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From the data submitted to the Pan American Health Organization (PAHO) by nationwide programs against sexually transmitted diseases (STD), HIV infection, and AIDS (2002), one can estimate the overall prevalence of syphilis among pregnant women to be 3.1 percent and to range from 1.00 percent in Peru to 6.21 percent in Paraguay. According to these data, the incidence of congenital syphilis ranges from 1.4 per 1 000 live births in El Salvador to 12.0 per 1 000 live births in Honduras. Among men who engage in sex with other men, who often classify themselves as heterosexual, as well as in female sex workers, the prevalence of syphilis ranged from 5 percent to 15 percent. Factors that determine the persistence of congenital syphilis as a public health problem include a lack of awareness of the seriousness of the problem among politicians, health officials, and health care providers, difficult access to prenatal care and screening services, a low demand for the test among users, and the stigma and discrimination that surround sexually transmitted diseases (STD). This paper seeks to focus the attention of health professionals on maternal and congenital syphilis so they will undertake actions, using an interprogrammatic approach, to eliminate congenital syphilis from Latin America and the Caribbean. Eliminating congenital syphilis will only become possible if interventions targeting vulnerable groups are also implemented. PAHO's role in eliminating congenital syphilis includes determining the baseline situation in the Region as a whole and in each country, developing communication and procurement strategies, supporting nationwide programs, promoting operational research, and facilitating interprogrammatic coordination.

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Estimates of HIV/AIDS prevalence are important, because they are the primary measure of the current state of the epidemic in a country. How estimates of HIV/AIDS are made depends on the level of the epidemic. For estimates of HIV/AIDS prevalence in low-level and concentrated epidemics it is necessary to disaggregate the total adult population into sub-groups based on the relative risk of infection. For each group, the major issues and questions are: identifying risk groups, estimating the size of the populations, and estimating HIV prevalence in these groups. The greatest difficulty in making estimates of prevalence in low-level and concentrated epidemics is often establishing the size of various populations. Because of the uncertainty inherent in making an estimate of population size for these groups at high risk, low and high estimates are used. In order to demonstrate the method the case of Honduras was used. The most recent HIV prevalence data and the estimates of population sizes were applied. It was estimated that Honduras, which has a total population of 6,575,000 (United Nations Population Division sources), has approximately 55,000 adults living with HIV/AIDS, with a range of uncertainty between 30,000 and 80,000. Estimations of the burden of HIV is a continuous process and should be updated on a regular basis according to the most recent and relevant information available.

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Se presenta una comparación de las tasas de participación y de las razones de la falta de respuesta en encuestas realizadas en cinco países de América Latina y el Caribe con el objetivo de medir la prevalencia de comportamientos de riesgo que determinan la transmisión del virus de la inmunodeficiencia humana. Dichas encuestas se basaron en muestras probabilísticas de la población de ambos sexos comprendida entre 15 y 49 años de edad, excepto en México, donde se estudió solo a los hombres. Se estimaron tres componentes de la participación: las proporciones de viviendas entrevistadas, de viviendas entrevistadas con personas elegibles y de personas elegibles que cumplimentaron la entrevista. Además, se calculó un índice global que combinaba los tres componentes. La tasa global de respuesta osciló entre 35,6 por ciento en México y 81,4 por ciento en Chile, y el componente de esta tasa con mayor variabilidad fue la participación de personas elegibles, que varió entre 50 por ciento en México y 95 por ciento en Cuba. Estos valores fueron más bajos de lo esperado, sobre todo en los hombres, y servirán de orientación para futuras encuestas, ya que se deberán considerar tasas de rechazo mayores de las previstas en el protocolo. Los resultados permiten inferir la validez de las estimaciones de la prevalencia de los diversos comportamientos de riesgo observados y establecen una referencia para calcular el tamaño muestral de futuras encuestas y mejorar la metodología de la investigación

This study compares participation rates and reasons for nonresponse in surveys conducted in five countries of Latin America and the Caribbean. The objective of the surveys was to measure the prevalence of risk behaviors affecting the transmission of human immunodeficiency virus. The surveys were based on probability samples of the population of both sexes between 15 and 49 years old, except in Mexico, where only men were included. Proportions of three components of participation were estimated: residences interviewed, interviewed residences with eligible persons, and eligible persons who completed the interview. In addition, an overall index that combined the three components was calculated. The overall response rate ranged from 35.6% in Mexico to 81.4% in Chile. The component with the greatest variability was the participation of eligible persons, which ranged from 50% in Mexico to 95% in Cuba. These values were lower than what had been expected, especially among men, and will serve to guide future surveys, since rejection rates higher than the ones expected in the protocol should be considered. The results make it possible to infer the validity of the prevalence estimates for the various observed risk behaviors. The results also establish a benchmark to calculate the sample size in future surveys and to improve research methodology

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Las enfermedades de transmisión sexual (ETS) constituyen un problema de salud pública con importantes consecuencias y secuelas que incluyen la enfermedad inflamatoria pélvica, la infertilidad, el carcinoma cervical y los desenlaces adversos del embarazo. En la última década, la estrecha asociación entre la presencia de ETS y el aumento del riesgo de transmisión sexual del virus de la inmunodeficiencia humana ha renovado el interés por la prevención y control de las ETS. Sin embargo, en América Latina y el Caribe, la información epidemiológica sobre la magnitud del problema de las ETS es escasa y, en general, está limitada a un pequeño número de estudios y a datos oficiales incompletos de los países de la zona. Tras una cuidadosa revisión de la literatura y un análisis de los datos que posee la Organización Mundial de la Salud sobre cada país, hemos estimado la prevalencia e incidencia en América Latina y el Caribe de cuatro ETS curables (sífilis, gonorrea, infección por clamídias y tricomoniasis) en hombres y mujeres de 15 a 49 años de edad. Para ello se utilizaron parámetros tales como la duración de la infección, la estimación de los pacientes tratados frente a los no tratados y los datos de población. En 1996, el número estimado de casos en América Latina y el Caribe fue de 1,3 millones para la sífilis, de 7,1 millones para la gonorrea, de 10,0 millones para las infecciones clamidiales y de 17,7 millones para la tricomoniasis. Con una cifra estimada total que, en el mejor de los casos, es superior a 36 millones de casos anuales, las ETS tratables parecen constituir un importante problema de salud pública en la zona

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Sexually transmitted diseases (STDs) have long been known for their great impact on health. In 1995, there were an estimated 333 million new cases of curable STDs among adults around the world (1). The prevalence of STDs in many developing countries, including those of Latin America and the Caribbean (LAC), is extremely high. In the AIDS era there is an urgent need to adequately control and manage these diseases. A delay in diagnosing and treating STDs can lead to chronic complications and irreversible sequelae. Women and children suffer the main consequences. In women, the most serious consequences are acute and chronic pelvic inflammatory diseases, infertility, ectopic pregnancy, and cervical cancer. Infection during pregnancy may cause spontaneous abortion, stillbirth, prematurity, low birthweight, congenital syphilis, and opthalmia neonatorum. There is an urgent need to improve STD surveillance and prevention in the LAC nations. This paper intends to help in that effort by reviewing relevant STD prevalence and incidence of gonorrhea, syphilis, chlamydia, and trichomoniasis in Latin America and the Caribbean (AU)

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This article reviews literature on the epidemiology, pathogenicity, and control of HIV and Micobacterium tuberculosis coinfection. Regarding pathogenicity, immune system deterioration makes HIV-infected people more likely to develop active tuberculosis on primary or secondary exposure to the bacillus or to suffer reactivation of latent infections, and to experience considerably higher rates of extrapulmonary manifestations, relapses, and death. Regarding epidemiology, as of 1990 there were an estimated 3 million people coinfected with HIV and M. tuberculosis, with some 300 000 active tuberculosis cases and 120 000-150 000 tuberculosis deaths occurring annually among those coinfected. Over 500 000 coinfected people are thought to reside in the Americas, over 400 000 of them in Latin America. In general, the impact of coinfection is evident. Relatively high and increasing prevalences of HIV infection have been detected among tuberculosis patients around the world, and tuberculosis has become a frequent complication of AIDS cases. Moreover, there is no longer any doubt that coinfection obstructs tuberculosis prevention and control. Among other things, it effects BCG vaccination policies, suggests the need to administer preventive chemoprophylaxis to HIV-infected individuals at high risk of harboring or contracting tuberculosis infections, and complicates both detection and treatment of active tuberculosis cases. The recent proliferation of M. tuberculosis strains resistant to multiple drugs, most notably in the United States, compounds the problem... (AU)

Revised translation of an article entitled "Epidemiología del SIDA y la tuberculosis" that was published in Spanish in the BOSP. Vol. 116(6):546-65, 1994

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At present, human immunodeficiency virus (HIV) is thought to have infected over 17 million people worldwide, over 1 million in North America and roughly 2 million in Latin America and the Caribbean. By comparison, infection with the tuberculosis (TB) agent mycobacterium tuberculosis is far more common, current estimates that roughly one-third of the world's population is infected. These two infections tend to aggravate each other. That is, HIV leads to a progressive immune system depression that favors reactivation of TB in people with latent tuberculous infections; it promotes progression of TB primary infections or reinfections to full-blown tuberculous disease; and it fosters TB transmission, because those simultaneously infected with HIV and M. tuberculosis tend to develop a bacilliferous and contagious TB that can be transmitted to other susceptible individuals, even though the latter are HIV-negative. In addition, this coinfection tends to promote circulation of drug-resistant M. tuberculosis and to produce peculiar manifestations that complicate TB diagnosis, treatment, and control. Overall, it seems clear that the growing threat posed by the these associated agents demands effective action in the form of well-coordinated measures involving thoroughgoing participation by all countries

Edited and updated version of a contribution previously published in Spanish in the BOSP. 116(3):250-262, 1994

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En el presente artículo se describen la pandemia del SIDA y su evolución desde que comenzó, así como la distribución geográfica de la enfermedad en América Latina y el Caribe. Posteriormente se examina el problema de la tuberculosis desde el punto de vista de su patogenia y repercusión en la salud pública de los países y se explica la interacción entre el virus de la inmunodeficiencia humana y Mycobacterium tuberculosis en América Latina y el Caribe, prestando atención a las características de la asociación que la convierten en un problema de salud pública de gravedad. Por último se señala la necesidad prioritaria de conocer el estado actual de esta asociación en los diversos países y de diseminar la información que en ellos se genera (AU)

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En este artículo, se revisan la patogenia de la coinfección por el virus de la inmunodeficiencia humana (VIH) y mycobacterium tuberculosis, sus características epidemiológicas en el mundo y especialmente en las Américas, así como las herramientas disponibles para su control. La relación entre la infección por VIH y por M. tuberculosis se hace evidente en dos situaciones: la frecuencia más alta de desarrollo de tuberculosis activa después de la primoinfección o reinfección exógena, y la reactivación del bacilo latente en el sujeto infectado por VIH al presentarse el deterioro de su sistema inmunitario. Se ha observado que las reacciones adversas a medicamentos, las recaídas y la mortalidad son más frecuentes en pacientes tuberculosos infectados por VIH que en los no infectados. El panorama en el mundo y el las Américas indica un aumento de los casos nuevos de tuberculosis y del síndrome de inmunodeficiencia adquirida (SIDA). La frecuencia de coinfectados es más alta en países y grupos humanos con alta prevalencia de infección por tuberculosis. El estudio de la coinfección puede realizarse desde tres enfoques. Primero, la estimación de la frecuencia de infección por VIH en pacientes tuberculosos. En las Américas, la prevalencia de infección por VIH en estos pacientes han sido más alta en las zonas metropolitanas del Brasil, Haití, los Estados Unidos de América y México. Segundo, la estimación de la frecuencia de tuberculosis en los casos de SIDA. En los casos de SIDA notificados anualmente en el Brasil y México se ha observado un aumento de la frecuencia de tuberculosis. La frecuencia más alta de tuberculosis en autopsias indica que la enfermedad no se diagnostica en el paciente vivo. Tercero, el estudio de la reactividad al PPD en poblaciones infectadas por VIH, cuya frecuencia varía entre 16 y 25 por ciento según el país. Por último se abordan los problemas de control de la tuberculosis en pacientes infectados por VIH o con SIDA: vacunación, quimioprofilaxis, búsqueda de casos y tratamiento

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At present, human immunodeficiency virus (HIV) is thought to have infected over 17 million people worldwide, over 1 million in North America and the Caribbean. By comparison, infection with the tuberculosis (TB) agent Mycobacterium tuberculosis is far more common, current estimates indicating that roughly one-third of the world's population is infected. These two infections tend to aggravate each other. That is, HIV leads to a progressive immune system depression that favors reactivation of TB in people with latent tuberculosis infections; it promotes progression of TB primary infections or reinfections to full-blown tuberculosis disease; and it fosters TB transmission, because those simultaneously infected with HIV and M. tuberculosis tend to develop a baciliferous and contagious TB that can be transmitted to other susceptible individuals, even though the latter are HIV-negative. In addition, this coinfection tends tok promote circulation of drug-resistant M. tuberculosis and to produce peculiar manifestations that complicate TB diagnosis, treatment, and control. Overall, it seems clear that the growing threat posed by these associated agents demands effective action in the form of well-coordinated measures involving thoroughgoing participation by all countries (AU)

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