Latin America and the Caribbean: Challenges and Opportunities for HIV Treatment and Prevention

In Latin America, there are rising numbers of new HIV acquisitions, while the Caribbean has achieved decreases in both new acquisitions and AIDS-related deaths. The Latin American and Caribbean (LAC) region has worked towards widely available treatment for people with HIV (PWHIV) within public health systems and, in Latin America, has relied principally on domestic financing to do so.

While new methods of prevention are in the process of being incorporated into regional HIV programmes, the HIV cascade of care remains below the UNAIDS goals. Only 17 of the 32 LAC countries (53%) report on the three pillars. Only Chile achieved >95% in two of the three pillars, with 95% of PWHIV knowing their status and 95% of people on treatment having a suppressed viral load. However, only 75% of those who know their status were on treatment. In the Caribbean, very little data is available, with all three cascade pillars missing for six of the countries. Only the Bahamas reached the 95% threshold for any of the cascade steps. Additionally, in the Caribbean, the viral suppression step of the cascade is much lower on average than in Latin America, with no countries reaching 80%. Biomedical HIV prevention with pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) is still being adopted and scaled up among populations in need. Scale-up of prevention efforts remains hindered by structural limitations of the health system, legal and policy limitations such as continuing to require informed consent for HIV testing and policies that block task-shifting, as well as persistent stigma. Recent reductions in international funding for HIV may adversely influence HIV programmes in LAC, which have relied on these for initial scale-up of innovations.

Accelerating differentiated and simplified delivery of PrEP and PEP, alongside sustained progress towards universal treatment coverage and viral suppression, are all essential for translating existing scientific advances into measurable progress towards HIV elimination in the region.