HIV and STD Global Burden

HIV infection is not distributed equally around the world. It is estimated that there are over 20 million people living with HIV infection worldwide. Approximately 68 percent of these individuals are in Sub-Saharan Africa, where the prevalence among sexually active adults has reached one third in some urban centers. Ten percent of people living with HIV infection are in Latin America and the Caribbean, although the prevalences vary widely throughout the region. Southeast Asia represents 7.5 percent of the total HIV infections, although that rate is rapidly rising. Similarly, 7.5 percent of HIV infections originate in North America, although the epidemic has stabilized in this region as it has in Europe where 6 percent of all infections reside.⁶

In the Latin America and Caribbean region, Haiti was the first country to be affected by HIV. Based on in-country data collected in the region between 1994 and 1996, the HIV prevalence among Haitian adults is 10 percent in urban areas and 4 percent in rural areas. Brazil accounted for the largest number of reported AIDS cases in the region due to its huge population and an estimated .4 percent prevalence in the sexually active adult population, with higher rates among high risk individuals. Among STD clinic attendees in Rio de Janeiro, men had an HIV prevalence of 18 percent and women 5 percent. In Jamaica, the HIV prevalence among adults was similar to that of Brazil, .4 percent. STD clinic attendees in urban Jamaica had an HIV prevalence of 4 percent. In the Dominican Republic, HIV prevalence among ante-natal women ranged from 1 to 2 percent but was as high as 8 percent in one urban area. The prevalence among STD clinic attendees varied from 1.5 percent among men or women presenting with either a urethral discharge or vaginal discharge, to 16.7 percent among patients presenting with genital ulcers. In Honduras, the prevalence of HIV among pregnant women in urban areas was 2 to 4 percent.

The worldwide burden of STDs is staggering. The World Health Organization estimates that between 150 and 330 million new cases of curable STDs are transmitted each year. These curable STDs include gonorrhea, chlamydial infection, trichomoniasis, syphilis, and chancroid. Between 40 and 50 percent of these STD cases occur in Southeast Asia, between 20 and 25 percent in sub-Saharan Africa, 10 to 11 percent in Latin America and the Caribbean, 5 to 6 percent from Northern Asia and Eastern Europe, and 1 to 2 percent in North America.⁶

In Latin America and the Caribbean, the STD prevalence rates and completeness of STD reporting vary from country to country. Between 1993 and 1997, STD prevalence rates were examined in the region. In Brazil, the prevalence of either chlamydia or gonorrhea among asymptomatic women or women presenting with vaginal discharge was similar, between 12 and 14 percent. In the general population of adults, the syphilis serology rate was 1 percent, but among STD clinic attendees it was 8 to 11 percent. Three to six percent of both men and women clinic attendees presented with genital ulcers. In the Dominican Republic, among women complaining of vaginal discharge, 8 percent were infected with either gonorrhea or chlamydia and 3 percent had positive syphilis serologies. Among men with symptoms of urethral discharge, 36 percent had gonorrhea and 29 percent had chlamydial infections. Of those men with genital ulcers, 37 percent had herpes, 16 percent had chancroid and 16 percent had syphilis. In Jamaica, symptomatic women had a chlamydial or gonococcal infection rate of 34 percent, and asymptomatic women had a chlamydial or gonococcal prevalence of 15 percent. Approximately 6 percent of STD clinic attendees presented with genital ulcers. Of these, 44 percent had genital herpes, 19 percent had chancroid and 10 percent had syphilis. In Haiti, 12 percent of asymptomatic women had either gonorrhea or chlamydia, and 35 percent were infected with trichomoniasis. Eleven percent had positive syphilis serologies. In Honduras, the actual prevalence of STDs is unknown, but reported cases show a population-based rate of gonorrhea at .04 percent and .06 percent for syphilis. Probably a better marker for syphilis prevalence is the .32 percent of pregnant women who had positive syphilis serologies.