With over 143,000 cases of AIDS reported to the World Health Organization from 145 countries and with an estimated 5 to 10 million people worldwide infected with HIV, AIDS has become firmly established as a global pandemic. In the region of the Americas over 100,862 cases of AIDS have been reported with indigenous transmission documented in 45 to 46 countries. While North America has the highest annual number of AIDS cases per population, with 72 cases/million, the Caribbean subregion has a disproportionately high number of cases, with annual rates as high as 200 to 300 cases/million population for some countries. Despite differences in absolute number of cases, there has been a remarkable similarity in the temporal rate of increase of AIDS in the countries of the Americas, reflecting delayed introduction of the virus to some areas with an early exponential increase similar to that observed initially in the United States. Although the modes of transmission of HIV are the same throughout the region, evidence of increasing bisexual and heterosexual transmission, particularly in the Caribbean subregion, has resulted in a lower male-to-female ratio of AIDS cases and increased perinatal transmission. Clinically, a resurgence of diarrheal diseases, respiratory infections, and tuberculosis has been documented in association with HIV infection in many tropical countries of the Americas. With relatively high rates of HTLV-I infection already established in the Caribbean subregion, the overall public health problems of the Americas will be markedly potentiated by further spread of these 2 human retroviruses. If HIV infection continues to penetrate the poor and less advantaged populations in Latin America and the Caribbean, the potential exists for a massive epidemic in the Americas that may rapidly parallel the situation in Africa.
PIP: The article describes in detail the extent and nature of HIV and HTLV-1 infections, and AIDS in the Americas. Surveillance statistics are provided for general populations, homosexual and bisexual men, IV-drug users, female prostitutes, hemophiliacs, heterosexual partners of HIV-infected persons, blood donors, and pregnant women. As of publication, over 100,862 AIDS cases have been reported in the region, with indigenous transmission documented in 45-46 countries. Clinical manifestations of HIV infection and AIDS are discussed. North America claims the highest annual AIDS cases per population at 72/million, while the Caribbean subregion has a disproportionately high number of cases, with annual rates reaching 200-300/million for some countries. The temporal rate of increase of AIDS cases has, however, been fundamentally comparable for all countries of the Americas. While HIV transmission modes are the same throughout the region, increasingly lower male-female ratios of AIDS cases, and more cases of perinatal transmission especially in Caribbean countries. Diarrheal disease, respiratory infections, and tuberculosis have also been documented as associated with HIV infection in many tropical countries of the Americas. Further, relatively high rates of HTLV-1 infection in the Caribbean will only exacerbate already significant public health problems faced by some countries of the region. Should HIV continue infiltrating poor, disadvantaged populations of Latin America and the Caribbean, HIV infection levels and AIDS could reach epidemic proportions similar to that witnesses in Africa.