Brazil, where a pioneering government program that offers antiretroviral drugs to all in need now finds itself facing escalating costs that threaten its future. Although the government saves costs by making several of the older drugs itself, officials have so far refrained from breaking patents and making copies of newer preparations, instead cutting deals with the big pharmaceutical companies.

Brazil also has had a model prevention program. In 1992, the World Bank predicted that Brazil would have 1.2 million cases of HIV by the year 2000. However, at the end of 2005, only 620,000 Brazilians were infected, according to UNAIDS estimates. Between 1996 and 2002, AIDS mortality dropped 50 percent, apparently because of the use of antiretroviral drug cocktails. The government says it saved 90,000 patients from death as well as $1.2 billion that would have been spent on hospitalization and treatment of opportunistic infections.

Argentina, where the epidemic's characteristics have changed dramatically. Once driven mainly by gay men and injecting drug users, today HIV mainly spreads by sex between men and women, who now have nearly the same new infection rate. By 2005, the HIV prevalence rate was 0.6 percent. Government data showed 50.7 percent of people with AIDS had been infected through heterosexual sex. By contrast, an analysis from 1982 to 2001 showed that 40.1 percent of cases were contracted through intravenous drug use.

Mexico, where the spread of HIV is linked to men who have sex with men, migration, the sex industry, and near the U.S. border, injecting drug use. The epidemic in Mexico has not spread as quickly as feared, according to researchers, but epidemiologists say they are most concerned about the heterosexual spread of the virus in rural communities.

Another source of concern is migration, which researchers are finding puts people at a much higher risk of
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Contact: Natasha Pinol
npinol@aaas.org
202-326-7088
American Association for the Advancement of Science
27-Jul-2006