RESUMO
Chile is a country with a relatively low prevalence of HIV infection, where successful prevention has the potential to change the future course of the epidemic. A controversial national prevention strategy based upon public education has emerged in response to characterizations of the epidemic as well-dispersed with a growing involvement of heterosexuals. This characterization is not consistent with the observed facts. There is a comparatively well-organized health care system in Santiago that is doing a good job of detecting HIV infection and already has in place the elements of a targeted intervention scheme. Chile should place priority on the use of the existing health care infrastructure for implementing both the traditional public health interventions for sexually transmitted diseases (contact tracing and partner notification) and the AIDS-necessitated strategy of focused counseling and education.
PIP: 93% of the 1016 cumulative AIDS cases reported through June 1994 in Chile have been among men. People aged 20-49 years comprise 85% of cases. The cases are concentrated in the Santiago metropolitan area with a second cluster in the urban sea coast region which includes Valparaiso and Vina-del-Mar. An additional 1627 people have been confirmed HIV seropositive. 86% of AIDS cases are the result of sexual intercourse. Of the 815 adult males diagnosed with AIDS as of the middle of 1994, 58% were homosexual, 24% were bisexual, and 18% were heterosexual. These figures suggested that HIV infection was spreading into the general heterosexual population of the country and prompted the government to implement a mass media HIV/AIDS campaign as the cornerstone of its AIDS prevention plan. However, interview findings suggest that the extent of bisexual- and heterosexual-related HIV transmission reflected in official statistics could be high by as much as 50%. Many men who have sex with men do not identify themselves as homosexual. HIV/AIDS route of infection statistics based upon self-identified sexual categories are therefore inaccurate. The AIDS epidemic in Chile to date is more like the largely homosexual epidemic in San Francisco during the 1980s than that occurring in the countries of the Caribbean or elsewhere with a heterosexual transmission pattern. A highly focused AIDS prevention program effectively slowed the spread of HIV in San Francisco. Rather than continue with the mass media prevention campaign, Chile should use its existing blood donor system combined with partner tracing and case investigation to capture a manageable number of HIV-positive people and identify nascent localized epidemics.