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== Affected Populations ==
== Affected Populations ==
=== HIV in MSM (Men who have sex with men) ===
=== HIV in MSM (Men who have sex with men) ===
The prevalence of HIV among [[men who have sex with men]] in Colombia ranges from 6% to 24%<ref>{{cite journal|last1=Carol A. Reisen,1 Maria Cecilia Zea,Fernanda T. Bianchi, Paul J. Poppen, Ana Maria del Río González, Rodrigo A. Aguayo Romero, and Carolin Pérez|title=HIV testing among MSM in Bogotá, Colombia: The role of structural and individual characteristics|pmid=PMC4121962|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4121962/}}</ref>, and is highest in [[Cali]], [[Bogotá]], and [[Barranquilla]].<ref>{{cite journal|last1=Martha Lucía Rubio Mendoza , Jerry Owen Jacobson, Sonia Morales-Miranda, Clara Ángela Sierra Alarcón, Ricardo Luque Núñez|title=High HIV Burden in Men Who Have Sex with Men across Colombia’s Largest Cities: Findings from an Integrated Biological and Behavioral Surveillance Study|url=http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0131040}}</ref> Bogotá's rate of HIV among MSM is 15%, and the rate of HIV among MSM in Colombia as a whole is 17%.<ref>{{cite web|url=http://www.unaids.org/en/regionscountries/countries/colombia|website=UNAIDS|accessdate=11/9/17}}</ref>
[[Men who have sex with men]] in Colombia experience significantly higher rates of HIV infection than does the general population. The prevalence of HIV among men who have sex with men in Colombia ranges from 6% to 24%<ref>{{cite journal|last1=Carol A. Reisen,1 Maria Cecilia Zea,Fernanda T. Bianchi, Paul J. Poppen, Ana Maria del Río González, Rodrigo A. Aguayo Romero, and Carolin Pérez|title=HIV testing among MSM in Bogotá, Colombia: The role of structural and individual characteristics|pmid=PMC4121962|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4121962/}}</ref>, and is highest in [[Cali]], [[Bogotá]], and [[Barranquilla]].<ref>{{cite journal|last1=Martha Lucía Rubio Mendoza , Jerry Owen Jacobson, Sonia Morales-Miranda, Clara Ángela Sierra Alarcón, Ricardo Luque Núñez|title=High HIV Burden in Men Who Have Sex with Men across Colombia’s Largest Cities: Findings from an Integrated Biological and Behavioral Surveillance Study|url=http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0131040}}</ref> Bogotá's rate of HIV among MSM is 15%, and the rate of HIV among MSM in Colombia as a whole is 17%.<ref>{{cite web|url=http://www.unaids.org/en/regionscountries/countries/colombia|website=UNAIDS|accessdate=11/9/17}}</ref>


In a survey of seven Colombian cities, between 14% and 31% of men who have sex with men reported ever being tested for HIV.
In a survey of seven Colombian cities, between 14% and 31% of men who have sex with men reported ever being tested for HIV.

Revision as of 06:34, 14 December 2017

Introduction

The first officially diagnosed case of HIV in Colombia was diagnosed in 1983 in Cartagena.[1] The epidemic in Colombia peaked during the mid 1990's, with new infections gradually decreasing in the following years.[2] The epidemic in Colombia today is consistent with the epidemic in Latin America as a whole, both in terms of the prevalence of HIV infection and specific populations affected. Overall, Colombia has a relatively low rate of HIV infection. However, specific groups, particularly men who have sex with men, bear the burden of significantly higher rates of infection than the general population.[3]

Prevalence

Approximately 120,000 people in Colombia are living with HIV, according to UNAIDS.[4] Colombia's rate of HIV prevalence, which is 0.4%, is on par with HIV prevalence in other Latin American and Caribbean nations.[5] New HIV infections in Colombia peaked between the years of 1993-1997, and have since dropped off. In recent years, the estimated number of new HIV infections in the country has dropped gradually, with an estimated 5,600 new infections in 2016.[6]

HIV is more common among men than women in Colombia. Men have an HIV prevalence rate of about 0.6%, whereas women have a prevalence rate of about 0.2%.[7]

Government Policies

Two landmark decisions, one in 1993 and one in 2008, significantly altered access to HIV treatment in Colombia.

In 1993, the passage of Law 100 created a system of privatized but regulated universal healthcare — under the new system, private insurance companies competed for clients with government oversight. Insurance companies were mandated only to cover treatment listed under Colombia's obligatory health plan. There were two types of insurance schemes under the new system — one to which employees and employers contributed, and one which was subsidized by the government. Although the contributory scheme offered more comprehensive healthcare overall, the antiretroviral medication used to treat HIV (AZT) was not covered under either version of the government's obligatory health plan. Individuals seeking AZT were forced to file tutelas, or pleas, in order to access it.[8] One activist action, called Operation Wasp, involved filing seven tutelas in seven different courts in Bogotá so as to occupy the court dockets for ten days. All of the judges targeted by Operation Wasp ruled in favor of the tutelas.[9] At the beginning of the HIV epidemic, about 20% of Colombia's population was on private healthcare, with the rest relying on public healthcare.

In 2008, with annual tutelas totaling around 100,000 the Constitutional Court of Colombia reached the T-760 decision, which made the obligatory government health plan more generous and provided for measures to be taken to decrease the incidence of arbitrary denial of health coverage.[10] The T-760 decision fundamentally reframed how health care was viewed in Colombia, and is commonly viewed as having created a "right to health" conception of health care in which health care is viewed as a human right.[11]

Today, almost 100% of Colombians are insured. However, the quality of that insurance has often been disputed, with reports of individuals being denied healthcare due to administrative or bureaucratic reasons.[12]

Needle and Syringe Program

In 2014, the Colombian Ministry of Health launched needle and syringe programs (NSPs) in five Colombian cities: Medellín, Bogotá, Cali, Cucuta, and Armenia. At its launch, the government allotted 100,000 syringes for distribution to people who inject drugs, in most cases heroin.[13]

Opioid substitution therapy

Colombia is one of only five countries in Latin America and the Caribbean to offer opioid substitution therapy, a drug therapy that involves replacing a drug such as heroin with another, less harmful opioid. OST services are available in seven Colombian cities, but it is unknown how widely used these services are.[14]

AIDS Activism in Colombia

Influenced by the emergence of similar groups in the U.S, early AIDS activism in Colombia initially consisted of support groups for people with AIDS. These groups, such as Seguro Social, El Club de la Alegría, and El Cartel de la Vida, focused initially on issues such as self-care and support for people with AIDS. Later, the groups would shift their focus towards access to treatment for HIV and AIDS.[15] Consistent with AIDS activism in other countries, early AIDS activism in Colombia was closely linked to LGBTQ organizations and the LGBTQ community as a whole. [16]

Affected Populations

HIV in MSM (Men who have sex with men)

Men who have sex with men in Colombia experience significantly higher rates of HIV infection than does the general population. The prevalence of HIV among men who have sex with men in Colombia ranges from 6% to 24%[17], and is highest in Cali, Bogotá, and Barranquilla.[18] Bogotá's rate of HIV among MSM is 15%, and the rate of HIV among MSM in Colombia as a whole is 17%.[19]

In a survey of seven Colombian cities, between 14% and 31% of men who have sex with men reported ever being tested for HIV.

HIV in Intravenous Drug Users

In Colombia, people who inject drugs have an HIV prevalence rate of 2.8%.[20] Although additional studies are needed, recent epidemiological studies have shown an increase in both heroin usage and heroin injection in Colombia. Of particular note is the fact that though exported heroin in Colombia is of high quality, the heroin that is not exported and remains in Colombia to be sold to Colombian drug users tends to be of low quality and therefore tends to be water-soluble, which makes it more likely to be injected. A primary concern about the rise in the rate of drug injection in Colombia is the spread of HIV, both among drug-injecting and non drug-injecting populations.[21] A 2014 study found that heroin production in the country had formed "injection networks" which have the potential to spread HIV, particularly among young men.[22]

HIV in Sex Workers

The prevalence of HIV among sex workers in Colombia is 1.2%. Over 90% of sex workers are aware of their HIV status, and over 94% report condom usage.[23] At the same time, many sex workers say that the see HIV testing as pointless, because they lack access to adequate treatment should they test positive.[24]

References

  1. ^ Corey Prachniak-rincóncorresponding author and Jimena Villar de Onís (Dec 2016). "HIV and the Right to Health in Colombia". Health and Human Rights Journal. PMID PMC5395009 PMCID: PMC5395009. Retrieved 12/14/17. {{cite journal}}: |last1= has generic name (help); Check |pmid= value (help); Check date values in: |accessdate= (help)
  2. ^ UNAIDS http://www.unaids.org/en/regionscountries/countries/colombia. Retrieved 11/6/17. {{cite web}}: Check date values in: |accessdate= (help); Missing or empty |title= (help)
  3. ^ Ballvé, Teo. "Colombia: AIDS in the Time of War". nacla.org. Retrieved 12/14/17. {{cite web}}: Check date values in: |accessdate= (help)
  4. ^ UNAIDS. UNAIDS http://aidsinfo.unaids.org/. Retrieved 11/7/17. {{cite web}}: Check date values in: |accessdate= (help); Missing or empty |title= (help)
  5. ^ García, Patricia J, Bayer, Angela, Cárcamo, César P. "The Changing Face of HIV in Latin America and the Caribbean". doi:10.1007/s11904-014-0204-1. PMID PMC4136548. {{cite journal}}: |access-date= requires |url= (help); Check |pmid= value (help); Check date values in: |accessdate= (help); Cite journal requires |journal= (help)CS1 maint: multiple names: authors list (link)
  6. ^ UNAIDS http://www.unaids.org/en/regionscountries/countries/colombia. Retrieved 11/6/17. {{cite web}}: Check date values in: |accessdate= (help); Missing or empty |title= (help)
  7. ^ UNAIDS http://www.unaids.org/en/regionscountries/countries/colombia. {{cite web}}: Missing or empty |title= (help)
  8. ^ Corey Prachniak-rincóncorresponding author and Jimena Villar de Onís (Dec 2016). "HIV and the Right to Health in Colombia". Health and Human Rights Journal. PMID PMC5395009 PMCID: PMC5395009. Retrieved 11/9/17. {{cite journal}}: |last1= has generic name (help); Check |pmid= value (help); Check date values in: |accessdate= (help)
  9. ^ Corey Prachniak-rincóncorresponding author and Jimena Villar de Onís (Dec 2016). "HIV and the Right to Health in Colombia". Health and Human Rights Journal. PMID PMC5395009 PMCID: PMC5395009. Retrieved 11/9/17. {{cite journal}}: |last1= has generic name (help); Check |pmid= value (help); Check date values in: |accessdate= (help)
  10. ^ Cite error: The named reference HIV and the Right to Health was invoked but never defined (see the help page).
  11. ^ Corey Prachniak-rincóncorresponding author and Jimena Villar de Onís (Dec 2016). "HIV and the Right to Health in Colombia". Health and Human Rights Journal. PMID PMC5395009 PMCID: PMC5395009. Retrieved 11/9/17. {{cite journal}}: |last1= has generic name (help); Check |pmid= value (help); Check date values in: |accessdate= (help)
  12. ^ Corey Prachniak-rincóncorresponding author and Jimena Villar de Onís (Dec 2016). "HIV and the Right to Health in Colombia". Health and Human Rights Journal. PMID PMC5395009 PMCID: PMC5395009. Retrieved 11/9/17. {{cite journal}}: |last1= has generic name (help); Check |pmid= value (help); Check date values in: |accessdate= (help)
  13. ^ McKenzie, Victoria. "Colombia kicks off 1st clean needle program for drug addicts". Colombia Reports. Retrieved 11/8/17. {{cite web}}: Check date values in: |accessdate= (help)
  14. ^ "HIV AND AIDS IN LATIN AMERICA THE CARIBBEAN REGIONAL OVERVIEW". Avert. Retrieved 12/13/17. {{cite web}}: Check date values in: |accessdate= (help)
  15. ^ Corey Prachniak-rincón, Jimena Villar de Onís (Dec 2016). "HIV and the Right to Health in Colombia". Health and Human Rights Journal. PMID PMC5395009. Retrieved 11/16/17. {{cite journal}}: Check |pmid= value (help); Check date values in: |accessdate= (help)
  16. ^ Corey Prachniak-rincón, Jimena Villar de Onís (Dec 2016). "HIV and the Right to Health in Colombia". Health and Human Rights Journal. PMID PMC5395009. Retrieved 11/16/17. {{cite journal}}: Check |pmid= value (help); Check date values in: |accessdate= (help)
  17. ^ Carol A. Reisen,1 Maria Cecilia Zea,Fernanda T. Bianchi, Paul J. Poppen, Ana Maria del Río González, Rodrigo A. Aguayo Romero, and Carolin Pérez. "HIV testing among MSM in Bogotá, Colombia: The role of structural and individual characteristics". PMID PMC4121962. {{cite journal}}: Check |pmid= value (help); Cite journal requires |journal= (help)CS1 maint: multiple names: authors list (link) CS1 maint: numeric names: authors list (link)
  18. ^ Martha Lucía Rubio Mendoza , Jerry Owen Jacobson, Sonia Morales-Miranda, Clara Ángela Sierra Alarcón, Ricardo Luque Núñez. "High HIV Burden in Men Who Have Sex with Men across Colombia's Largest Cities: Findings from an Integrated Biological and Behavioral Surveillance Study". {{cite journal}}: Cite journal requires |journal= (help)CS1 maint: multiple names: authors list (link)
  19. ^ UNAIDS http://www.unaids.org/en/regionscountries/countries/colombia. Retrieved 11/9/17. {{cite web}}: Check date values in: |accessdate= (help); Missing or empty |title= (help)
  20. ^ UNAIDS http://www.unaids.org/en/regionscountries/countries/colombia. Retrieved 11/8/17. {{cite web}}: Check date values in: |accessdate= (help); Missing or empty |title= (help)
  21. ^ Maria José Miguez'Correspondence information about the author Maria José Miguez, Bryan Page, Marianna K Baum (1997). "Illegal drug use and HIV-1 infection in Colombia". The Lancet. doi:http://dx.doi.org/10.1016/S0140-6736(05)64059-7. {{cite journal}}: |last1= has generic name (help); Check |doi= value (help); External link in |doi= (help)CS1 maint: multiple names: authors list (link)
  22. ^ P. Mateu-Gelabert1, D. Berbesi2, I.E.M. Motta3,4, H. Guarino1, S. Harris (2014). "Heroin production in Colombia: A time-bomb for a drug injection-driven HIV epidemic in Colombia?". National Institute of Drug Abuse. Retrieved 11/16/17. {{cite journal}}: Check date values in: |accessdate= (help)CS1 maint: multiple names: authors list (link) CS1 maint: numeric names: authors list (link)
  23. ^ UNAIDS http://www.unaids.org/en/regionscountries/countries/colombia. {{cite web}}: Missing or empty |title= (help)
  24. ^ Corey Prachniak-rincóncorresponding author and Jimena Villar de Onís (Dec 2016). "HIV and the Right to Health in Colombia". Health and Human Rights Journal. PMID PMC5395009 PMCID: PMC5395009. Retrieved 11/9/17. {{cite journal}}: |last1= has generic name (help); Check |pmid= value (help); Check date values in: |accessdate= (help)

C. Volcy, Lo malo y lo feo de los microbios, facultad de ciencias, Universidad Nacional de Colombia, p181. (2004).

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