This week I had a chance to have a discussion via Skype with a class in Ithaca, New York, which had read my book on the AIDS Pandemic in Latin America. The class asked what had changed with the epidemic since I wrote my book, as well as what would I change if I were to write it now? The good news is that there has been a great deal of progress in the fight against HIV in the region. More people are receiving appropriate therapy, fewer babies are being born with HIV, and the rate of condom use is up in many nations. At the same time, the number of people living with HIV is slowly increasing, in part because people are now living longer with the infection, thanks to better therapy.
Nonetheless, there are a number of points of concern, particularly with Mexico and Central America. On the one hand, Mexico has one of the lowest rates of HIV in Latin America and the Caribbean, even though the absolute number of people infected is still fairly large. One change, however, has been the impact of the drug war. President Calderon began the drug war in December 2006, just months before my book was published. In the years since perhaps 150,000 people have died or disappeared (the true figure is contested, and good data is lacking) and the state has been gravely weakened, especially in Northern Mexico. It is now hard to do fieldwork on drug use in Mexico. Still, there seem to be changes to the country’s drug market. In the past, there appears to have been a tacit agreement between drug lords and the government that Mexico would be a transshipment site for drugs, but that these drugs would not be sold within Mexico itself. With the onset of the drug war, any such agreements have vanished, if they ever existed at all. In particular, a byproduct of cocaine production has now become more common amongst low-income and homeless youth. This drug has many names in the region, such as basuco in Colombia and paco in the Southern Cone. It is highly addictive, and particularly destructive, because it is laden with many chemicals used during the cocaine creation process. I don’t know of any good numbers on increases in its use, and the research is likely too dangerous to undertake in the current climate. Still, I am concerned that Mexico may not remain one of the low prevalence nations in the HIV epidemic in Latin America. Everyone who has followed the epidemic knows what took place in Southern Africa in the late 1990s, and how quickly the epidemic can change. I don’t mean to suggest that Mexico will have the same experience as Southern Africa. My point is that we can’t assume that the epidemic can’t grow quickly in some populations in Mexico because it has never done so in the past.
If I were to rewrite the book today, I would do fieldwork in both Colombia and Venezuela, which have the largest number of people infected in South America outside Brazil. I would also wish to travel to Honduras, which has an unusually high prevalence of the virus for the region. I would also spend more time in the book discussing the early history of HIV in the region, and the voyage that the virus took from Central Africa to the Americas. As I discussed in my recent review of Quammen’s book, The Chimp and the River, much more is now known about the virus’s history than was the case even a decade before.
I’ve become fascinated with conspiracy theories and epidemics, and have a new article on this topic with the 2009 influenza pandemic. Certainly, with every major epidemic you see conspiracy theories, as is the case now with Ebola and polio. I heard many conspiracy theories about HIV while researching in Brazil, Cuba and Mexico. In particular, multiple people living with HIV in Brazil told me that the U.S. government had found a cure for the virus that it was not releasing, because its pharmaceutical companies were making immense profits off of drug sales for HIV. These stories circulated earlier in the United States amongst both the gay and African-American population. I suspect that these theories may have declined over time, at least in Latin America, but I would like to know if that was the case.
Lastly, if I were to rewrite the book now, I would discuss the many new approaches to treatment. A recent trial of gene therapy for the disease had striking success, although this approach is in its very earliest stages. Researchers are also experimenting with broadly neutralizing antibodies, and early results are also promising. This would likely not replace traditional antiretroviral therapy, but rather serve as a supplemental treatment, which might help to control the problem of drug resistance. Finally, research continues on vaccines. Of course, all of these therapies are many years from broad adoption. I suspect, however, that the next two decades will yield striking advances in medicine’s ability to treat the virus.
I want to thank the class for a great discussion this week, and my colleague Jonathan Ablard for inviting me to take part. Interested in Latin America? Click here to see my book on military terror in Brazil.
Prof. Shawn Smallman, Portland State University