The AIDS epidemic claimed 3.1 million (range 2.8-3.5 million) lives in 2004, and an estimated 4.9 million (4.3-6.4 million) people acquired the HIV virus in 2004—bringing to 39.4 million (range 35.9-44.3 million) the number of people globally living with the virus.

Globally, about one-third of adults living with HIV are young people aged 15 – 24 years, and new infections included an estimated 640 000 [570 000-750 000] children - over 90% of them infected through mother-to-child transmission (MTCT). Almost 90% of these new child infections occurred in sub-Saharan Africa, but the number of such infections is increasing in other regions.

In Latin America and the Caribbean, the total number of people living with HIV continues to rise. It is estimated that 2.2 million people (range: 1.7 million–2.8 million) are living with HIV in these countries—a figure that includes the 290 000 (range: 220 000–500 000) who were newly infected in 2004. In 2004, AIDS claimed approximately 130 000 lives (range: 110 000- 170 000).

In the Caribbean, 53 000 people (range: 27 000–140 000) acquired HIV in the past year, bringing the total number of people living with HIV or AIDS to around 440 000 (range: 270 000–780 000). In 2004, AIDS killed a further 36 000 people (range: 24 000–61 000).

In 2003, five countries in the Caribbean had national HIV prevalence levels of at least 2%: the Bahamas, Belize, Guyana, Haiti, and Trinidad and Tobago. Barbados was at 1.5% and Cuba’s prevalence was well below 1%.

Haiti continues to have the largest number of people living with HIV in the Caribbean: some 280,000 (range: 120 000-600 000) at the end of 2003. The most recent sentinel surveillance studies suggest a decline in HIV prevalence. The latest data suggest that median HIV prevalence among women (15-49) attending antenatal clinics has fallen from 4.5% in 1996 to 2.8% in 2003-2004. HIV prevalence among pregnant women varied between 1.8% and almost 7% in different parts of Haiti.

In Latin America, an estimated 1.7 million people (range: 1.3–2.2 million) are living with HIV—a figure that includes the 240 000 (range: 170 000–430 000) who were newly infected in 2004. In 2004, AIDS killed a further 95,000 people (range: 73 000 - 120 000).

Two countries in this region—Guatemala and Honduras—had national adult HIV prevalence of over 1% in 2003. But lower prevalence in other countries disguises the fact that serious, localized epidemics are also underway in several other countries—not least Brazil, which accounts for more than one third of the people living with HIV in Latin America.

The Caribbean’s epidemic is predominantly heterosexual, and is concentrated among sex workers in many places. However, the virus is spreading in the general population.

Latin America’s epidemic tends to be highly concentrated among populations at particular risk of HIV, rather than being generalized. In most South American countries, the majority of infections are caused by contaminated drug-injecting equipment or sex between men.

In Central America, where the epidemic to a large extent is still concentrated in large urban areas, the numbers of HIV infections have been rising in several countries (including El Salvador, Nicaragua and Panama) since the late 1990s, but HIV prevalence remains highest in Guatemala and Honduras.

Among people living with HIV, men outnumber women by roughly 3:1 in most countries. Worst-affected is Honduras, where adult prevalence of almost 2% meant that an estimated 63 000 [35 000–110 000] people were living with HIV at the end of 2003 (UNAIDS, 2004). AIDS-related diseases are now estimated to be the second-leading cause of death in Honduras. The country’s epidemic has matured considerably, spreading among the wider population in some parts (such as Valle de Sula), while concentrated in other parts among sex workers and men who have sex with men and other vulnerable groups. HIV prevalence of 13% was measured in a study among men who have sex with men in 2001. Earlier studies found HIV levels of 7% among a sample of prisoners and 8.4% among the Garifuna population (Secretaria de Salud de Honduras, 2004). In this subregion, HIV is spread predominantly through sex, and the highest levels of HIV infection are found in men who have sex with men and in female sex workers. Among the latter, HIV rates have varied considerably from about 1% in Nicaragua and Panama, to above 10% in Honduras and El Salvador.

In most Central American countries, street-based sex workers are at least twice as likely to be HIV-infected as their counterparts working out of brothels, bars and hotels (various Ministries of Health, 2003; MAP Report, 2003). In Guatemala, HIV prevalence of 3.6% and 15% has been measured among brothel-based and street-based sex workers, respectively, while similar HIV levels (4% and 14%, respectively) have been found in Honduras (Secretaria de Salud de Honduras, 2003; Ministerio de Salud Pública y Asistencia Social de Guatemala, 2003).

In El Salvador, HIV prevalence of 16% was found among street-based sex workers (in San Salvador and Puerto de Acajutla) (Ministerio de Salud Pública y Asistencia Social de El Salvador, 2003). It bears noting that, on the few occasions where prisoners have been tested for HIV, high prevalence has been found (7% in Honduras in the late 1990s, for example).