Development Roast
http://inesad.edu.bo/developmentroast/2019/02/hiv-is-on-the-rise-in-bolivia-but-it-is-concentrated-in-just-a-handful-of-municipalities/

HIV is on the rise in Bolivia, but it is concentrated in just a handful of municipalities


By: Lykke E. Andersen* and Alejandra Gonzales**

Thanks to the diligent work of the “Programa Nacional ITS/VIH/SIDA y Hepatitis Virales” in Bolivia, we able to present a good overview of the HIV situation in Bolivia. HIV (Human Immunodeficiency Virus) is a virus, which can lead to Acquired Immunodeficiency Syndrome (AIDS). The bad news is that it has been on the rise in Bolivia for the last two decades, but the good news is that it is still at a low level by international standards, and it is concentrated in just a handful of municipalities.



In general, the prevalence of HIV is low in Bolivia, at just 0.3% of the population aged 15-49 years (see Map 1 below).


Map 1: HIV prevalence in 2017, by country


However, it has been rising steadily during this century. According to internationally comparable data from UNAIDS, the HIV prevalence rate in Bolivia has increased from 0.1% of 15-49 year olds in the 1990s, to 0.2% in the early 2000s, to 0.3% now (see Figure 1, and notice that the figure is interactive, so you can add any other country you like for comparison).


Figure 1: HIV prevalence in Bolivia and the World, 1990-2017



0.3% of the population aged 15-49 corresponds to 0.15% of the total population, as the 15-49-year-old age group amounts to about 52% of the total population. 0.15% is equivalent to 1,500 per million inhabitants, which is how we measure HIV prevalence in Bolivia.


However, as HIV is incurable, prevalence is the accumulated outcome of decades of infections (minus deaths). HIV incidence is an alternative measure that better reflects what is currently happening, as it measures new cases of HIV per year per million inhabitants.


Figure 2 presents the annual incidence of HIV in Bolivia according to data from the “Programa Nacional ITS/VIH/SIDA y Hepatitis Virales.” Some of the increase over time may be due to improved detection and diagnostic capabilities, but it is clear that the number of new cases of HIV is increasing steadily. With almost 10 thousand new cases detected between 2014 and 2017, it is no longer a negligible risk, and people have to be careful.


Figure 2: Annual incidence of HIV in Bolivia (per million inhabitants), 1984-2017




Source: Programa Nacional ITS/VIH/SIDA y Hepatitis Virales.

Map 1 shows average annual HIV incidence per municipality for the period 2014-2017. More than 200 municipalities have registered no cases of HIV at all, and they are coloured in green. The municipalities coloured in red show the highest incidence, and is therefore where there is the highest risk of acquiring HIV.


Map 1: Average annual HIV incidence, 2014-2017, by municipality




Source: Authors' elaboration based on data from Programa Nacional ITS/VIH/SIDA y Hepatitis Virales.

The 10 municipalities with the highest average annual HIV incidences during 2014-2017 are the following:




  1. Sopachuy – La Paz (686 cases per year per million inhabitants)

  2. Tomina – La Paz (515)

  3. Puerto Villarroel – Cochabamba (509)

  4. Cochabamba (487)

  5. Santa Cruz de la Sierra (484)

  6. La Paz (446)

  7. Montero – Santa Cruz (435)

  8. Zudañez – La Paz (417)

  9. Trinidad – Beni (403)

  10. Ascensión de Guarayos – Santa Cruz (391)


However, just a handful of municipalities concentrate more than three quarters of all the new HIV cases registered during 2014-2017 (see Figure 3)


Figure 3: Distribution of all new HIV cases registered during 2014-2017, by municipality




Source: Authors' elaboration based on data from Programa Nacional ITS/VIH/SIDA y Hepatitis Virales.

Men are almost twice as likely to contract HIV than women. The only age-group where women are more likely to get HIV than men are for the 14-19-year-olds. Figure 4 shows the distribution of all HIV cases from 1984 to 2017 by age and gender.


Figure 4: Percent distribution of all notified HIV cases, 1984-2017, by age and gender




Source: Authors' elaboration based on data from Programa Nacional ITS/VIH/SIDA y Hepatitis Virales.

Finally, unless successfully managed with antiretroviral drugs, HIV can lead to AIDS. In Bolivia, about 10% of people with HIV develop AIDS, but the prevalence of AIDS differs substantially between departments. In 2004, the department of Santa Cruz had by far the highest AIDS prevalence (126 people with AIDS per million inhabitants), but they managed to get it under control, reducing it to 69 in 2013, although it has been picking up again lately. The situation is very different in the department of Cochabamba, which had a low prevalence of AIDS in 2004 (26 people with AIDS per million inhabitants), but that rate has increased 16-fold to 410 in 2017, by far the highest rate of any department in Bolivia, and showing no signs of slowing.


Figure 5: Prevalence of AIDS, 2004-2017, by department.




Source: Authors' elaboration based on data from Programa Nacional ITS/VIH/SIDA y Hepatitis Virales.

While Bolivia has a dedicated program to prevent, monitor and control HIV, AIDS and other sexually transmitted diseases, it is clear that it is not working equally well in all parts of the country. One municipality that really stands out in the detailed data kindly provided by the Programa Nacional de ITS/VIH/SIDA y Hepatitis Virales is Puerto Villarroel in the department of Cochabamba. Not just because it has one of the highest HIV incidences in the country, and is 11th in terms of the absolute number of new cases in 2014-2017, but because young girls have been particularly hard hit. Whereas girls aged 15-19 account for only 6.3% of new HIV cases in the rest of the country, in Puerto Villarroel they account for 45.1% of the cases.


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* Lykke E. Andersen, Ph.D., Executive Director of SDSN Bolivia at: Lykke.E.Andersen@sdsnbolivia.org.

** Alejandra Gonzales, Assistant Director at SDSN Bolivia

The viewpoints expressed in the blog are the responsibility of the authors and do not necessarily reflect the position of their institutions or of INESAD. These posts are part of the project “Atlas of the SDGs in Bolivia at the municipal level” that is currently carried out by the Sustainable Development Solutions Network (SDSN) in Bolivia, of which INESAD is a member.