The AIDS epidemic in Nicaragua is several years behind that in the United States and neighboring countries of Central and South America. A combination of events, including the isolation caused by the war of the U.S.-backed Contra army against the Sandinista government, the complete economic embargo imposed on Nicaragua by the United States in 1985, self-sufficiency for blood products, and a low rate of recreational injectable-drug use, have contributed to this situation. Since the Sandinistas were defeated in the general election of 1990, people have returned to Nicaragua from areas where HIV is more prevalent, such as Honduras and the United States. It is probable that many HIV-infected persons have now entered the country. Because of the high rates of sexually transmitted diseases and cultural factors such as "machismo," HIV is likely to spread rapidly by heterosexual transmission, unless effective, culturally appropriate education and sexually transmitted disease prevention programs are implemented now.
PIP: AIDS arrived in Nicaragua much later than it did in other Latin American countries, even though both sexually transmitted diseases (STDs) and multiple partners are common. During the 1980s, HIV spread rapidly worldwide, except in a few countries such as Nicaragua. The 10 year US-sponsored low-intensity war and economic embargo isolated Nicaragua, thereby delaying the arrival of HIV. Election of the UNO party in 1990 restored diplomatic and trading relations with the US, resulting in a large influx of repatriates and refugees from countries with a high HIV/AIDS prevalence. The largest number of AIDS cases were identified in 1990-1992 (25 cases which comprised 81% of all cases through 1992). A 30-year-old heterosexual man, diagnosed with AIDS in July 1987, was the first AIDS case diagnosed in Nicaragua. He died within 30 days. As of September 1992, Nicaragua has had the only 31 reported AIDS cases. Since people in Nicaragua often have diarrhea, respiratory infections, and skin conditions, it is possible that AIDS cases have been underdiagnosed and underreported. Yet, serologic surveys have found only 52 HIV-infected persons, confirming that HIV/AIDS has not yet reached epidemic proportions in Nicaragua. Male-to-female ratios show that HIV is spread largely through heterosexual transmission. Only two prostitutes are HIV-positive, but this is likely to change, since prostitution had increased greatly at the same time the economic crisis has intensified. Many Nicaraguans are misinformed about AIDS and other STDs. Few use condoms. A correlation exists between the cumulative number of AIDS cases in Central America and US foreign aid as well as revenues from tourism. IV drug use is increasing. It is not uncommon for unsterilized equipment to be used to inject medically sanctioned drugs. Contaminated blood may soon be a problem, since remunerated blood donations continue to occur in regions with no blood banks. Machismo encourages young men to have intercourse with prostitutes or sexually experienced women and values multiple sexual conquests; thus, machismo will also likely contribute to HIV transmission.