 000 140 000 150 000 People living with HIV (all ages) [120 000–170 000] [120 000–180 000] [120 000–180 000] 4600 3500 1800 People living with HIV (0–14) [3700–5400] [2900–4200] [1400–2300] 44 000 40 000 37 000 People living with HIV (women, 15+) [36 000–54 000] [34 000–50 000] [31 000–44 000] 94 000 99 000 110 000 People living with HIV (men, 15+) [78 000–120 000] [80 000–120 000] [90 000–130 000] LAWS AND POLICIES STIGMA AND DISCRIMINATION Laws criminalizing the transmission of, non- Yes 2015 disclosure of or exposure to HIV transmission Percentage of women and men aged 15–49 years who report discriminatory attitudes Sex work is not subject to punitive towards people living with HIV Criminalization of sex work 37.2 regulations or is not criminalized Percentage of people living with HIV denied Criminalization of same-sex sexual acts No penalty specified health services because of their HIV status in the last 12 months Possession of drugs for personal Drug use or possession for personal use is an use is specified as a non-criminal offence Percentage of people living with HIV who offence reported a health-care professional told others Neither criminalized nor about their HIV status without their consent Criminalization of transgender people prosecuted Laws or policies restricting the entry, stay and residence of people living with HIV No VIOLENCE Parental consent for adolescents to access HIV Yes, for adolescents younger than Proportion of ever-married or partnered 2010 2015 testing 14 years women aged 15–49 years who experienced physical or sexual violence from a male Spousal consent for married women to access No intimate partner in the past 12 months 37.4 33.3 sexual and reproductive health services Mandatory HIV testing for marriage, work or No residence permits or for certain groups EXPENDITURES Financing sources International: Global International: Domestic private Domestic public International: PEPFAR Total Fund all others Last available report: 2013 US$ 34 547 857 US$ 84 674 170 ... ... ... US$ 119 528 046 18
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	21	EPIDEMIC TRANSITION METRICS N umber of people 1 14 000 0.04 15 000 N umber of people 12 000 N umber of people 1 10 000 0.03 1 10 000 8 000 Rate 0.02 0 6 000 4 000 5 000 0 0.01 2 000 0 0 0 0 2000 2005 2010 2015 2000 2005 2010 2015 1990 2000 2010 2000 2005 2010 2015 N ew H IV infections Incidence:prevalence ratio N ew H IV infections A ID S-related deaths D eaths among people Targ et living with HIV Change in new Change in AIDS- Incidence: HIV infections = related deaths = -53% prevalence = ... since 2010 since 2010 ratio KEY POPULATIONS HIV COMORBIDITIES Gay men and 2200 Sex other men People who Transgender Estimated number of incident tuberculosis Prisoners [1400 workers who have inject drugs people cases among people living with HIV (2016) sex with men –3100] Estimated size of population ... 576 999 15 062 24 000 180 009 Proportion of people living with HIV newly enrolled in HIV care with active tuberculosis 12.5% HIV prevalence 1.2% 17% 2.8% 21.4% ... (2016) Know their HIV status 90.6% 26.3% ... 42.9% Cervical cancer screening of women living ... Antiretroviral therapy coverage ... ... ... ... ... with HIV Condom use 94.7% 17% 35.8% ... Proportion of people coinfected with HIV and Coverage of HIV prevention hepatitis B virus receiving combined ... ... ... ... ... treatment programmes Avoidance of health care Proportion of people coinfected with HIV and because of stigma and ... ... ... ... hepatitis C virus starting hepatitis C ... discrimination treatment HIV TESTING AND TREATMENT CASCADE HIV PREVENTION 140 000 100% Knowledge of HIV prevention among young people aged 15–24 years (2015) 120 000 Number of people living with HIV 75% ― Women 31.63% 100 000 Gap to reaching the ― Men 28.52% 80 000 second 90: 50% 41005 Condom use at last higher-risk sex (with a 60 000 non-marital, non-cohabiting partner) (2015) 40 000 25% ― Women ... 20 000 ― Men 70.5% 0 0% People living with HIV who know People living with HIV on People living with HIV who are Women aged 15–49 years who have their their status treatment virally suppressed demand for family planning satisfied by 86.6% modern methods (2015) ...% 54% ...% All ages [...–...%] [44–64%] [...–...%] Not Men aged 15–49 years who are circumcised ...% 59% ...% applicable Children (0–14) [...–...%] [46–77%] [...–...%] Male circumcisions performed according to Not ...% 48% ...% Women (15+) national standards applicable [...–...%] [40–57%] [...–...%] ...% 56% ...% People who received PrEP at least once Men (15+) ... [...–...%] [45–67%] [...–...%] during the reporting period (2017) Is antiretroviral therapy provided in community settings (such as Harm reduction outside health facilities) for people who are stable on antiretroviral Yes ― Use of sterile injecting equipment at therapy? ... last injection ― Needles and syringes distributed per ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ... person who injects 2010 2017 ― Coverage of opioid substitution ... Percentage of pregnant women living with HIV 47% 66% therapy accessing antiretroviral medicines [40–58%] [54–77%] ― Naloxone available (2016) No 10% 48% Early infant diagnosis [8–12%] [41–59%] ― Safe injection rooms available (2016) No 19
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	22	COSTA RICA COUNTRY DATA EPIDEMIC ESTIMATES 2005 2010 2017 New HIV infections 530 720 1100 New HIV infections (all ages) [<500–590] [640–800] [910–1200] <100 <100 <100 New HIV infections (0–14) [<100– <100] [<100– <100] [<100– <100] <200 <500 <500 New HIV infections (women, 15+) [<200– <200] [<200– <500] [<500– <500] <500 500 740 New HIV infections (men, 15+) [<500– <500] [<500–570] [610–880] HIV incidence per 1000 population 0.13 [0.11–0.14] 0.16 [0.14–0.18] 0.22 [0.19–0.25] AIDS-related deaths <200 <200 <200 AIDS-related deaths (all ages) [<100– <200] [<200– <200] [<200– <500] <100 <100 <100 AIDS-related deaths (0–14) [<100– <100] [<100– <100] [<100– <100] <100 <100 <100 AIDS-related deaths (women, 15+) [<100– <100] [<100– <100] [<100– <100] <100 <100 <100 AIDS-related deaths (men, 15+) [<100– <100] [<100– <200] [<100– <200] People living with HIV 4900 7500 13 000 People living with HIV (all ages) [4400–5400] [6700–8200] [11 000–14 000] <100 <100 <100 People living with HIV (0–14) [<100– <100] [<100– <100] [<100– <100] 1400 2200 3500 People living with HIV (women, 15+) [1300–1600] [2000–2400] [3200–3900] 3400 5200 9000 People living with HIV (men, 15+) [3000–3900] [4600–5800] [8000–10 000] LAWS AND POLICIES STIGMA AND DISCRIMINATION Laws criminalizing the transmission of, non- No, but prosecutions exist based disclosure of or exposure to HIV transmission on general criminal laws Percentage of women and men aged 15–49 years who report discriminatory attitudes towards people living with HIV Criminalization of sex work Partial criminalization of sex work Laws penalizing same-sex sexual Percentage of people living with HIV denied 2014 Criminalization of same-sex sexual acts acts have been decriminalized or health services because of their HIV status in never existed the last 12 months 8.8 Possession of drugs for personal Drug use or possession for personal use is an use is specified as a criminal 2014 offence Percentage of people living with HIV who offence reported a health-care professional told others Neither criminalized nor about their HIV status without their consent Criminalization of transgender people 15.5 prosecuted Laws or policies restricting the entry, stay and residence of people living with HIV No VIOLENCE Parental consent for adolescents to access HIV No Proportion of ever-married or partnered testing women aged 15–49 years who experienced physical or sexual violence from a male Spousal consent for married women to access No intimate partner in the past 12 months sexual and reproductive health services Mandatory HIV testing for marriage, work or No residence permits or for certain groups EXPENDITURES Financing sources International: Global International: Domestic private Domestic public International: PEPFAR Total Fund all others Last available report: 2014 US$ 6 028 593 US$ 12 236 072 ... ... ... US$ 19 139 767 20
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	23	EPIDEMIC TRANSITION METRICS 1 400 300 0.15 1 500 N umber of people 1 200 N umber of people N umber of people 250 1 000 200 0.1 1 000 800 Rate 150 600 400 100 0.05 500 200 50 0 0 0 0 2000 2005 2010 2015 2000 2005 2010 2015 1990 2000 2010 2000 2005 2010 2015 N ew H IV infections Incidence:prevalence ratio N ew H IV infections A ID S-related deaths D eaths among people Targ et living with HIV Change in new Change in AIDS- Incidence: HIV infections = 47% related deaths = 26% prevalence = 0.08 since 2010 since 2010 ratio KEY POPULATIONS HIV COMORBIDITIES Gay men and Sex other men People who Transgender Estimated number of incident tuberculosis 39 Prisoners workers who have inject drugs people cases among people living with HIV (2016) [25–56] sex with men Estimated size of population 3 032 10 127 ... 416 ... Proportion of people living with HIV newly enrolled in HIV care with active tuberculosis 3.1% HIV prevalence 1.4% 15.4% ... 24.6% 0.1% (2016) Know their HIV status ... ... ... ... Cervical cancer screening of women living ... Antiretroviral therapy coverage ... ... ... ... 100% with HIV Condom use 74% 39.1% ... 78.6% Proportion of people coinfected with HIV and Coverage of HIV prevention hepatitis B virus receiving combined ... 83.3% ... ... 83.3% treatment programmes Avoidance of health care Proportion of people coinfected with HIV and because of stigma and ... ... ... ... hepatitis C virus starting hepatitis C ... discrimination treatment HIV TESTING AND TREATMENT CASCADE HIV PREVENTION 12 000 100% Knowledge of HIV prevention among young people aged 15–24 years 10 000 Number of people living with HIV Gap to 75% ― Women ... reaching the 8 000 Gap to first 90: ― Men ... 3076 reaching the 6 000 second 90: 50% 3437 Condom use at last higher-risk sex (with a non-marital, non-cohabiting partner) 4 000 25% ― Women ... 2 000 ― Men ... 0 0% People living with HIV who know People living with HIV on People living with HIV who are Women aged 15–49 years who have their their status treatment virally suppressed demand for family planning satisfied by ... modern methods 66% 54% ...% All ages [59–73%] [48–60%] [...–...%] Not Men aged 15–49 years who are circumcised 92% 92% ...% applicable Children (0–14) [76– >95%] [76– >95%] [...–...%] Male circumcisions performed according to Not 44% 34% ...% Women (15+) national standards applicable [40–49%] [31–38%] [...–...%] 74% 61% ...% People who received PrEP at least once Men (15+) ... [66–84%] [54–69%] [...–...%] during the reporting period (2017) Is antiretroviral therapy provided in community settings (such as Harm reduction outside health facilities) for people who are stable on antiretroviral No ― Use of sterile injecting equipment at therapy? ... last injection ― Needles and syringes distributed per ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ... person who injects 2010 2017 ― Coverage of opioid substitution ... Percentage of pregnant women living with HIV 69% 71% therapy accessing antiretroviral medicines [61–77%] [62–79%] ― Naloxone available (2016) No 69% 71% Early infant diagnosis [61–78%] [64–81%] ― Safe injection rooms available (2016) No 21
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	24	ECUADOR COUNTRY DATA EPIDEMIC ESTIMATES 2005 2010 2017 New HIV infections 2100 2100 2000 New HIV infections (all ages) [1400–4000] [1200–4200] [1100–4400] <200 <100 <100 New HIV infections (0–14) [<100– <500] [<100– <500] [<100– <500] 590 590 570 New HIV infections (women, 15+) [<500–1100] [<500–1200] [<500–1100] 1400 1400 1400 New HIV infections (men, 15+) [900–2700] [820–2800] [780–3000] HIV incidence per 1000 population 0.16 [0.1–0.29] 0.14 [0.08–0.29] 0.12 [0.07–0.27] AIDS-related deaths 1700 1200 960 AIDS-related deaths (all ages) [910–3100] [660–2500] [<500–2400] <200 <100 <100 AIDS-related deaths (0–14) [<100– <200] [<100– <200] [<100– <100] <500 <500 <200 AIDS-related deaths (women, 15+) [<500–870] [<200–770] [<100–530] 1100 790 760 AIDS-related deaths (men, 15+) [620–2100] [<500–1600] [<500–1800] People living with HIV 28 000 30 000 36 000 People living with HIV (all ages) [19 000–52 000] [21 000–55 000] [25 000–65 000] 730 710 660 People living with HIV (0–14) [<500–1400] [<500–1400] [<500–1500] 8200 9000 11 000 People living with HIV (women, 15+) [5400–16 000] [6100–17 000] [7800–20 000] 19 000 21 000 24 000 People living with HIV (men, 15+) [13 000–34 000] [14 000–37 000] [17 000–43 000] LAWS AND POLICIES STIGMA AND DISCRIMINATION Laws criminalizing the transmission of, non- ... 2017 disclosure of or exposure to HIV transmission Percentage of women and men aged 15–49 years who report discriminatory attitudes Sex work is not subject to punitive towards people living with HIV Criminalization of sex work 36.9 regulations or is not criminalized Laws penalizing same-sex sexual Percentage of people living with HIV denied Criminalization of same-sex sexual acts acts have been decriminalized or health services because of their HIV status in never existed the last 12 months Possession of drugs for personal Drug use or possession for personal use is an use is specified as a non-criminal offence Percentage of people living with HIV who offence reported a health-care professional told others about their HIV status without their consent Criminalization of transgender people ... Laws or policies restricting the entry, stay and residence of people living with HIV ... VIOLENCE Parental consent for adolescents to access HIV Yes, for adolescents younger than Proportion of ever-married or partnered testing 18 years women aged 15–49 years who experienced physical or sexual violence from a male Spousal consent for married women to access No intimate partner in the past 12 months sexual and reproductive health services Mandatory HIV testing for marriage, work or No residence permits or for certain groups EXPENDITURES Financing sources International: Global International: Domestic private Domestic public International: PEPFAR Total Fund all others Last available report: 2017 ... US$ 24 904 746 ... ... ... US$ 24 904 746 22
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	25	EPIDEMIC TRANSITION METRICS 6 000 3 500 1.5 4 000 N umber of people N umber of people 5 000 3 000 N umber of people 2 500 3 000 4 000 1 2 000 Rate 3 000 2 000 1 500 2 000 1 000 0.5 1 000 1 000 500 0 0 0 0 2000 2005 2010 2015 2000 2005 2010 2015 1990 2000 2010 2000 2005 2010 2015 N ew H IV infections Incidence:prevalence ratio N ew H IV infections A ID S-related deaths D eaths among people Targ et living with HIV Change in new Change in AIDS- Incidence: HIV infections = -1% related deaths = -20% prevalence = 0.06 since 2010 since 2010 ratio KEY POPULATIONS HIV COMORBIDITIES Gay men and Sex other men People who Transgender Estimated number of incident tuberculosis 1100 Prisoners workers who have inject drugs people cases among people living with HIV (2016) [690–1500] sex with men Estimated size of population 34 420 47 410 12 230 12 230 ... Proportion of people living with HIV newly enrolled in HIV care with active tuberculosis 21.3% HIV prevalence ... 16.5% ... 34.8% ... (2016) Know their HIV status ... 56.3% ... 60.4% Cervical cancer screening of women living ... Antiretroviral therapy coverage ... ... ... ... 89.7% with HIV Condom use 96.2% 68.1% ... 50.9% Proportion of people coinfected with HIV and Coverage of HIV prevention hepatitis B virus receiving combined ... ... ... ... ... treatment programmes Avoidance of health care Proportion of people coinfected with HIV and because of stigma and ... ... ... ... hepatitis C virus starting hepatitis C ... discrimination treatment HIV TESTING AND TREATMENT CASCADE HIV PREVENTION 35 000 100% Knowledge of HIV prevention among young people aged 15–24 years 30 000 Number of people living with HIV Gap to 75% ― Women ... 25 000 reaching the Gap to ― Men ... first 90: 20 000 reaching the 9274 second 90: Gap to 50% Condom use at last higher-risk sex (with a 15 000 9854 reaching non-marital, non-cohabiting partner) the third 90: 10 000 14309 25% ― Women ... 5 000 ― Men ... 0 0% People living with HIV who know People living with HIV on People living with HIV who are Women aged 15–49 years who have their their status treatment virally suppressed demand for family planning satisfied by ... modern methods 64% 54% 34% All ages [45– >95%] [37– >95%] [23–60%] Not Men aged 15–49 years who are circumcised ...% >95% ...% applicable Children (0–14) [...–...%] [59– >95%] [...–...%] Male circumcisions performed according to Not ...% 61% ...% Women (15+) national standards applicable [...–...%] [42– >95%] [...–...%] ...% 50% ...% People who received PrEP at least once Men (15+) ... [...–...%] [34–87%] [...–...%] during the reporting period (2017) Is antiretroviral therapy provided in community settings (such as Harm reduction outside health facilities) for people who are stable on antiretroviral ... ― Use of sterile injecting equipment at therapy? ... last injection ― Needles and syringes distributed per ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ... person who injects 2010 2017 ― Coverage of opioid substitution ... Percentage of pregnant women living with HIV 80% 63% therapy accessing antiretroviral medicines [52– >95%] [45– >95%] ― Naloxone available (2016) ... 1% 69% Early infant diagnosis [0–1%] [41– >95%] ― Safe injection rooms available (2016) ... 23
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	26	EL SALVADOR COUNTRY DATA EPIDEMIC ESTIMATES 2005 2010 2017 New HIV infections 1700 1500 1200 New HIV infections (all ages) [1600–1900] [1400–1700] [1100–1300] <100 <100 <100 New HIV infections (0–14) [<100– <100] [<100– <100] [<100– <100] 540 <500 <500 New HIV infections (women, 15+) [<500–590] [<500–520] [<500– <500] 1100 990 790 New HIV infections (men, 15+) [980–1300] [870–1100] [710–890] HIV incidence per 1000 population 0.28 [0.26–0.31] 0.25 [0.23–0.27] 0.19 [0.18–0.21] AIDS-related deaths 530 <500 610 AIDS-related deaths (all ages) [<500–600] [<500– <500] [510–720] <100 <100 <100 AIDS-related deaths (0–14) [<100– <100] [<100– <100] [<100– <100] <200 <200 <200 AIDS-related deaths (women, 15+) [<200– <200] [<100– <200] [<200– <200] <500 <500 <500 AIDS-related deaths (men, 15+) [<500– <500] [<200– <500] [<500–510] People living with HIV 16 000 21 000 25 000 People living with HIV (all ages) [14 000–18 000] [19 000–23 000] [22 000–27 000] <500 <500 520 People living with HIV (0–14) [<500– <500] [<500–500] [<500–590] 5300 6800 8500 People living with HIV (women, 15+) [4700–6000] [6100–7700] [7700–9500] 11 000 13 000 16 000 People living with HIV (men, 15+) [9200–12 000] [12 000–15 000] [14 000–17 000] LAWS AND POLICIES STIGMA AND DISCRIMINATION Laws criminalizing the transmission of, non- Yes 2014 disclosure of or exposure to HIV transmission Percentage of women and men aged 15–49 years who report discriminatory attitudes Sex work is not subject to punitive towards people living with HIV Criminalization of sex work 33.1* regulations or is not criminalized Percentage of people living with HIV denied Criminalization of same-sex sexual acts No specific legislation health services because of their HIV status in the last 12 months Possession of drugs for personal Drug use or possession for personal use is an use is specified as a non-criminal offence Percentage of people living with HIV who offence reported a health-care professional told others Neither criminalized nor about their HIV status without their consent Criminalization of transgender people prosecuted Laws or policies restricting the entry, stay and residence of people living with HIV Yes VIOLENCE Parental consent for adolescents to access HIV No Proportion of ever-married or partnered testing women aged 15–49 years who experienced physical or sexual violence from a male Spousal consent for married women to access No intimate partner in the past 12 months sexual and reproductive health services Mandatory HIV testing for marriage, work or No *Female respondents only residence permits or for certain groups EXPENDITURES Financing sources International: Global International: Domestic private Domestic public International: PEPFAR Total Fund all others Last available report: 2017 US$ 3 366 539 US$ 48 152 828 US$ 2 934 096 US$ 4 816 917 ... US$ 60 112 211 24
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	27	EPIDEMIC TRANSITION METRICS 2 500 800 0.4 2 000 N umber of people N umber of people N umber of people 2 000 600 0.3 1 500 1 500 Rate 400 0.2 1 000 1 000 500 200 0.1 500 0 0 0 0 2000 2005 2010 2015 2000 2005 2010 2015 1990 2000 2010 2000 2005 2010 2015 N ew H IV infections Incidence:prevalence ratio N ew H IV infections A ID S-related deaths D eaths among people Targ et living with HIV Change in new Change in AIDS- Incidence: HIV infections = -20% related deaths = 73% prevalence = 0.05 since 2010 since 2010 ratio KEY POPULATIONS HIV COMORBIDITIES Gay men and Sex other men People who Transgender Estimated number of incident tuberculosis 260 Prisoners workers who have inject drugs people cases among people living with HIV (2016) [170–370] sex with men Estimated size of population 44 972 54 140 ... 1 835 ... Proportion of people living with HIV newly enrolled in HIV care with active tuberculosis ... HIV prevalence 0% 7.7% ... 7.4% 0.1% (2016) Know their HIV status 89.5% 77.3% ... 74.4% Cervical cancer screening of women living ... Antiretroviral therapy coverage ... ... ... ... ... with HIV Condom use 92.9% 58% ... 60.5% Proportion of people coinfected with HIV and Coverage of HIV prevention hepatitis B virus receiving combined ... ... ... ... ... treatment programmes Avoidance of health care Proportion of people coinfected with HIV and because of stigma and ... ... ... ... hepatitis C virus starting hepatitis C ... discrimination treatment HIV TESTING AND TREATMENT CASCADE HIV PREVENTION 25 000 100% Knowledge of HIV prevention among young people aged 15–24 years (2014) Number of people living with HIV 20 000 Gap to ― Women 31.1% 75% reaching the 15 000 first 90: Gap to ― Men 33.9% 3841 reaching the 50% second 90: Gap to Condom use at last higher-risk sex (with a 10 000 reaching non-marital, non-cohabiting partner) 8132 the third 90: 10247 25% 5 000 ― Women ... ― Men ... 0 0% People living with HIV who know People living with HIV on People living with HIV who are Women aged 15–49 years who have their their status treatment virally suppressed demand for family planning satisfied by ... modern methods 74% 48% 31% All ages [67–83%] [43–53%] [28–35%] Not Men aged 15–49 years who are circumcised ...% 34% ...% applicable Children (0–14) [...–...%] [29–39%] [...–...%] Male circumcisions performed according to Not ...% 56% ...% Women (15+) national standards applicable [...–...%] [51–62%] [...–...%] ...% 44% ...% People who received PrEP at least once Men (15+) ... [...–...%] [39–49%] [...–...%] during the reporting period (2017) Is antiretroviral therapy provided in community settings (such as Harm reduction outside health facilities) for people who are stable on antiretroviral No ― Use of sterile injecting equipment at therapy? ... last injection ― Needles and syringes distributed per ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ... person who injects 2010 2017 ― Coverage of opioid substitution ... Percentage of pregnant women living with HIV 25% 35% therapy accessing antiretroviral medicines [22–28%] [31–39%] ― Naloxone available (2016) No 28% 34% Early infant diagnosis [25–32%] [31–39%] ― Safe injection rooms available (2016) No 25
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	28	GUATEMALA COUNTRY DATA EPIDEMIC ESTIMATES 2005 2010 2017 New HIV infections 3300 2700 2300 New HIV infections (all ages) [2700–4200] [2200–3400] [1700–3100] <500 <500 <500 New HIV infections (0–14) [<500– <500] [<200– <500] [<500– <500] 1200 970 760 New HIV infections (women, 15+) [950–1500] [790–1200] [540–1000] 1900 1500 1300 New HIV infections (men, 15+) [1500–2500] [1200–1900] [940–1800] HIV incidence per 1000 population 0.26 [0.21–0.33] 0.19 [0.15–0.23] 0.14 [0.1–0.19] AIDS-related deaths 720 840 2000 AIDS-related deaths (all ages) [<500–1100] [530–1200] [1500–2500] <200 <200 <200 AIDS-related deaths (0–14) [<200– <200] [<200– <200] [<200– <500] <500 <500 540 AIDS-related deaths (women, 15+) [<200– <500] [<200– <500] [<500–700] <500 <500 1200 AIDS-related deaths (men, 15+) [<500–530] [<500–710] [980–1500] People living with HIV 30 000 40 000 46 000 People living with HIV (all ages) [25 000–35 000] [35 000–45 000] [40 000–52 000] 970 1300 1800 People living with HIV (0–14) [790–1200] [1100–1500] [1600–2000] 9200 13 000 17 000 People living with HIV (women, 15+) [7600–11 000] [12 000–15 000] [15 000–19 000] 20 000 25 000 28 000 People living with HIV (men, 15+) [16 000–24 000] [22 000–29 000] [24 000–32 000] LAWS AND POLICIES STIGMA AND DISCRIMINATION Laws criminalizing the transmission of, non- No, but prosecutions exist based 2015 disclosure of or exposure to HIV transmission on general criminal laws Percentage of women and men aged 15–49 years who report discriminatory attitudes towards people living with HIV Criminalization of sex work Partial criminalization of sex work 57.3 Laws penalizing same-sex sexual Percentage of people living with HIV denied Criminalization of same-sex sexual acts acts have been decriminalized or health services because of their HIV status in never existed the last 12 months Possession of drugs for personal Drug use or possession for personal use is an use is specified as a criminal offence Percentage of people living with HIV who offence reported a health-care professional told others Neither criminalized nor about their HIV status without their consent Criminalization of transgender people prosecuted Laws or policies restricting the entry, stay and residence of people living with HIV No VIOLENCE Parental consent for adolescents to access HIV Yes, for adolescents younger than Proportion of ever-married or partnered 2015 testing 18 years women aged 15–49 years who experienced physical or sexual violence from a male Spousal consent for married women to access No intimate partner in the past 12 months 8.5 sexual and reproductive health services Mandatory HIV testing for marriage, work or Yes residence permits or for certain groups EXPENDITURES Financing sources International: Global International: Domestic private Domestic public International: PEPFAR Total Fund all others Last available report: 2016 US$ 2 482 205 US$ 32 542 621 US$ 5 366 063 US$ 8 558 383 US$ 1 515 104 US$ 50 464 376 26
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	29	EPIDEMIC TRANSITION METRICS 6 000 3 000 0.6 4 000 N umber of people N umber of people 5 000 N umber of people 2 500 0.5 3 000 4 000 2 000 0.4 Rate 3 000 1 500 0.3 2 000 2 000 1 000 0.2 1 000 1 000 500 0.1 0 0 0 0 2000 2005 2010 2015 2000 2005 2010 2015 1990 2000 2010 2000 2005 2010 2015 N ew H IV infections Incidence:prevalence ratio N ew H IV infections A ID S-related deaths D eaths among people Targ et living with HIV Change in new Change in AIDS- Incidence: HIV infections = -14% related deaths = 133% prevalence = 0.05 since 2010 since 2010 ratio KEY POPULATIONS HIV COMORBIDITIES Gay men and Sex other men People who Transgender Estimated number of incident tuberculosis 310 Prisoners workers who have inject drugs people cases among people living with HIV (2016) [200–440] sex with men Estimated size of population ... ... ... 4 840 20 853 Proportion of people living with HIV newly enrolled in HIV care with active tuberculosis 5.4% HIV prevalence 1.6% 7.14% ... 22.2% ... (2016) Know their HIV status 85.9% 77.9% ... ... Cervical cancer screening of women living ... Antiretroviral therapy coverage 0.8% 26.02% ... ... ... with HIV Condom use 97.7% 63.3% ... ... Proportion of people coinfected with HIV and Coverage of HIV prevention hepatitis B virus receiving combined 87.5% 29% 26% ... 29% treatment (2017) programmes Avoidance of health care Proportion of people coinfected with HIV and because of stigma and ... ... ... ... hepatitis C virus starting hepatitis C ... discrimination treatment HIV TESTING AND TREATMENT CASCADE HIV PREVENTION 45 000 100% Knowledge of HIV prevention among young people aged 15–24 years (2015) 40 000 Number of people living with HIV 35 000 Gap to 75% ― Women 22.2% 30 000 reaching the first 90: ― Men 21.9% 25 000 10571 Gap to reaching the 50% 20 000 Gap to Condom use at last higher-risk sex (with a second 90: 19479 reaching non-marital, non-cohabiting partner) (2015) 15 000 the third 90: 10 000 20688 25% ― Women 19.9% 5 000 ― Men 45.3% 0 0% People living with HIV who know People living with HIV on People living with HIV who are Women aged 15–49 years who have their their status treatment virally suppressed demand for family planning satisfied by 66.2% modern methods (2015) 67% 39% 28% All ages [59–76%] [34–44%] [25–32%] Men aged 15–49 years who are circumcised Not ...% 42% 30% (2015) applicable Children (0–14) [...–...%] [37–48%] [26–33%] Male circumcisions performed according to Not ...% 40% 28% Women (15+) national standards applicable [...–...%] [36–46%] [25–32%] ...% 38% 28% People who received PrEP at least once Men (15+) 30 [...–...%] [33–43%] [24–32%] during the reporting period (2017) Is antiretroviral therapy provided in community settings (such as Harm reduction outside health facilities) for people who are stable on antiretroviral No ― Use of sterile injecting equipment at therapy? ... last injection ― Needles and syringes distributed per ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ... person who injects 2010 2017 ― Coverage of opioid substitution ... Percentage of pregnant women living with HIV 25% 21% therapy accessing antiretroviral medicines [22–28%] [18–24%] ― Naloxone available (2016) ... ...% 17% Early infant diagnosis [...–...%] [15–19%] ― Safe injection rooms available (2016) ... 27
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	30	HONDURAS COUNTRY DATA EPIDEMIC ESTIMATES 2005 2010 2017 New HIV infections 1000 840 880 New HIV infections (all ages) [720–1400] [570–1200] [560–1200] <200 <100 <100 New HIV infections (0–14) [<200– <500] [<100– <200] [<100– <100] <500 <500 <500 New HIV infections (women, 15+) [<200– <500] [<200– <500] [<200– <500] 610 530 580 New HIV infections (men, 15+) [<500–850] [<500–750] [<500–810] HIV incidence per 1000 population 0.15 [0.1–0.2] 0.11 [0.07–0.15] 0.1 [0.06–0.13] AIDS-related deaths 2200 1500 1000 AIDS-related deaths (all ages) [1800–2700] [1200–1900] [690–1400] <200 <100 <100 AIDS-related deaths (0–14) [<200– <200] [<100– <100] [<100– <100] 510 <500 <500 AIDS-related deaths (women, 15+) [<500–640] [<500– <500] [<200– <500] 1600 1200 710 AIDS-related deaths (men, 15+) [1300–1900] [900–1400] [<500–960] People living with HIV 31 000 26 000 22 000 People living with HIV (all ages) [25 000–37 000] [20 000–32 000] [17 000–27 000] 1500 1300 830 People living with HIV (0–14) [1300–1800] [1100–1500] [620–1000] 9300 8600 8200 People living with HIV (women, 15+) [7700–11 000] [7100–10 000] [6800–9800] 20 000 16 000 13 000 People living with HIV (men, 15+) [16 000–24 000] [12 000–20 000] [10 000–16 000] LAWS AND POLICIES STIGMA AND DISCRIMINATION Laws criminalizing the transmission of, non- No, but prosecutions exist based 2006 2012 disclosure of or exposure to HIV transmission on general criminal laws Percentage of women and men aged 15–49 years who report discriminatory attitudes Sex work is not subject to punitive towards people living with HIV Criminalization of sex work 50.8* 44.9 regulations or is not criminalized Percentage of people living with HIV denied 2013 Criminalization of same-sex sexual acts No specific legislation health services because of their HIV status in the last 12 months 4.1 Possession of drugs for personal Drug use or possession for personal use is an use is specified as a criminal 2013 offence Percentage of people living with HIV who offence reported a health-care professional told others Neither criminalized nor about their HIV status without their consent Criminalization of transgender people 9.9 prosecuted Laws or policies restricting the entry, stay and residence of people living with HIV No VIOLENCE Parental consent for adolescents to access HIV Yes, for adolescents younger than Proportion of ever-married or partnered 2012 testing 18 years women aged 15–49 years who experienced physical or sexual violence from a male Spousal consent for married women to access No intimate partner in the past 12 months 11 sexual and reproductive health services Mandatory HIV testing for marriage, work or Yes *Female respondents only residence permits or for certain groups EXPENDITURES Financing sources International: Global International: Domestic private Domestic public International: PEPFAR Total Fund all others Last available report: 2013 US$ 3 692 374 US$ 15 784 431 US$ 4 855 998 US$ 8 468 368 US$ 1 958 363 US$ 36 713 777 28
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	31	EPIDEMIC TRANSITION METRICS 3 000 4 000 0.4 3 000 N umber of people N umber of people 2 500 N umber of people 3 000 0.3 2 000 2 000 Rate 1 500 2 000 0.2 1 000 1 000 1 000 0.1 500 0 0 0 0 2000 2005 2010 2015 2000 2005 2010 2015 1990 2000 2010 2000 2005 2010 2015 N ew H IV infections Incidence:prevalence ratio N ew H IV infections A ID S-related deaths D eaths among people Targ et living with HIV Change in new Change in AIDS- Incidence: HIV infections = 4% related deaths = -33% prevalence = 0.04 since 2010 since 2010 ratio KEY POPULATIONS HIV COMORBIDITIES Gay men and Sex other men People who Transgender Estimated number of incident tuberculosis 310 Prisoners workers who have inject drugs people cases among people living with HIV (2016) [240–400] sex with men Estimated size of population 22 771 40 949 2 658 2 975 ... Proportion of people living with HIV newly enrolled in HIV care with active tuberculosis 8.3% HIV prevalence 3.6% 12.4% ... 9.7% 1.7% (2016) Know their HIV status ... ... ... ... Cervical cancer screening of women living ... Antiretroviral therapy coverage ... ... ... ... ... with HIV Condom use 93.8% 84.8% ... 91.2% Proportion of people coinfected with HIV and Coverage of HIV prevention hepatitis B virus receiving combined ... ... 70.6% ... ... treatment programmes Avoidance of health care Proportion of people coinfected with HIV and because of stigma and ... ... ... ... hepatitis C virus starting hepatitis C ... discrimination treatment HIV TESTING AND TREATMENT CASCADE HIV PREVENTION 20 000 100% Knowledge of HIV prevention among young 18 000 people aged 15–24 years Number of people living with HIV 16 000 ― Women ... 75% 14 000 Gap to 12 000 reaching the ― Men ... Gap to second 90: 10 000 reaching 50% 6401 the third 90: Condom use at last higher-risk sex (with a 8 000 non-marital, non-cohabiting partner) 6279 6 000 25% 4 000 ― Women ... 2 000 ― Men ... 0 0% People living with HIV who know People living with HIV on People living with HIV who are Women aged 15–49 years who have their their status treatment virally suppressed demand for family planning satisfied by 75.9% modern methods (2012) ...% 52% 45% All ages [...–...%] [41–63%] [35–54%] Not Men aged 15–49 years who are circumcised ...% 65% 51% applicable Children (0–14) [...–...%] [49–79%] [38–62%] Male circumcisions performed according to Not ...% 65% 56% Women (15+) national standards applicable [...–...%] [54–78%] [46–66%] ...% 43% 37% People who received PrEP at least once Men (15+) ... [...–...%] [33–54%] [29–47%] during the reporting period (2017) Is antiretroviral therapy provided in community settings (such as Harm reduction outside health facilities) for people who are stable on antiretroviral No ― Use of sterile injecting equipment at therapy? ... last injection ― Needles and syringes distributed per ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ... person who injects 2010 2017 ― Coverage of opioid substitution ... Percentage of pregnant women living with HIV 52% 53% therapy accessing antiretroviral medicines [42–62%] [41–63%] ― Naloxone available (2016) No 69% 59% Early infant diagnosis [59–86%] [50–76%] ― Safe injection rooms available (2016) No 29
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	32	MEXICO COUNTRY DATA EPIDEMIC ESTIMATES 2005 2010 2017 New HIV infections 12 000 13 000 15 000 New HIV infections (all ages) [10 000–12 000] [12 000–14 000] [13 000–16 000] <500 <500 <500 New HIV infections (0–14) [<500– <500] [<500– <500] [<500– <500] 2500 2700 3100 New HIV infections (women, 15+) [2200–2700] [2400–2900] [2800–3500] 8700 10 000 11 000 New HIV infections (men, 15+) [7700–9400] [8700–11 000] [9500–12 000] HIV incidence per 1000 population 0.11 [0.1–0.12] 0.11 [0.1–0.12] 0.12 [0.1–0.13] AIDS-related deaths 4700 3900 4000 AIDS-related deaths (all ages) [4100–5500] [3200–4600] [3200–5200] <500 <200 <200 AIDS-related deaths (0–14) [<500– <500] [<200– <200] [<200– <200] 710 790 760 AIDS-related deaths (women, 15+) [610–790] [660–900] [560–950] 3800 2900 3100 AIDS-related deaths (men, 15+) [3200–4500] [2300–3600] [2300–4100] People living with HIV 140 000 170 000 230 000 People living with HIV (all ages) [120 000–150 000] [160 000–190 000] [210 000–260 000] 1800 2200 2600 People living with HIV (0–14) [1600–1900] [2000–2400] [2300–2900] 25 000 35 000 50 000 People living with HIV (women, 15+) [23 000–28 000] [32 000–38 000] [45 000–54 000] 110 000 140 000 180 000 People living with HIV (men, 15+) [95 000–120 000] [120 000–150 000] [160 000–200 000] LAWS AND POLICIES STIGMA AND DISCRIMINATION Laws criminalizing the transmission of, non- Yes 2015 disclosure of or exposure to HIV transmission Percentage of women and men aged 15–49 years who report discriminatory attitudes towards people living with HIV Criminalization of sex work Partial criminalization of sex work 15.4* Percentage of people living with HIV denied Criminalization of same-sex sexual acts No specific legislation health services because of their HIV status in the last 12 months Possession of drugs for personal Drug use or possession for personal use is an use is specified as a non-criminal offence Percentage of people living with HIV who offence reported a health-care professional told others Neither criminalized nor about their HIV status without their consent Criminalization of transgender people prosecuted Laws or policies restricting the entry, stay and residence of people living with HIV No VIOLENCE Parental consent for adolescents to access HIV Yes, for adolescents younger than Proportion of ever-married or partnered 2011 2016 testing 18 years women aged 15–49 years who experienced physical or sexual violence from a male Spousal consent for married women to access No intimate partner in the past 12 months 6.5 8.1 sexual and reproductive health services Mandatory HIV testing for marriage, work or No *Female respondents only residence permits or for certain groups EXPENDITURES Financing sources International: Global International: Domestic private Domestic public International: PEPFAR Total Fund all others Last available report: 2015 US$ 67 939 646 US$ 867 060 986 ... ... US$ 283 595 US$ 936 191 579 30
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	33	EPIDEMIC TRANSITION METRICS 20 000 7 000 0.25 20 000 N umber of people N umber of people 6 000 N umber of people 15 000 0.2 5 000 15 000 4 000 0.15 Rate 10 000 10 000 3 000 0.1 5 000 2 000 5 000 1 000 0.05 0 0 0 0 2000 2005 2010 2015 2000 2005 2010 2015 1990 2000 2010 2000 2005 2010 2015 N ew H IV infections Incidence:prevalence ratio N ew H IV infections A ID S-related deaths D eaths among people Targ et living with HIV Change in new Change in AIDS- Incidence: HIV infections = 12% related deaths = 3% prevalence = 0.06 since 2010 since 2010 ratio KEY POPULATIONS HIV COMORBIDITIES Gay men and 3700 Sex other men People who Transgender Estimated number of incident tuberculosis Prisoners [2800 workers who have inject drugs people cases among people living with HIV (2016) sex with men –4700] Estimated size of population 239 333 1 175 098 109 079 117 510 204 617 Proportion of people living with HIV newly enrolled in HIV care with active tuberculosis 5.3% HIV prevalence ... 20.7% 2.5% ... 0.7% (2016) Know their HIV status 65.8% 39.8% ... 62.3% Cervical cancer screening of women living ... Antiretroviral therapy coverage ... ... ... ... ... with HIV Condom use 86.8% 65.3% 27.8% ... Proportion of people coinfected with HIV and Coverage of HIV prevention hepatitis B virus receiving combined ... ... ... ... ... treatment programmes Avoidance of health care Proportion of people coinfected with HIV and because of stigma and ... ... ... ... hepatitis C virus starting hepatitis C ... discrimination treatment HIV TESTING AND TREATMENT CASCADE HIV PREVENTION 250 000 100% Knowledge of HIV prevention among young people aged 15–24 years (2015) Number of people living with HIV 200 000 ― Women 31.3% 75% Gap to 150 000 reaching the Gap to ― Men ... first 90: reaching the second 90: Gap to 50% 61203 Condom use at last higher-risk sex (with a 100 000 45097 reaching the third 90: non-marital, non-cohabiting partner) 62904 25% 50 000 ― Women ... ― Men ... 0 0% People living with HIV who know People living with HIV on People living with HIV who are Women aged 15–49 years who have their their status treatment virally suppressed demand for family planning satisfied by ... modern methods 64% 62% 46% All ages [58–70%] [56–68%] [42–51%] Not Men aged 15–49 years who are circumcised >95% 69% 47% applicable Children (0–14) [92– >95%] [61–77%] [42–53%] Male circumcisions performed according to Not 62% 57% 42% Women (15+) national standards applicable [56–68%] [52–62%] [38–46%] 64% 63% 47% People who received PrEP at least once Men (15+) ... [57–70%] [57–70%] [43–52%] during the reporting period (2017) Is antiretroviral therapy provided in community settings (such as Harm reduction outside health facilities) for people who are stable on antiretroviral Yes ― Use of sterile injecting equipment at therapy? 71.3% last injection (2014) ― Needles and syringes distributed per ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION 6.19 person who injects (2017) 2010 2017 ― Coverage of opioid substitution ... Percentage of pregnant women living with HIV 32% 49% therapy accessing antiretroviral medicines [28–35%] [44–54%] ― Naloxone available (2016) No ...% ...% Early infant diagnosis [...–...%] [...–...%] ― Safe injection rooms available (2016) No 31
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	34	NICARAGUA COUNTRY DATA EPIDEMIC ESTIMATES 2005 2010 2017 New HIV infections 770 <500 <500 New HIV infections (all ages) [510–1200] [<500–690] [<500–680] <100 <100 <100 New HIV infections (0–14) [<100– <100] [<100– <100] [<100– <100] <500 <200 <200 New HIV infections (women, 15+) [<200– <500] [<100– <200] [<100– <200] <500 <500 <500 New HIV infections (men, 15+) [<500–800] [<500– <500] [<200– <500] HIV incidence per 1000 population 0.14 [0.1–0.23] 0.08 [0.06–0.12] 0.07 [0.04–0.11] AIDS-related deaths 500 500 <500 AIDS-related deaths (all ages) [<500–730] [<500–730] [<500–560] <100 <100 <100 AIDS-related deaths (0–14) [<100– <100] [<100– <100] [<100– <100] <200 <200 <100 AIDS-related deaths (women, 15+) [<100– <200] [<200– <500] [<100– <200] <500 <500 <500 AIDS-related deaths (men, 15+) [<500– <500] [<500– <500] [<200– <500] People living with HIV 9700 9300 9000 People living with HIV (all ages) [7000–14 000] [6800–13 000] [7000–12 000] <500 <500 <200 People living with HIV (0–14) [<500– <500] [<500– <500] [<200– <500] 2900 2800 2900 People living with HIV (women, 15+) [2100–4200] [2000–4100] [2300–3800] 6500 6200 6000 People living with HIV (men, 15+) [4600–9100] [4500–9200] [4500–8000] LAWS AND POLICIES STIGMA AND DISCRIMINATION Laws criminalizing the transmission of, non- Yes disclosure of or exposure to HIV transmission Percentage of women and men aged 15–49 years who report discriminatory attitudes Sex work is not subject to punitive towards people living with HIV Criminalization of sex work regulations or is not criminalized Laws penalizing same-sex sexual Percentage of people living with HIV denied 2013 Criminalization of same-sex sexual acts acts have been decriminalized or health services because of their HIV status in never existed the last 12 months 4 Possession of drugs for personal Drug use or possession for personal use is an use is specified as a non-criminal 2013 offence Percentage of people living with HIV who offence reported a health-care professional told others Neither criminalized nor about their HIV status without their consent Criminalization of transgender people 8.1 prosecuted Laws or policies restricting the entry, stay and residence of people living with HIV ... VIOLENCE Parental consent for adolescents to access HIV Yes, for adolescents younger than Proportion of ever-married or partnered 2012 testing 16 years women aged 15–49 years who experienced physical or sexual violence from a male Spousal consent for married women to access No intimate partner in the past 12 months 30.1 sexual and reproductive health services Mandatory HIV testing for marriage, work or Yes residence permits or for certain groups EXPENDITURES Financing sources International: Global International: Domestic private Domestic public International: PEPFAR Total Fund all others Last available report: 2010 US$ 1 150 592 US$ 9 682 304 ... US$ 9 155 592 US$ 2 713 494 US$ 24 894 867 32
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	35	EPIDEMIC TRANSITION METRICS 2 000 800 0.8 1 500 N umber of people N umber of people N umber of people 1 500 600 0.6 1 000 Rate 1 000 400 0.4 500 500 200 0.2 0 0 0 0 2000 2005 2010 2015 2000 2005 2010 2015 1990 2000 2010 2000 2005 2010 2015 N ew H IV infections Incidence:prevalence ratio N ew H IV infections A ID S-related deaths D eaths among people Targ et living with HIV Change in new Change in AIDS- Incidence: HIV infections = -9% related deaths = -36% prevalence = 0.05 since 2010 since 2010 ratio KEY POPULATIONS HIV COMORBIDITIES Gay men and Sex other men People who Transgender Estimated number of incident tuberculosis 140 Prisoners workers who have inject drugs people cases among people living with HIV (2016) [100–170] sex with men Estimated size of population 14 810 34 082 ... 6 462 10 000 Proportion of people living with HIV newly enrolled in HIV care with active tuberculosis 4.5% HIV prevalence 2.6% 8.6% ... 8.1% 3.1% (2016) Know their HIV status 83% ... ... ... Cervical cancer screening of women living ... Antiretroviral therapy coverage ... ... ... ... 79.5% with HIV Condom use 92.1% 55.1% ... 60.4% Proportion of people coinfected with HIV and Coverage of HIV prevention hepatitis B virus receiving combined 100% 88.4% 70.8% ... 88.4% treatment (2017) programmes Avoidance of health care Proportion of people coinfected with HIV and because of stigma and ... ... ... ... hepatitis C virus starting hepatitis C ... discrimination treatment HIV TESTING AND TREATMENT CASCADE HIV PREVENTION 8 000 100% Knowledge of HIV prevention among young people aged 15–24 years 7 000 Number of people living with HIV 6 000 75% ― Women ... Gap to 5 000 reaching the ― Men ... 4 000 second 90: 50% 2957 Gap to Condom use at last higher-risk sex (with a 3 000 reaching non-marital, non-cohabiting partner) the third 90: 2 000 4648 25% ― Women ... 1 000 ― Men ... 0 0% People living with HIV who know People living with HIV on People living with HIV who are Women aged 15–49 years who have their their status treatment virally suppressed demand for family planning satisfied by ... modern methods ...% 48% 21% All ages [...–...%] [38–63%] [17–28%] Not Men aged 15–49 years who are circumcised ...% 73% 39% applicable Children (0–14) [...–...%] [54– >95%] [29–62%] Male circumcisions performed according to Not ...% 49% 21% Women (15+) national standards applicable [...–...%] [38–65%] [17–28%] ...% 47% 21% People who received PrEP at least once Men (15+) ... [...–...%] [36–64%] [16–28%] during the reporting period (2017) Is antiretroviral therapy provided in community settings (such as Harm reduction outside health facilities) for people who are stable on antiretroviral No ― Use of sterile injecting equipment at therapy? ... last injection ― Needles and syringes distributed per ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ... person who injects 2010 2017 ― Coverage of opioid substitution ... Percentage of pregnant women living with HIV 58% 88% therapy accessing antiretroviral medicines [43–87%] [68– >95%] ― Naloxone available (2016) No 38% 75% Early infant diagnosis [25–51%] [58– >95%] ― Safe injection rooms available (2016) No 33
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	36	PANAMA COUNTRY DATA EPIDEMIC ESTIMATES 2005 2010 2017 New HIV infections 1300 1500 1600 New HIV infections (all ages) [1200–1400] [1300–1600] [1400–1800] <100 <100 <100 New HIV infections (0–14) [<100– <100] [<100– <100] [<100– <100] <500 <500 <500 New HIV infections (women, 15+) [<500– <500] [<500– <500] [<500–510] 920 1000 1100 New HIV infections (men, 15+) [800–1000] [860–1100] [940–1300] HIV incidence per 1000 population 0.41 [0.37–0.45] 0.41 [0.37–0.45] 0.4 [0.35–0.44] AIDS-related deaths <500 520 680 AIDS-related deaths (all ages) [<500–540] [<500–610] [550–810] <100 <100 <100 AIDS-related deaths (0–14) [<100– <100] [<100– <100] [<100– <100] <200 <200 <200 AIDS-related deaths (women, 15+) [<200– <200] [<200– <200] [<200– <500] <500 <500 <500 AIDS-related deaths (men, 15+) [<500– <500] [<500– <500] [<500–590] People living with HIV 14 000 19 000 25 000 People living with HIV (all ages) [12 000–16 000] [17 000–21 000] [23 000–27 000] <500 <500 <500 People living with HIV (0–14) [<500– <500] [<500– <500] [<500–510] 4200 5500 7400 People living with HIV (women, 15+) [3800–4800] [5000–6200] [6700–8200] 9800 13 000 17 000 People living with HIV (men, 15+) [8500–11 000] [11 000–14 000] [15 000–19 000] LAWS AND POLICIES STIGMA AND DISCRIMINATION Laws criminalizing the transmission of, non- Yes 2013 disclosure of or exposure to HIV transmission Percentage of women and men aged 15–49 years who report discriminatory attitudes Other punitive regulation of sex towards people living with HIV Criminalization of sex work 36.5* work Laws penalizing same-sex sexual Percentage of people living with HIV denied Criminalization of same-sex sexual acts acts have been decriminalized or health services because of their HIV status in never existed the last 12 months Possession of drugs for personal Drug use or possession for personal use is an use is specified as a criminal offence Percentage of people living with HIV who offence reported a health-care professional told others Neither criminalized nor about their HIV status without their consent Criminalization of transgender people prosecuted Laws or policies restricting the entry, stay and residence of people living with HIV No VIOLENCE Parental consent for adolescents to access HIV Yes, for adolescents younger than Proportion of ever-married or partnered testing 16 years women aged 15–49 years who experienced physical or sexual violence from a male Spousal consent for married women to access No intimate partner in the past 12 months sexual and reproductive health services Mandatory HIV testing for marriage, work or Yes *Female respondents only residence permits or for certain groups EXPENDITURES Financing sources International: Global International: Domestic private Domestic public International: PEPFAR Total Fund all others Last available report: 2012 US$ 25 136 198 US$ 19 286 886 US$ 2 020 143 US$ 919 786 US$ 25 796 641 US$ 47 835 016 34
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	37	EPIDEMIC TRANSITION METRICS 2 000 1 000 0.3 2 000 N umber of people N umber of people N umber of people 800 0.25 1 500 1 500 0.2 600 Rate 1 000 0.15 1 000 400 0.1 500 200 500 0.05 0 0 0 0 2000 2005 2010 2015 2000 2005 2010 2015 1990 2000 2010 2000 2005 2010 2015 N ew H IV infections Incidence:prevalence ratio N ew H IV infections A ID S-related deaths D eaths among people Targ et living with HIV Change in new Change in AIDS- Incidence: HIV infections = 10% related deaths = 31% prevalence = 0.06 since 2010 since 2010 ratio KEY POPULATIONS HIV COMORBIDITIES Gay men and Sex other men People who Transgender Estimated number of incident tuberculosis 250 Prisoners workers who have inject drugs people cases among people living with HIV (2016) [160–360] sex with men Estimated size of population 5 217 15 842 ... 888 17 618 Proportion of people living with HIV newly enrolled in HIV care with active tuberculosis ... HIV prevalence 4.6% 12.1% ... 29.6% 0.8% (2016) Know their HIV status 54.4% 94.4% ... 95.4% Cervical cancer screening of women living ... Antiretroviral therapy coverage ... 56.6% ... 34.6% 94% with HIV Condom use 93.7% 75% ... 93.9% Proportion of people coinfected with HIV and Coverage of HIV prevention hepatitis B virus receiving combined ... 99.4% 100% ... 99.4% treatment programmes Avoidance of health care Proportion of people coinfected with HIV and because of stigma and ... ... ... ... hepatitis C virus starting hepatitis C ... discrimination treatment HIV TESTING AND TREATMENT CASCADE HIV PREVENTION 25 000 100% Knowledge of HIV prevention among young people aged 15–24 years Number of people living with HIV 20 000 ― Women ... Gap to 75% reaching the 15 000 first 90: Gap to ― Men ... 4975 reaching the 50% second 90: Condom use at last higher-risk sex (with a 10 000 6940 Gap to non-marital, non-cohabiting partner) reaching the third 90: 25% 5 000 12787 ― Women ... ― Men ... 0 0% People living with HIV who know People living with HIV on People living with HIV who are Women aged 15–49 years who have their their status treatment virally suppressed demand for family planning satisfied by ... modern methods 70% 53% 21% All ages [64–77%] [48–58%] [20–24%] Not Men aged 15–49 years who are circumcised >95% 51% 30% applicable Children (0–14) [>95– >95%] [42–61%] [25–36%] Male circumcisions performed according to Not 73% 55% 20% Women (15+) national standards applicable [66–81%] [49–60%] [18–22%] 67% 52% 22% People who received PrEP at least once Men (15+) ... [60–75%] [47–59%] [20–25%] during the reporting period (2017) Is antiretroviral therapy provided in community settings (such as Harm reduction outside health facilities) for people who are stable on antiretroviral No ― Use of sterile injecting equipment at therapy? ... last injection ― Needles and syringes distributed per ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ... person who injects 2010 2017 ― Coverage of opioid substitution ... Percentage of pregnant women living with HIV 50% 55% therapy accessing antiretroviral medicines [44–56%] [49–60%] ― Naloxone available (2016) No 30% 49% Early infant diagnosis [27–35%] [45–56%] ― Safe injection rooms available (2016) No 35
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	38	PARAGUAY COUNTRY DATA EPIDEMIC ESTIMATES 2005 2010 2017 New HIV infections 1600 1400 1400 New HIV infections (all ages) [1000–2800] [860–2800] [640–4900] <100 <100 <100 New HIV infections (0–14) [<100– <200] [<100– <200] [<100– <200] <500 <500 <500 New HIV infections (women, 15+) [<500–810] [<500–750] [<200–1300] 1100 960 950 New HIV infections (men, 15+) [660–2000] [570–1900] [<500–3300] HIV incidence per 1000 population 0.28 [0.17–0.49] 0.23 [0.14–0.46] 0.2 [0.09–0.72] AIDS-related deaths ... ... ... AIDS-related deaths (all ages) [...–...] [...–...] [...–...] ... ... ... AIDS-related deaths (0–14) [...–...] [...–...] [...–...] ... ... ... AIDS-related deaths (women, 15+) [...–...] [...–...] [...–...] ... ... ... AIDS-related deaths (men, 15+) [...–...] [...–...] [...–...] People living with HIV 12 000 16 000 20 000 People living with HIV (all ages) [6200–21 000] [10 000–27 000] [13 000–43 000] <500 <500 <500 People living with HIV (0–14) [<200– <500] [<200–570] [<500–700] 3400 4500 5900 People living with HIV (women, 15+) [1800–6200] [3100–8300] [3800–12 000] 8300 11 000 14 000 People living with HIV (men, 15+) [4300–14 000] [7100–18 000] [8500–30 000] LAWS AND POLICIES STIGMA AND DISCRIMINATION Laws criminalizing the transmission of, non- No disclosure of or exposure to HIV transmission Percentage of women and men aged 15–49 years who report discriminatory attitudes Sex work is not subject to punitive towards people living with HIV Criminalization of sex work regulations or is not criminalized Percentage of people living with HIV denied 2016 Criminalization of same-sex sexual acts No penalty specified health services because of their HIV status in the last 12 months 16.5 Possession of drugs for personal Drug use or possession for personal use is an use is specified as a criminal 2016 offence Percentage of people living with HIV who offence reported a health-care professional told others Neither criminalized nor about their HIV status without their consent Criminalization of transgender people 19.8 prosecuted Laws or policies restricting the entry, stay and residence of people living with HIV Yes VIOLENCE Parental consent for adolescents to access HIV No Proportion of ever-married or partnered testing women aged 15–49 years who experienced physical or sexual violence from a male Spousal consent for married women to access No intimate partner in the past 12 months sexual and reproductive health services Mandatory HIV testing for marriage, work or No residence permits or for certain groups EXPENDITURES Financing sources International: Global International: Domestic private Domestic public International: PEPFAR Total Fund all others Last available report: 2013 US$ 1 133 010 US$ 10 841 743 ... US$ 2 932 872 ... US$ 14 941 352 36
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	39	EPIDEMIC TRANSITION METRICS 6 000 1 1.5 2 000 N umber of people N umber of people 5 000 N umber of people 1 1 500 4 000 1 1 Rate 3 000 1 000 0 2 000 0.5 0 500 1 000 0 0 0 0 2000 2005 2010 2015 2000 2005 2010 2015 1990 2000 2010 2000 2005 2010 2015 N ew H IV infections Incidence:prevalence ratio N ew H IV infections A ID S-related deaths D eaths among people Targ et living with HIV Change in new Change in AIDS- Incidence: HIV infections = -1% related deaths = prevalence = 0.07 since 2010 since 2010 ratio KEY POPULATIONS HIV COMORBIDITIES Gay men and Sex other men People who Transgender Estimated number of incident tuberculosis 270 Prisoners workers who have inject drugs people cases among people living with HIV (2016) [170–390] sex with men Estimated size of population 5 180 15 868 ... 719 ... Proportion of people living with HIV newly enrolled in HIV care with active tuberculosis 10.1% HIV prevalence 1.34% 20.7% ... 23.03% ... (2016) Know their HIV status ... 80.3% ... 86.9% Cervical cancer screening of women living ... Antiretroviral therapy coverage ... 26.1% ... 60.7% ... with HIV Condom use 96% 66.8% 44.7% 54.3% Proportion of people coinfected with HIV and Coverage of HIV prevention hepatitis B virus receiving combined 96.5% ... ... ... ... treatment (2017) programmes Avoidance of health care Proportion of people coinfected with HIV and because of stigma and 5.8% 23.6% ... ... hepatitis C virus starting hepatitis C ... discrimination treatment HIV TESTING AND TREATMENT CASCADE HIV PREVENTION 20 000 100% Knowledge of HIV prevention among young 18 000 people aged 15–24 years (2016) Number of people living with HIV 16 000 ― Women 27.5% Gap to 75% 14 000 reaching the 12 000 first 90: ― Men ... 4343 Gap to 10 000 reaching the 50% Condom use at last higher-risk sex (with a 8 000 second 90: Gap to non-marital, non-cohabiting partner) 6 000 8266 reaching the third 90: 25% 4 000 10080 ― Women ... 2 000 ― Men ... 0 0% People living with HIV who know People living with HIV on People living with HIV who are Women aged 15–49 years who have their their status treatment virally suppressed demand for family planning satisfied by ... modern methods 68% 39% 22% All ages [43– >95%] [25–85%] [14–48%] Not Men aged 15–49 years who are circumcised 80% 49% 20% applicable Children (0–14) [46– >95%] [28–90%] [12–37%] Male circumcisions performed according to Not 85% 44% 25% Women (15+) national standards applicable [55– >95%] [28–92%] [16–52%] 60% 37% 21% People who received PrEP at least once Men (15+) ... [38– >95%] [23–82%] [13–47%] during the reporting period (2017) Is antiretroviral therapy provided in community settings (such as Harm reduction outside health facilities) for people who are stable on antiretroviral No ― Use of sterile injecting equipment at therapy? 92.1% last injection (2016) ― Needles and syringes distributed per ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ... person who injects 2010 2017 ― Coverage of opioid substitution ... Percentage of pregnant women living with HIV 45% 61% therapy accessing antiretroviral medicines [31–73%] [40– >95%] ― Naloxone available (2016) Yes 27% 52% Early infant diagnosis [17–40%] [26–80%] ― Safe injection rooms available (2016) No 37
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	40	PERU COUNTRY DATA EPIDEMIC ESTIMATES 2005 2010 2017 New HIV infections 4800 3300 2800 New HIV infections (all ages) [3600–6400] [2100–5200] [1700–5200] <500 <200 <100 New HIV infections (0–14) [<500– <500] [<200– <500] [<100– <200] 1200 760 640 New HIV infections (women, 15+) [880–1600] [520–1200] [<500–1200] 3300 2300 2100 New HIV infections (men, 15+) [2500–4400] [1500–3700] [1300–3900] HIV incidence per 1000 population 0.18 [0.13–0.24] 0.11 [0.07–0.18] 0.09 [0.05–0.16] AIDS-related deaths 5200 2900 2100 AIDS-related deaths (all ages) [4100–7200] [2000–4200] [1200–3600] <500 <200 <100 AIDS-related deaths (0–14) [<500– <500] [<100– <500] [<100– <200] 1500 750 610 AIDS-related deaths (women, 15+) [1200–1900] [520–1100] [<500–1100] 3500 2000 1400 AIDS-related deaths (men, 15+) [2700–4700] [1400–2900] [810–2500] People living with HIV 73 000 69 000 72 000 People living with HIV (all ages) [56 000–96 000] [54 000–92 000] [58 000–100 000] 2500 1900 1200 People living with HIV (0–14) [2000–3200] [1500–2600] [880–1800] 20 000 20 000 20 000 People living with HIV (women, 15+) [16 000–27 000] [16 000–27 000] [16 000–27 000] 50 000 48 000 51 000 People living with HIV (men, 15+) [38 000–65 000] [37 000–65 000] [41 000–73 000] LAWS AND POLICIES STIGMA AND DISCRIMINATION Laws criminalizing the transmission of, non- Yes 2008 2012 disclosure of or exposure to HIV transmission Percentage of women and men aged 15–49 years who report discriminatory attitudes towards people living with HIV Criminalization of sex work Partial criminalization of sex work 49.5* 46.2* Laws penalizing same-sex sexual Percentage of people living with HIV denied Criminalization of same-sex sexual acts acts have been decriminalized or health services because of their HIV status in never existed the last 12 months Possession of drugs for personal Drug use or possession for personal use is an use is specified as a non-criminal offence Percentage of people living with HIV who offence reported a health-care professional told others about their HIV status without their consent Criminalization of transgender people ... Laws or policies restricting the entry, stay and residence of people living with HIV ... VIOLENCE Parental consent for adolescents to access HIV Yes, for adolescents younger than Proportion of ever-married or partnered 2011 2015 testing 18 years women aged 15–49 years who experienced physical or sexual violence from a male Spousal consent for married women to access No intimate partner in the past 12 months 13.6 12.9 sexual and reproductive health services Mandatory HIV testing for marriage, work or Yes *Female respondents only residence permits or for certain groups EXPENDITURES Financing sources International: Global International: Domestic private Domestic public International: PEPFAR Total Fund all others Last available report: 2014 ... US$ 78 148 248 ... ... ... US$ 78 148 248 38
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	41	EPIDEMIC TRANSITION METRICS 10 000 10 000 0.2 8 000 N umber of people N umber of people N umber of people 8 000 8 000 0.15 6 000 6 000 6 000 Rate 0.1 4 000 4 000 4 000 2 000 2 000 0.05 2 000 0 0 0 0 2000 2005 2010 2015 2000 2005 2010 2015 1990 2000 2010 2000 2005 2010 2015 N ew H IV infections Incidence:prevalence ratio N ew H IV infections A ID S-related deaths D eaths among people Targ et living with HIV Change in new Change in AIDS- Incidence: HIV infections = -14% related deaths = -29% prevalence = 0.04 since 2010 since 2010 ratio KEY POPULATIONS HIV COMORBIDITIES Gay men and 2200 Sex other men People who Transgender Estimated number of incident tuberculosis Prisoners [1600 workers who have inject drugs people cases among people living with HIV (2016) sex with men –2800] Estimated size of population 67 201 252 004 ... 33 640 82 023 Proportion of people living with HIV newly enrolled in HIV care with active tuberculosis 15.4% HIV prevalence 1.3% 12.2% ... 15.6% 2% (2016) Know their HIV status ... ... ... ... Cervical cancer screening of women living ... Antiretroviral therapy coverage ... ... ... ... 79.8% with HIV Condom use 90.5% 49.8% ... ... Proportion of people coinfected with HIV and Coverage of HIV prevention hepatitis B virus receiving combined 100% ... ... ... ... treatment (2017) programmes Avoidance of health care Proportion of people coinfected with HIV and because of stigma and ... ... ... ... hepatitis C virus starting hepatitis C ... discrimination treatment HIV TESTING AND TREATMENT CASCADE HIV PREVENTION 70 000 100% Knowledge of HIV prevention among young people aged 15–24 years (2016) 60 000 Number of people living with HIV 75% ― Women 75.3% 50 000 Gap to reaching the ― Men 0% 40 000 second 90: 10184 50% Condom use at last higher-risk sex (with a 30 000 non-marital, non-cohabiting partner) 20 000 25% ― Women ... 10 000 ― Men ... 0 0% People living with HIV who know People living with HIV on People living with HIV who are Women aged 15–49 years who have their their status treatment virally suppressed demand for family planning satisfied by 62.2% modern methods (2012) ...% 67% ...% All ages [...–...%] [54–93%] [...–...%] Not Men aged 15–49 years who are circumcised ...% 78% ...% applicable Children (0–14) [...–...%] [57– >95%] [...–...%] Male circumcisions performed according to Not ...% 64% ...% Women (15+) national standards applicable [...–...%] [50–87%] [...–...%] ...% 68% ...% People who received PrEP at least once Men (15+) ... [...–...%] [54– >95%] [...–...%] during the reporting period (2017) Is antiretroviral therapy provided in community settings (such as Harm reduction outside health facilities) for people who are stable on antiretroviral ... ― Use of sterile injecting equipment at therapy? ... last injection ― Needles and syringes distributed per ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ... person who injects 2010 2017 ― Coverage of opioid substitution ... Percentage of pregnant women living with HIV 39% 84% therapy accessing antiretroviral medicines [33–52%] [69– >95%] ― Naloxone available (2016) ... ...% 78% Early infant diagnosis [...–...%] [60–95%] ― Safe injection rooms available (2016) ... 39
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	42	URUGUAY COUNTRY DATA EPIDEMIC ESTIMATES 2005 2010 2017 New HIV infections 660 770 670 New HIV infections (all ages) [510–860] [590–960] [<500–900] <100 <100 <100 New HIV infections (0–14) [<100– <100] [<100– <100] [<100– <100] <200 <200 <200 New HIV infections (women, 15+) [<200– <500] [<200– <200] [<100– <200] <500 600 530 New HIV infections (men, 15+) [<500–640] [<500–780] [<500–730] HIV incidence per 1000 population 0.2 [0.15–0.26] 0.23 [0.17–0.29] 0.19 [0.14–0.26] AIDS-related deaths <500 540 <500 AIDS-related deaths (all ages) [<500–530] [<500–660] [<500– <500] <100 <100 <100 AIDS-related deaths (0–14) [<100– <100] [<100– <100] [<100– <100] <200 <200 <100 AIDS-related deaths (women, 15+) [<100– <500] [<200– <500] [<100– <100] <500 <500 <500 AIDS-related deaths (men, 15+) [<200– <500] [<500– <500] [<200– <500] People living with HIV 9700 10 000 13 000 People living with HIV (all ages) [8200–12 000] [8800–12 000] [11 000–15 000] <200 <200 <100 People living with HIV (0–14) [<100– <500] [<200– <500] [<100– <200] 3300 3200 3500 People living with HIV (women, 15+) [2800–4200] [2700–3600] [3000–4000] 6300 7100 9100 People living with HIV (men, 15+) [5200–7700] [6000–8400] [7500–11 000] LAWS AND POLICIES STIGMA AND DISCRIMINATION Laws criminalizing the transmission of, non- No 2013 disclosure of or exposure to HIV transmission Percentage of women and men aged 15–49 years who report discriminatory attitudes Sex work is not subject to punitive towards people living with HIV Criminalization of sex work 12.7* regulations or is not criminalized Laws penalizing same-sex sexual Percentage of people living with HIV denied Criminalization of same-sex sexual acts acts have been decriminalized or health services because of their HIV status in never existed the last 12 months Possession of drugs for personal Drug use or possession for personal use is an use is specified as a non-criminal offence Percentage of people living with HIV who offence reported a health-care professional told others Neither criminalized nor about their HIV status without their consent Criminalization of transgender people prosecuted Laws or policies restricting the entry, stay and residence of people living with HIV No VIOLENCE Parental consent for adolescents to access HIV No Proportion of ever-married or partnered testing women aged 15–49 years who experienced physical or sexual violence from a male Spousal consent for married women to access No intimate partner in the past 12 months sexual and reproductive health services Mandatory HIV testing for marriage, work or Yes *Female respondents only residence permits or for certain groups EXPENDITURES Financing sources International: Global International: Domestic private Domestic public International: PEPFAR Total Fund all others Last available report: 2007 US$ 6 543 398 US$ 6 851 169 ... ... US$ 291 464 US$ 14 077 809 40
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	43	EPIDEMIC TRANSITION METRICS 1 400 800 1.5 1 000 N umber of people 1 200 N umber of people N umber of people 600 800 1 000 1 800 600 Rate 400 600 400 400 0.5 200 200 200 0 0 0 0 2000 2005 2010 2015 2000 2005 2010 2015 1990 2000 2010 2000 2005 2010 2015 N ew H IV infections Incidence:prevalence ratio N ew H IV infections A ID S-related deaths D eaths among people Targ et living with HIV Change in new Change in AIDS- Incidence: HIV infections = -13% related deaths = -44% prevalence = 0.05 since 2010 since 2010 ratio KEY POPULATIONS HIV COMORBIDITIES Gay men and Sex other men People who Transgender Estimated number of incident tuberculosis 160 Prisoners workers who have inject drugs people cases among people living with HIV (2016) [140–190] sex with men Estimated size of population 7 801 25 813 1 583 853 11 150 Proportion of people living with HIV newly enrolled in HIV care with active tuberculosis ... HIV prevalence 1.3% ... ... ... 1.3% (2016) Know their HIV status ... ... ... ... Cervical cancer screening of women living ... Antiretroviral therapy coverage ... ... ... ... ... with HIV Condom use ... ... ... ... Proportion of people coinfected with HIV and Coverage of HIV prevention hepatitis B virus receiving combined ... ... ... ... ... treatment programmes Avoidance of health care Proportion of people coinfected with HIV and because of stigma and ... ... ... ... hepatitis C virus starting hepatitis C ... discrimination treatment HIV TESTING AND TREATMENT CASCADE HIV PREVENTION 12 000 100% Knowledge of HIV prevention among young people aged 15–24 years 10 000 Gap to Number of people living with HIV reaching the ― Women ... 75% first 90: 8 000 Gap to 1004 ― Men ... reaching the second 90: Gap to 6 000 reaching 50% 3086 Condom use at last higher-risk sex (with a the third 90: non-marital, non-cohabiting partner) 4 000 3639 25% ― Women ... 2 000 ― Men ... 0 0% People living with HIV who know People living with HIV on People living with HIV who are Women aged 15–49 years who have their their status treatment virally suppressed demand for family planning satisfied by ... modern methods 82% 57% 44% All ages [69–94%] [48–65%] [37–51%] Not Men aged 15–49 years who are circumcised >95% >95% 71% applicable Children (0–14) [>95– >95%] [>95– >95%] [62–83%] Male circumcisions performed according to Not 85% 66% 56% Women (15+) national standards applicable [74– >95%] [58–75%] [49–63%] 81% 52% 40% People who received PrEP at least once Men (15+) 28 [67– >95%] [43–62%] [33–47%] during the reporting period (2017) Is antiretroviral therapy provided in community settings (such as Harm reduction outside health facilities) for people who are stable on antiretroviral No ― Use of sterile injecting equipment at therapy? ... last injection ― Needles and syringes distributed per ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION ... person who injects 2010 2017 ― Coverage of opioid substitution ... Percentage of pregnant women living with HIV >95% >95% therapy accessing antiretroviral medicines [87– >95%] [93– >95%] ― Naloxone available (2016) No 62% >95% Early infant diagnosis [54–73%] [>95– >95%] ― Safe injection rooms available (2016) No 41
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	44	42
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	45	METHODS 43
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	46	Methods for deriving UNAIDS estimates INTRODUCTION the routine HIV tests conducted when pregnant women at antenatal clinics are tested as part of programmes for UNAIDS annually provides revised global, regional and the prevention of mother-to-child transmission. These country-specific modelled estimates using the best data avoid the need to conduct a separate surveillance available epidemiological and programmatic data to effort, and they provide a complete set of data from all track the HIV epidemic. Modelled estimates are required clinics instead of samples from specific sites. because it is impossible to count the exact number of people living with HIV, people who are newly infected The prevalence trends among pregnant women at with HIV or people who have died from AIDS-related antenatal clinics, whether determined from surveillance illness in any country: doing so would require regularly or routine data, can be used to inform estimates testing every person for HIV and investigating all deaths, of national prevalence trends, whereas data from which is logistically impossible and ethically problematic. population-based surveys—which are conducted less Modelled estimates—and the lower and upper bounds frequently but have broader geographical coverage around these estimates—provide a scientifically and also include men—are more useful for informing appropriate way of describing HIV epidemic levels and estimates of national HIV prevalence levels. Data from trends. these surveys also contribute to estimating age- and sex-specific HIV prevalence levels and trends. For a few PARTNERSHIPS IN DEVELOPING METHODS countries in sub-Saharan Africa that have not conducted FOR UNAIDS ESTIMATES population-based surveys, HIV prevalence levels are adjusted based on comparisons of antenatal clinic Country teams use UNAIDS-supported software to surveillance and population-based survey data from develop estimates annually. The country teams are other countries in the region. HIV prevalence trends and primarily comprised of demographers, epidemiologists, numbers of people on antiretroviral therapy are then monitoring and evaluation specialists, and technical used to derive an estimate of HIV incidence trends. partners. Historically, countries with high HIV transmission have The software used to produce the estimates is produced separate HIV prevalence and incidence Spectrum, which is developed by Avenir Health, and the trends for rural and urban areas when there are well- Estimates and Projections Package, which is developed established geographical differences in prevalence. To by the East–West Center.1 The UNAIDS Reference better describe and account for further geographical Group on Estimates, Modelling and Projections provides heterogeneity, an increasing number of countries have technical guidance on the development of the HIV produced subnational estimates (e.g. at the level of the component of the software.2 province or state) that, in some cases, also account for A BRIEF DESCRIPTION OF METHODS USED rural and urban differences. These subnational or rural– BY UNAIDS TO CREATE ESTIMATES urban estimates and trends are then aggregated to obtain national estimates. For countries where HIV transmission is high enough to sustain an epidemic in the general population, available In the remaining countries, where HIV transmission epidemiological data typically consist of HIV prevalence largely occurs among key populations at higher risk of results from pregnant women attending antenatal clinics HIV and the epidemic can be described as low-level, the and from nationally representative population-based estimates are derived from either surveillance among surveys. Many countries have historically conducted key populations and the general low-risk population, or HIV sentinel surveillance among women attending from HIV case reporting data, depending on which data antenatal clinics, which requires collecting data from a are most reliable in a particular country. In countries selection of clinics for several months every few years. with high-quality HIV surveillance data among the key More recently, many countries have stopped conducting populations, the data from repeated HIV prevalence sentinel surveillance and are now using the data from studies focused on key populations are used to derive 1 More information on Avenir Health can be found at www.avenirhealth.org. The East–West Center website can be found at www.eastwestcenter.org. 2 For more on the UNAIDS Reference Group on Estimates, Modelling and Projections, please visit www.epidem.org. 44
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	47	national estimates and trends. Estimates of the size of UNCERTAINTY BOUNDS AROUND UNAIDS key populations are increasingly derived empirically ESTIMATES in each country; when studies are not available, they are derived based on regional values and consensus The estimation software calculates uncertainty bounds among experts. Other data sources—including HIV around each estimate. These bounds define the range case reporting data, population-based surveys and within which the true value lies (if it can be measured). surveillance among pregnant women—are used to Narrow bounds indicate that an estimate is precise, estimate the HIV prevalence in the general low-risk while wide bounds indicate greater uncertainty population. The HIV prevalence curves and numbers of regarding the estimate. people on antiretroviral therapy are then used to derive In countries using HIV surveillance data, the quantity and national HIV incidence trends. source of the data available partly determine the precision For most countries in western and central Europe and of the estimates: countries with more HIV surveillance data North America—and many countries in Latin America, have smaller ranges than countries with less surveillance the Caribbean and the Middle East and North Africa data or smaller sample sizes. Countries in which a that have insufficient HIV surveillance or survey data, national population-based survey has been conducted but which have robust disease reporting systems—HIV generally have smaller ranges around estimates than case reporting and AIDS-related mortality data from vital countries where such surveys have not been conducted, registration systems are used directly to inform trends while countries producing subnational estimates at the and levels in national HIV prevalence and incidence. provincial level have wider ranges. In countries using These methods also allow countries to take into account HIV case reporting and AIDS-related mortality data, the evidence of underreporting or reporting delays in HIV number of years of data and the magnitude of the cases case report data, as well as the misclassification of reported or the deaths from AIDS-related illness observed deaths from AIDS-related illness. will contribute to the precision of the estimate. In all countries where UNAIDS supports the development The assumptions required to arrive at the estimate of estimates, assumptions about the effectiveness of HIV also contribute to the width of the ranges around the programme scale-up and patterns of HIV transmission estimates: in brief, the more assumptions that are made, and disease progression are used to obtain age- and the wider the uncertainty range, since each assumption sex-specific estimates of (a) people living with HIV, (b) introduces additional uncertainties. For example, the people newly infected with HIV, (c) people dying from ranges around the estimates of adult HIV prevalence are AIDS-related illness and (d) other important indicators smaller than those around the estimates of HIV incidence (including treatment programme coverage statistics). among children, which require additional data on These assumptions are based on systematic literature prevalence among pregnant women and the probability reviews and analyses of research study data by scientific of mother-to-child HIV transmission, each of which have experts. Demographic population data, including fertility their own additional uncertainty. estimates, are derived from the United Nations Population UNAIDS is confident that the actual numbers of people Division’s World Population Prospects 2017 data. living with HIV, people who are newly infected with HIV Selected inputs into the model—including the number of or people who have died from AIDS-related illness lie people on antiretroviral therapy and the number of women within the reported ranges. Over time, more and better accessing services for the prevention of mother-to-child data from countries will steadily reduce uncertainty. transmission of HIV by type of regimen—are reviewed and validated in partnership with the United Nations Children’s IMPROVEMENTS TO THE 2018 UNAIDS Fund (UNICEF), the World Health Organization (WHO), the ESTIMATES MODEL Global Fund to Fight AIDS, Tuberculosis and Malaria (the Country teams create new Spectrum files every year. Global Fund), and selected technical partners. The files may differ from one year to the next for two reasons. First, new surveillance and programme data are Final country-submitted files containing the modelled entered into the model; this can change HIV prevalence outputs are reviewed at UNAIDS to ensure that the results and incidence trends over time, including for past years. are comparable across regions and countries and over time. 45
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	48	Second, improvements are incorporated into the model MEASURING ANTIRETROVIRAL THERAPY based on the latest available science and statistical COVERAGE methods that lead to the creation of more accurate trends in HIV incidence. Due to these improvements Since 2013, UNAIDS has provided the number and to the model and the addition of new data to create estimates of the proportion of all adults and children the estimates, the results from previous years cannot living with HIV who are on antiretroviral therapy (as be compared with the results from this year. However, opposed to those eligible for therapy according to a full historical set of estimates are created each year, national or international guidelines). This approach to enabling a description of trends over time. estimating coverage reflects the WHO recommendations of starting antiretroviral therapy among everyone Between the previous estimates and the 2018 estimates, diagnosed as HIV-positive. the following changes were applied to the model under the guidance of the UNAIDS Reference Group on Countries report the number of people on treatment Estimates, Modelling and Projections and based on the through the Global AIDS Monitoring (GAM) tool and latest scientific evidence. Spectrum. Although those values come through routine data, they are likely to have some level of uncertainty ■■ Demographic data in the models were updated from if the country cannot deduplicate individuals who the World Population Prospects 2015 estimates to the might receive medication from two different clinics 2017 estimates. or if there are delays in reporting data. Using results from data quality reviews through 2016, an estimated ■■ Assumptions about retention on antiretroviral uncertainty—0.88 and 1.04 for the lower and upper therapy among pregnant women living with HIV were bounds, respectively—was added to the number of included. people on treatment at the regional and global levels. ■■ Aggregate routine data on prevalence among women attending antenatal clinics are now used to estimate PUBLICATION OF COUNTRY-SPECIFIC the number of women living with HIV who are giving ESTIMATES birth. UNAIDS aims to publish estimates for all countries with populations of 250 000 or more in 2017. For ■■ Assumptions about the trends in HIV prevalence countries with populations of 250 000 or more among pregnant women versus trends among the that did not submit estimates, UNAIDS developed general population were updated. estimates using the Spectrum software that ■■ Annual HIV mortality probabilities among people on were based on published or otherwise available treatment in western and central Europe and North information. These estimates contributed to regional America were revised based on a special analysis and global totals but were not published as country- conducted by the Antiretroviral Therapy Cohort specific estimates. Collaboration. In countries with low-level epidemics, the number of ■■ An option was added in the model to prioritize pregnant women living with HIV is difficult to estimate. allocation of treatment to individuals with the lowest Many women living with HIV in these countries are sex CD4 count who had not yet initiated treatment. workers or people who use drugs—or they are the sexual partners of gay men and other men who have ■■ A new approach to fitting more complex incidence sex with men or people who use drugs—making them patterns for countries using case reporting and vital likely to have different fertility levels than the general registration data is available. population. UNAIDS does not present estimates of mother-to-child HIV transmission, including estimates ■■ New methods to estimate the proportion of people related to children in some countries that have dying before diagnosis and time from infection to concentrated epidemics, unless adequate data are diagnosis were incorporated into the model for available to validate these estimates. UNAIDS also does countries using case reporting data to estimate not publish these estimates for countries where the incidence. estimated number of pregnant women living with HIV is More detailed information on revisions to the 2018 model less than 100. and Spectrum generally can be found at www.epidem. With regard to reporting incidence trends, if there are org. not enough historical data to state with confidence 46
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	49	whether a decline in incidence has occurred, UNAIDS Finally, UNAIDS does not publish country estimates does not publish data other than that from the most when further data or analyses are needed to produce recent year; this prevents users from making inaccurate valid estimates. More information on the UNAIDS inferences about trends. Specifically, incidence trends estimates and the individual Spectrum files for most are not published if there are fewer than four data countries can be found on the UNAIDS website (www. points for the key population or if there have been no unaids.org). Resulting estimates can be found in the data for the past four years for countries using repeated Aidsinfo section of the UNAIDS website (http://aidsinfo. survey or routine testing data. Trends prior to 2000 unaids.org/). are not published for countries using case surveillance models if there is no early case surveillance or mortality data available. Methods for deriving the 90–90–90 targets INTRODUCTION recommended by WHO, we can have confidence in the accuracy of the estimate of viral suppression among all Starting in 2016, UNAIDS has provided estimates of people living with HIV. global, regional and country-specific progress against METHODS FOR MEASURING THE 90–90–90 the 90–90–90 targets. Progress towards these targets is TARGETS directly monitored using three basic indicators: To describe country-level progress against the 90–90–90 ■■ Indicator 1 (the first 90): the percentage of all people targets, UNAIDS analysed data on the number of people living with HIV who know their HIV status. who knew their HIV status, the number of people on ■■ Indicator 2 (the second 90): the percentage of people treatment and the number of people who were virally who know their HIV-positive status and are accessing suppressed among those tested, as reported through treatment. the GAM tool and Spectrum. A description of the GAM system and the treatment ■■ Indicator 3 (the third 90): the percentage of people target-related indicators that countries report against on treatment who have suppressed viral loads. are provided in the UNAIDS GAM 2018 guidelines (1). Metrics related to Indicators 2 and 3 can also be All programme data submitted to UNAIDS—including expressed as a percentage of all people living with HIV. the number of people reported to know their status, the When numbers or coverage of the treatment target are number of people accessing treatment and the number expressed relative to the total number of people living with of people on treatment who are virally suppressed—were HIV, this is called the “HIV testing and treatment cascade.” validated by UNAIDS and its partners prior to publication. Using this approach, the second and third targets of the 90–90–90 targets translate into 81% coverage of Country-submitted data that did not meet the required antiretroviral therapy and 73% of people achieving viral validation checks for quality either at the indicator level suppression by 2020. or across the treatment cascade were not published. Not all countries were able to report against all three UNAIDS published its first set of global and regional prongs of the 90–90–90 targets. testing and treatment cascades in 2015. Estimates of antiretroviral therapy coverage among people living with The final set of country measures of progress against the HIV are available going back to when treatment was first 90–90–90 targets for 2015 through 2017 are available at introduced. Results presented in this report supersede http://aidsinfo.unaids.org. Complete treatment cascades the previously published 2015 and 2016 values. were available for 53 countries in 2017. Upper and lower ranges of uncertainty for country-level estimates were Since 2015, UNAIDS has also tracked progress towards calculated from the range of estimated numbers of the 90–90–90 targets by monitoring viral load testing people living with HIV. This range may not fully capture access among people on treatment. If most people in uncertainty in the reported programme data. the country are receiving a viral load test annually, as 47
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	50	To estimate regional and global progress against therapy, the reported value was excluded from the the 90–90–90 targets, UNAIDS supplemented the analysis and replaced by a regionally-derived estimate. country-supplied data submitted through GAM with For countries using HIV surveillance or programme data obtained from a review of other published and data, a country’s measure was included only if the HIV unpublished data sources, including grey literature and surveillance system had been functioning since before Demographic and Health Survey results. There were 2008. Countries with more recent systems may not have insufficient reported data from countries in western and captured all people living with HIV who were diagnosed central Europe and North America in 2017 to present prior to 2008. results for the region, although the country values that were available in the region were used to construct the Although HIV surveillance systems, including those global totals. Upper and lower ranges of uncertainty based on programme registers, can be a reasonably for global and regional estimates were calculated from robust source of data to estimate the number of the range of numbers of people living with HIV and the people living with HIV who know their status, biases lower and upper ranges of the numbers of people on in the reported numbers may still exist. For example, treatment in the region. This range may not fully capture a country’s measure of the knowledge of status uncertainty in the reported or missing programme data may be underestimated if not all people diagnosed for the first and third indicators. are reported to the surveillance system in a timely manner; the measure also may be overestimated if DATA SOURCES AND INDICATOR-SPECIFIC people are reported to the system or included on a METHODS FOR DERIVING GLOBAL AND register more than once and these duplicates are not REGIONAL METHODS detected. Similarly, if people die or emigrate but are not removed from the system, the number of people Estimates of people living with HIV living with HIV who are reported to know their HIV status also will be overstated. Unless otherwise stated, all progress measures in this report are based on UNAIDS global, regional and The estimated numbers of people living with HIV who country-specific modelled estimates of the numbers knew their status for 14 countries in sub-Saharan Africa of people living with HIV from Spectrum. Estimates of in 2017 were derived from nationally representative people living with HIV were available for 169 countries. population-based surveys conducted since 2011 and More details about how UNAIDS derives estimates and from treatment data reported through GAM. Four uncertainty bounds around the number of people living countries with surveys through 2017 directly asked with HIV and those accessing antiretroviral therapy respondents who tested HIV-positive whether they can be found under “Measuring antiretroviral therapy knew their HIV status as part of the survey, and this coverage” (above, in Part 1 of this annex). proportion was applied to the total number of people estimated to be living with HIV in the country. In the Knowledge of HIV status among people living with HIV remaining 10 countries with a survey that did not directly ask participants about knowledge of their HIV status, a Global and regional measures of the number of people stepwise approach was used to estimate knowledge of living with HIV who know their status were derived status. using the most recent HIV surveillance, programme data, nationally representative population-based survey ■■ In the first step, the total percentage of people who data and modelled estimates for 102 countries in 2017. could know their status in the year of the most recent Where data were available separately for children survey is estimated. For adults, this percentage is (aged 0–14 years) and adults (aged 15 years and older), estimated by calculating the percentage of those who age-specific measures were first calculated and then tested HIV-positive in the survey who had reported aggregated to produce a national measure. ever having been tested for HIV and had received the last test result. For children, who are not included in For 80 countries in 2017, the number of people the survey, a proxy measure of treatment coverage living with HIV who knew their HIV status is based in the survey year is used to estimate knowledge of on HIV surveillance systems, programme registers or status among children. This is a conservative measure, modelled estimates derived from case surveillance and as some children may not have initiated treatment. programme data. If the measure from these sources was To estimate knowledge of status for all people in the lower than the number of people accessing antiretroviral 48
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	51	year of the survey, the child and adult estimates are about their HIV status. In these instances, the risk is that combined, weighted by the numbers of children and survey participants do not disclose their HIV status to adults living with HIV. interviewers and are incorrectly classified as unaware of it. While it is impossible to measure the exact magnitude ■■ In the second step, the percentage of people who of this bias, in previous surveys in Kenya, Malawi and could know their status in the current or previous Uganda, anywhere from one tenth to one third of HIV- reporting year is derived by projecting the results positive participants misreported their HIV status as from the first step forward. To do this, an assumption negative (2). Underestimation of knowledge of status also is made that the rate of testing scale-up in the era can occur at the national level if people living with HIV of test-and-treat was the same as the rate of scale- learn their status either as a result of—or subsequent to— up of people starting treatment, calculated by the survey, although this proportion of the total number the percentage point difference in total treatment of people in a country who know their status will be small. coverage (for both adults and children) between the survey year and the treatment coverage value For 34 countries without a current measure of for either the current or previous year. For surveys knowledge of status in 2017, UNAIDS used published conducted in 2017, the 2015 and 2016 values are and unpublished grey literature and historical estimates estimated for previous years using a similar process reported through GAM to inform the regional and global as the one described above. values. A similar method used to project estimated knowledge of status for direct surveys from historical ■■ In the third step, the estimate of people living with data was applied to estimates from such countries before HIV who know their status for the year is derived 2017. by using the midpoint between the percentage of people living with HIV who could know their status For 40 countries without any estimate of the number of (i.e. the second step) and the percentage of people people living with HIV who know their status—countries living with HIV on treatment. that are home to just 8% of the total estimated number of people living with HIV worldwide—the regional average The measurement of knowledge of HIV status based of the ratio of the number of people who know their on survey data when participants are not directly asked status and the number on treatment was calculated from if they know their HIV status has several limitations. available data submitted by countries in the region and Typically, estimates derived from these surveys will weighted according to the number of people living with underestimate knowledge of status for three reasons: HIV by country. Knowledge of status was capped at 95%. The total number of people estimated to know their 1. In settings where stigma and discrimination is HIV status in countries was added across the region and or has been high, people may be reluctant to globally to construct the numerator of the first 90 and the disclose that they have ever tested for HIV and denominator of the second 90. received their results. People accessing antiretroviral therapy 2. People who report ever testing may have seroconverted after their last test result and are Global and regional measures of antiretroviral therapy therefore incorrectly counted as aware of their HIV numbers are calculated from country-reported status. programme data through GAM and the UNAIDS- supported Spectrum software. For a small number 3. Most surveys that do not directly ask respondents of countries where reported numbers of people on about their HIV status occurred prior to 2017. treatment are not available—primarily in western and Although surveys conducted prior to 2011 were central Europe and North America—estimates of the excluded, it is possible that the adjustment method number of people on treatment are developed either in based on treatment scale-up does not accurately consultation with the public health agency responsible capture increases in the knowledge of status that for monitoring the national treatment programme or occur over time among people living with HIV. based on published sources. Underestimation of the reported number of people In partnership with UNICEF, WHO and other partners living with HIV who know their status can also occur in that support treatment service delivery in countries, countries where survey respondents are directly asked 49
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	52	UNAIDS reviews and validates treatment numbers Based on the more stringent coverage threshold, reported through GAM and Spectrum on an annual 67 countries reported viral load suppression data basis. UNAIDS staff also provide technical assistance from case-based surveillance or laboratory-based and training to country public health and clinical reporting systems in 2018 (compared with 88 in 2017). officers to ensure the quality of the treatment data Five countries had estimates based on nationally that are reported. Nevertheless, this measure may representative population-based surveys, where viral overestimate the number of people on treatment if load testing was done only among those who self- people who transfer from one facility to another are reported that they were on treatment. reported by both facilities. Similarly, coverage may be overestimated if people who have died, disengaged Estimates for the remaining countries were constructed from care or emigrated are not identified and removed using the regional average of the number of people from treatment registries. Treatment numbers also may on antiretroviral therapy who are virally suppressed, be underestimated if not all clinics report the numbers weighted according to the number of people on on treatment completely or in a timely manner. treatment in a country. The total number of people suppressed was added across the region and globally to In 2016, UNAIDS completed a triangulation of data to construct the third 90 and the overall estimate of viral verify the UNAIDS global estimate of people accessing suppression among people living with HIV. The same antiretroviral therapy at the end of 2015. In 2018, approach also was used to construct historical regional UNAIDS has partnered with WHO, the Global Fund, and global estimates. selected technical partners and ministries of health in 28 countries (most in sub-Saharan Africa) to conduct A number of challenges exist in using country-reported data quality reviews of reported treatment numbers. For data to monitor the viral load suppression target. more details about how confident UNAIDS is in reported ■■ Routine viral load testing may not be offered at treatment numbers, please see How many people living all treatment facilities, and those facilities where with HIV access treatment?3 it is offered may not be representative of the care People who have achieved viral suppression available at facilities without viral load testing. By assuming that the percentage of people Progress towards the viral suppression target among suppressed among those accessing viral load people on treatment and as a proportion of all people testing is representative of all people on treatment living with HIV is derived from data reported to GAM. in countries with incomplete viral load testing For the purposes of reporting, the threshold for uptake, the measure may be either overestimated or suppression is a viral load of less than 1000 copies per underestimated depending on the characteristics of ml, although some countries may set lower thresholds the reporting clinics where testing is available. or require persons to achieve an undetectable viral load. This guidance also specifies that only a person’s ■■ Reported access to viral load testing varies last test result from the reporting year be submitted, so considerably across each region, and it is difficult the reported number suppressed among those tested to know whether the experience in countries that should represent people and not tests performed. reported data to UNAIDS is similar to that of countries in the same region that did not report UNAIDS GAM 2018 guidelines were updated from data. In western and central Africa, for example, those of 2017 to include a threshold for reporting viral only 7 of 14 countries reported estimates of viral load suppression outcomes, such that testing coverage load suppression in 2017, representing just 14% of should be accessible to all or nearly all (>90%), or that all people on treatment in the region. In Asia and it is nationally representative of people on treatment the Pacific, nationally representative estimates of (typically 50–90% testing coverage). For countries with viral load suppression are not available for China nationally representative but not universally accessible and India in 2017. As a result, estimates for that access to treatment, the estimate of viral suppression region are constructed based on the remaining among those tested (i.e. the third 90) was multiplied by quarter of all people accessing treatment in the the number of people on treatment nationally to obtain region where viral load suppression data are overall viral suppression levels in the country. available. 3 This document is available at http://www.unaids.org/en/resources/documents/2016/how-many-people-living-with-HIV-access-treatment. 50
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	53	■■ UNAIDS guidance requests routine (annual) viral country submissions for quality, but it is not always load testing results only for people who are on possible to identify cases where both routine and treatment and eligible for testing. If people newly other types of testing are occurring. initiated on treatment achieve viral suppression but have not yet been offered viral load testing, ■■ UNAIDS guidance recommends reporting viral they will be incorrectly classified as not suppressed load test results only for people on antiretroviral and the resulting viral suppression estimate will be treatment; persons who naturally suppress understated. UNAIDS also requests that countries the virus and are not on treatment will not be only report results from routine viral load testing; included in this measure. if countries report test results that are primarily As access to viral load testing coverage expands and performed because of suspected treatment failure, routine monitoring systems are strengthened to compile the number of people virally suppressed in these and report these data, the ability to quantify and eventually countries will be underestimated. UNAIDS validates reduce bias in the 90–90–90 targets will improve. Distribution of new HIV infections by subpopulation The distribution of new HIV infections by region was the European Centre for Disease Prevention and Control estimated based on data for 169 countries using five (ECDC) and World Health Organization Regional Office data sources. for Europe HIV/AIDS surveillance in Europe 2017–2016 data (3). The proportions of new diagnoses for each For countries that model their HIV epidemic based on region in Europe (West, central and East) were applied data from subpopulations, including key populations, to UNAIDS estimates of new infections in each country the numbers of new infections were extracted from for people who inject drugs and gay men and other men Spectrum 2017 files. This source provided data for sex who have sex with men. Data for sex workers were not workers from 58 countries, for people who inject drugs available from the ECDC report. New HIV infections in from 36 countries, for gay men and other men who have China, the Russian Federation and the United States were sex with men from 56 countries, and for transgender taken from the most recent available national reports of people from 15 countries (all of which were located in new diagnoses. Latin America, the Caribbean and Asia). Additionally, 21 countries (mostly from Asia) had data from clients of New HIV infections among countries without a direct sex workers. data source were calculated from regional benchmarks. The benchmarks were set by the median proportion The second source was mode of transmission studies of new infections in the specific subpopulation in all conducted in countries between 2006 and 2012. The available countries in the same region. The majority proportions of new infections estimated for each of these countries were located in sub-Saharan Africa. subpopulation, calculated by modes of transmission There were 73 countries that used benchmark values analyses, were multiplied by the number of total new for the sex work estimate, 95 countries for the people gender-specific adult infections (among those aged 15– who inject drugs estimate, 33 countries for the gay men 49 years) to derive an estimated number of new infections and other men who have sex with men estimate, and 36 by subpopulation. This source provided data for sex countries for the transgender people estimate. workers from 18 countries, for people who inject drugs from 25 countries, and for gay men and other men who have sex The calculated proportions of infections for each key with men from 22 countries. population include the sex partners of members of key populations. New infections among sex partners of key New HIV infections for European countries with neither populations were estimated using the number of sex of the aforementioned data sources were derived from partners and transmission probabilities from the literature. 51
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	54	References 1. Global AIDS monitoring 2018: indicators for monitoring the 2016 United Nations Political Declaration on HIV and AIDS. Geneva: UNAIDS; 2018 (http://www.unaids.org/sites/default/files/media_asset/2017-Global-AIDS-Monitoring_en.pdf). 2. Johnston LG, Sabin ML, Prybylski D, Sabin K, McFarland W, Baral S et al. Policy and practice: the importance of assessing self-reported HIV status in bio-behavioural surveys. Bull World Health Organ. 2016;94:605–12. 3. European Centre for Disease Prevention and Control (ECDC), World Health Organization Regional Office for Europe. HIV/AIDS surveillance in Europe 2017–2016 data. Stockholm: ECDC; 2017. 52
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latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	56	
latin_america_pdf/miles-to-go_latin-america_en.pdf	Miles to go : the response to HIV in Latin America	UNAIDS/JC2924/Latin America	2018	Documents and Publications	57	Copyright: © 2018 Joint United Nations Programme on HIV/AIDS (UNAIDS) All rights reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of UNAIDS concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. UNAIDS does not warrant that the information published in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. UNAIDS/JC2924/Latin America
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latin_america_pdf/2994-3Rev-2.pdf	Latin America and Caribbean [cartographic material]	2994 Rev. 2	1991-07	Maps	1	
latin_america_pdf/S_10932_Rev.2-EN.pdf	Revised draft resolution [on the use of coercive measures endangering peace and security in Latin America]	S/10932/Rev.2	1973-03-21	Draft Resolutions and Decisions	1	S/10932/Rev.2 21 March 1973 E!K&ISE i I ., : :,/ ,. '? ORIGINAL: SPANXSE Chinea, Kenya, Pans&klL,u, &dan and Yu&osl.avia: revised- -""--Y&aft -- resolution ._., L..e..-- The Security Counci!. e---J RecsLling - - Genera!. Ass~.bly resolutions 1803 (XVII) and 30.1-G (XVIS) concerning permanen% sovereignty over natural resources, ReaPfimxi.~ General Assembly resolution 2625 (XXV), which states that no State may use or encourage the use of economic, poli-tical or any other type of measures '60 coerce another State in order to obtain from it the subordination of ';, the exercise of rits rights and to secu3:e from it advantages of any kind, swerc?;gn ,; Further recal.ling -.- Genera.!. AsscR'bly resolution 2993 (XXVII) on implementation j ' df the Declaration on the Strengthen@, n of Lnternational Securi%y, in particular paragraph 4, _Noting with deep ,concern -_,- the exlo*-team and use of coercive measures which affect the free exercise of permanent oovctrcignty over the natural resources of Latin American countries, -Jstz "":cognizin& that the use or encouragemen, c of the use of . coercive measures may cre sate situations likely to endal'lger peace and security 3.n Latin heriCa, 1. w States to adopt appropriate measures to impede the activities of those enterprises which deliberately attempt to coerce Latin American countries; Requests States, with a view -to maintaining 2, and strengthening peace and Security in J4atin America, to r.$ren from using or eacouraging the use of any type of coercive measure against Stakes of the region?. .""--.<.c i ! PAN-l'7r( / :_-
latin_america_pdf/S_10932-EN.pdf	Draft resolution [on the use of coercive measures endangering peace and security in Latin America]	S/10932	1973-03-19	Draft Resolutions and Decisions	1	UNITED NATIONS Mstr. GENERAL SECURITY S/W32 COUNCIL 19 bfaxh 1973 ORIGINAL: ENGLISR Panama, Peru aYv3 Yugoslavia: draft resolution The Security Council, Recalling General Assembly resolutions 1803 (XVII) &nd 3016 (XXVII) concerning permanent sovereignty over natural resources, Reaffirming General Assembly resolution 2625 (XXV), which states that no State may use or encourage the use of economic, political or any other type of measures to coerce another State in order to obtain fron it the subordination of the exercise of its sovereigns rights and to secure from it advantages of any kind, Further recalling General Assembly resolution 2993 (XXVII) on implementatlon~ of the Declaration on the Strengthening of International Security, Noting with deep concern the existence and use of coercive measures which affect the free exercise of permanent sovereignty over the natural resources of Latin American countries, Recognizin& that the use or encouragement of the use of coercive measures may create situations likely to endanger peace and ,security in Latin America, 1. m States to adopt measures to impede the activities of those enterprises which deliberately attempt to coerce Latin American countries; 2. Requests States, with a view to maintaining and strengthening peace and security in Latin America,, to refrain frcm using or encouraging the use of any type of coercive measure in the region. PAN-89 73-05509
latin_america_pdf/S_10932_Rev.1-EN.pdf	Revised draft resolution [on the use of coercive measures endangering peace and security in Latin America]	S/10932/Rev.1	1973-03-19	Draft Resolutions and Decisions	1	r 4 Iflissi LINITED NATIONS Distr. GENERAL SECURITY s/10932/Fiev.1 COUNCIL 19 March ENGLISH 1913 ORIGINAL: SPANISH Panama, Peru and Yugoslavia: revised draft resolution The Security Council, Recalling General Assembly resolutions 1803 (XVII) and 3016 (XXVII) concerning permanent sovereignty over natural resources, Reaffirming General Assembly resolution 2625 (XXV),,which states, that no State may use or encourage the use of economic, political of any other type of measures to coerce another State in order to obtain from,it the subordination of the exercise of its sovereign rights and to secure from it advantages of any Wd, Further recalling General Assembly resolution 2993 (XXVII) on implementation of the Declaration on the Strengthening of International Security, in particular paragraph 4, Noting with deep concern the existence and use of coercive measures which affect the free exercise of permanent sovereignty over the natural resources of Latin American countries, Recognising that the use or encouragement of the use of coercive measures may create situations likely to endanger peace and security in Latin America, 1. Urges States to adopt measures to impede the 'activities of those enterprises which deliberately attempt to coerce Latin American countries; 2. Requests States, with a view to maintaining and strengthening peace and security in Latin America, to refrain from using or encouraging the use of any type of coercive measure in the region. PAN-112 73-05513