HIV/AIDS in the Dominican Republic

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The Dominican Republic has a 0.7 percent prevalence rate of HIV/AIDS, among the lowest percentage-wise in the Caribbean region. However, it has the second most cases in the Caribbean region in total web|url=http://www.avert.org/caribbean-hiv-aids-statistics.htm |title=Caribbean HIV & AIDS Statistics|date=21 July 2015}}</ref> with an estimated 46,000 HIV/AIDS-positive Dominicans as of 2013 (the Dominican Republic is the second most populated Caribbean nation). [1]

Contents

Prevalence

The U.S. Agency for International Development (USAID) reports that some urban areas of the Dominican Republic have HIV/AIDS infection rates well in excess of 10%.

In some parts of the Dominican Republic, HIV/AIDS has become one of the leading cause of death among teenagers and adults between 15–49 years old. Adult women living with HIV/AIDS are estimated at 23,000. HIV prevalence in pregnant women had been relatively stable for a number of years. However, 2005 sentinel surveillance reported HIV prevalence of more than 4.5 percent in pregnant women at two sites. In 2006, sentinel surveillance of pregnant women of all ages reported seroprevalence of 3.4 percent at four sites and 5.9 percent at one site. However, in the Santo Domingo National District, antenatal clinics have noted a decline in prevalence, probably because of a successful prevention campaign. [2]

HIV/AIDS was first reported in the Dominican Republic in 1983 and continued spreading until the mid-1990s, when prevalence started to decrease. Due to sex tourism, child sex tourism, and prostitution in tourism industry workers, spread of the epidemic began to increase again. Heterosexual intercourse reportedly the primary form of transmission of the disease, accounting for 81 percent of HIV infections in 15- to 44-year-olds of both sexes. However, because of strong stigma against homosexuality, it is possible that the number of infections resulting from men having sex with men, or male child prostitutes, may be higher than listed or may simply go unreported.

In addition to an increase in sex tourism , the country’s epidemic is driven by people with multiple sex partners, younger women in union with older men, sex workers and their clients and partners, and men who have sex with men (MSM). According to the 2002 Demographic and Health Survey, 29 percent of men had sex with more than one partner in the preceding 12 months. According to UNAIDS, females under 24 years of age are twice as likely to contract HIV as their male counterparts. This is in part due to young women having relationships with older men, who are more likely to have acquired HIV/AIDS from previous partners or exposure. [2]

A sentinel surveillance study in 2006 reported that prevalence among prostitutes, or commercial sex workers (CSWs), is 4.1 percent (2.4 to 6.5 percent, depending on location). In some sites, the prevalence among is declining and equals that of pregnant women. For example, in Santo Domingo, prevalence in sex workers has been decreasing for the last eight years and is reaching the same level as in pregnant women nationally. This may be attributable to the successful implementation of the “100% Condom Strategy” by two nongovernmental organizations (NGOs) in several provinces. [2]

For example, one community project in Santo Domingo in 2006 demonstrated an increase in condom use among sex workers, from 75 percent to 94 percent in just 12 months. According to the 2005 World Health Organization (WHO)/UNAIDS AIDS Epidemic Update, a 2004 study in Puerto Plata, Samana, and Santo Domingo found that 11 percent of MSM were HIV-positive. Infection levels among sugar cane plantation workers living in communities called bateyes average 5 percent, with some groups as high as 12 percent. [2]

According to WHO, the estimated incidence rate of tuberculosis (TB) in the Dominican Republic (40 cases per 100,000 people in 2005) is one of the highest in the Americas. Data on HIV-TB co-infection, albeit limited to certain areas of the country, suggest that 6 to 11 percent of TB patients are infected with HIV. Therefore, the Dominican Republic has the potential for a burgeoning epidemic of TB along with HIV. National HIV-TB guidelines have been recently developed and HIV-TB activities have been included in national plans. While the country has introduced some HIV-TB collaborative activities (e.g., isoniazid prophylaxis for HIV-infected people and provision of antiretroviral therapy [ART]), there are no data on the number of HIV-infected TB patients receiving ART. [2]

Factors that put the Dominican Republic at risk of a growing epidemic include early age at sexual debut, high birth rates among adolescent girls and young women, the high TB incidence, and active migration (including migration between cities and countryside, migration from Haiti, and migration to and from the United States). The Dominican Republic’s popularity as a tourist destination, coupled with increasing levels of sex tourism, also contributes to the spread of HIV. These and other factors suggest the need to target interventions to young adults, provinces with a high rate of tourism, and bateyes. [2]

National response

The Government of the Dominican Republic has responded aggressively to the HIV/AIDS epidemic. Established in 2000, the Presidential Council on AIDS (COPRESIDA) coordinates the HIV/AIDS National Strategic Plan for the Prevention and Control of HIV/AIDS and STDs 2007–2015. COPRESIDA’s activities include implementing public policies, providing care for those living with HIV/AIDS, promoting private sector involvement in response to the epidemic, and reducing stigma and discrimination (S&D). The Ministry of Health (MOH) implements HIV/AIDS services and diagnostic tests in the public sector. The National AIDS Program (NAP) develops HIV/AIDS-related norms, protocols, and surveillance. [2]

National-level government-directed activities include the following: [2]

Since 1995, an AIDS law has made it illegal to discriminate against PLWHA. The law is unique for the region; however, enforcement is uneven and inconsistent, and S&D against PLWHA and those engaging in behaviors putting them most at risk for HIV/AIDS are common. [2]

The government works with a number of international donors to combat HIV/AIDS, including the William J. Clinton Foundation, UNICEF, the United Nations Population Fund, the World Bank, and the Global Fund to Fight AIDS, Tuberculosis and Malaria. In 2004, the Dominican Republic received a second-round grant from the Global Fund to scale up HIV services throughout the country, with particular focus on vulnerable groups, including female sex workers, MSM, and migrants. With Global Fund support, the government also intends to scale up ART. [2]

Related Research Articles

The Caribbean is the second-most affected region in the world in terms of HIV prevalence rates. Based on 2009 data, about 1.0 percent of the adult population is living with the disease, which is higher than any other region except Sub-Saharan Africa. Several factors influence this epidemic, including poverty, gender, sex tourism, and stigma. HIV incidence in the Caribbean declined 49% between 2001 and 2012. Different countries have employed a variety of responses to the disease, with a range of challenges and successes.

Since the first HIV/AIDS case in the Lao People's Democratic Republic (PDR) was identified in 1990, the number of infections has continued to grow. In 2005, UNAIDS estimated that 3,700 people in Lao PDR were living with HIV.

HIV/AIDS in Eswatini was first reported in 1986 but has since reached epidemic proportions. As of 2016, Eswatini had the highest prevalence of HIV among adults aged 15 to 49 in the world (27.2%).

With less than 0.1 percent of the population estimated to be HIV-positive, Bangladesh is a low HIV-prevalence country.

HIV/AIDS in Jordan is characterized by a low prevalence rate compared to other regions, but the situation remains a concern due to potential for increase and the social and economic consequences that could result. As of 2007, the UNAIDS estimated that there were approximately 380 people living with HIV/AIDS (PLWHA) in Jordan. Despite the relatively low numbers, the country faces challenges in addressing the epidemic, including inadequate surveillance systems, limited adoption of preventive practices, and persistent stigma and discrimination against PLWHA.

<span class="mw-page-title-main">HIV/AIDS in Nepal</span>

The first HIV/AIDS cases in Nepal were reported in 1988. The HIV epidemic is largely attributed to sexual transmissions and account for more than 85% of the total new HIV infections. Coinciding with the outbreak of civil unrest, there was a drastic increase in the new cases in 1996. The infection rate of HIV/AIDS in Nepal among the adult population is estimated to be below the 1 percent threshold which is considered "generalized and severe". However, the prevalence rate masks a concentrated epidemic among at-risk populations such as female sex workers (FSWs), male sex workers (MSWs), injecting drug users (IDUs), men who have sex with men (MSM), Transgender Groups (TG), migrants and male labor migrants (MLMs) as well as their spouses. Socio-Cultural taboos and stigmas that pose an issue for open discussion concerning sex education and sex habits to practice has manifest crucial role in spread of HIV/AIDS in Nepal. With this, factors such as poverty, illiteracy, political instability combined with gender inequality make the tasks challenging.

The Philippines has one of the lowest rates of infection of HIV/AIDS, yet has one of the fastest growing number of cases worldwide. The Philippines is one of seven countries with growth in number of cases of over 25%, from 2001 to 2009.

The southeast-Asian nation of East Timor has dealt with HIV/AIDS since its first documented case in 2001. It has one of the lowest HIV/AIDS-prevalence rates in the world.

Since HIV/AIDS was first reported in Thailand in 1984, 1,115,415 adults had been infected as of 2008, with 585,830 having died since 1984. 532,522 Thais were living with HIV/AIDS in 2008. In 2009 the adult prevalence of HIV was 1.3%. As of 2016, Thailand had the highest prevalence of HIV in Southeast Asia at 1.1 percent, the 40th highest prevalence of 109 nations.

HIV/AIDS in Bolivia has a less than 1 percent prevalence of Bolivia's adult population estimated to be HIV-positive. Bolivia has one of the lowest HIV prevalence rates in the Latin America and Caribbean region.

Cases of HIV/AIDS in Peru are considered to have reached the level of a concentrated epidemic.

HIV/AIDS in El Salvador has a less than 1 percent prevalence of the adult population reported to be HIV-positive. El Salvador therefore is a low-HIV-prevalence country. The virus remains a significant threat in high-risk communities, such as commercial sex workers (CSWs) and men who have sex with men (MSM).

Honduras is the Central American country most adversely affected by the HIV/AIDS epidemic. It is estimated that the prevalence of HIV among Honduran adults is 1.5%.

HIV/AIDS in Jamaica has a 1.5 percent prevalence of the adult population estimated to be HIV-positive. There has been no significant change over the last five years and therefore Jamaica appears to have stabilized its HIV/AIDS epidemic.

In 2016, the prevalence rate of HIV/AIDS in adults aged 15–49 was 0.3%, relatively low for a developing country. This low prevalence has been maintained, as in 2006, the HIV prevalence in Mexico was estimated at around 0.3% as well. The infected population is remains mainly concentrated among high risk populations, men who have sex with other men, intravenous drug users, and commercial sex workers. This low national prevalence is not reflected in the high-risk populations. The prison population in Mexico, faces a fairly similar low rate of around 0.7%. Among the population of prisoners, around 2% are known to be infected with HIV. Sex workers, male and female, face an HIV prevalence of around 7%. Identifying gay men and men who have sex with other men have a prevalence of 17.4%. The highest risk-factor group is identifying transgender people; about 17.4% of this population is known to be infected with HIV. Around 90% of new infections occur by sex-related methods of transmission. Of these known infected populations, around 60% of living infected people are known to be on anti-retroviral therapy (ART).

Nicaragua has 0.2 percent of the adult population estimated to be HIV-positive. Nicaragua has one of the lowest HIV prevalence rates in Central America.

With less than 1 percent of the population estimated to be HIV-positive, Egypt is a low-HIV-prevalence country. However, between the years 2006 and 2011, HIV prevalence rates in Egypt increased tenfold. Until 2011, the average number of new cases of HIV in Egypt was 400 per year, but in 2012 and 2013, it increased to about 600 new cases, and in 2014, it reached 880 new cases per year. According to 2016 statistics from UNAIDS, there are about 11,000 people currently living with HIV in Egypt. The Ministry of Health and Population reported in 2020 over 13,000 Egyptians are living with HIV/AIDS. However, unsafe behaviors among most-at-risk populations and limited condom usage among the general population place Egypt at risk of a broader epidemic.

With 1.28 percent of the adult population estimated by UNAIDS to be HIV-positive in 2006, Papua New Guinea has one of the most serious HIV/AIDS epidemics in the Asia-Pacific subregion. Although this new prevalence rate is significantly lower than the 2005 UNAIDS estimate of 1.8 percent, it is considered to reflect improvements in surveillance rather than a shrinking epidemic. Papua New Guinea accounts for 70 percent of the subregion's HIV cases and is the fourth country after Thailand, Cambodia, and Burma to be classified as having a generalized HIV epidemic.

Morocco has been identified as one of the best countries within the MENA region in dealing with the HIV epidemic based on their research capacities, surveillance systems, and evidence-informed and comprehensive responses. While the general public has a fairly low HIV prevalence, the majority of HIV/AIDS cases can be found in three high-risk groups, which is important when deciding how to approach intervention and prevention.

References

  1. ↑ "Prevalence of HIV, total (% of population ages 15-49) | Data".
  2. 1 2 3 4 5 6 7 8 9 10 11 "Health Profile: Dominican Republic" Archived 2008-09-13 at the Wayback Machine . United States Agency for International Development (June 2008). Accessed September 7, 2008. PD-icon.svg This article incorporates text from this source, which is in the public domain .
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