HIV predominantly affects marginalised populations in this region, including people who inject drugs. Cocaine and its derivatives are the most commonly injected drugs in this region, with the exception of Northern Mexico and parts of Colombia, where heroin is more widely injected. It is estimated that there are over two million people who inject drugs in Latin America and over one quarter are living with HIV.
The majority of needle and syringe programmes operate in Brazil and Argentina, although there are some small projects in other countries. Mexico and Colombia are the only states that prescribe OST and coverage remains low. The development of harm reduction interventions for cocaine and its derivatives remains nascent. A lack of government support and an over reliance on international funding remain barriers to introducing and/or scaling up harm reduction services in several countries.
There is no access to harm reduction in prisons within Latin America. Immense political pressure to reduce drug cultivation and production has overridden public health responses to drug use and has in many cases violated the human rights of local farming communities cultivating coca crops.
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* Please refer to the table below for ranges, where these are available. The maps display midpoint averages only.
| Country/territory with reported injecting drug use | People who inject drugsb | Adult HIV prevalence amongst people who inject drugsb | Hepatitis C (anti-HCV) prevalence among people who inject drugs1 | Hepatitis B (anti-HBsAg) prevalence among people who inject drugs1 | Harm reduction responsec | |
|---|---|---|---|---|---|---|
| NSPd | OSTe | |||||
| Argentina | 65,829 (64,500–67,158) | 49.7 (35.4–64) | 54.6 | 8.6 | Y (25) | N |
| Bolivia | nk | nk | nk | nk | N | N |
| Brazil | 540,500 | 48 (18–78) | 63.9 | 2.3 | Y (150-450) | N |
| Chile | 42,176 | nk | nk | nk | N | N |
| Colombia | nk | 1f | nk | nk | N | Y (4) |
| Costa Rica | nk | nk | nk | nk | N | N |
| Ecuador | nk | nk | nk | nk | N | N |
| El Salvador | nk | nk | nk | nk | N | N |
| Guatemala | nk | nk | nk | nk | N | N |
| Honduras | nk | nk | nk | nk | N | N |
| Mexico | nk | 3 (1.9–4.1) | 97.4 (96–98.7) | nk | Y (19) | Y(21-25)(M) |
| Nicaragua | nk | 6 | nk | nk | N | N |
| Panama | nk | nk | nk | nk | N | N |
| Paraguay | nk | 9.35 (3.7–15) | 9.8 | nk | Y (3) | N |
| Peru | nk | 13g | nk | nk | N | N |
| Uruguay | nk | nk | 21.9 | 4.5 | Y | N |
| Venezuela | nk | nk | nk | nk | N | N |
nk= not known
a Latin American civil society respondents reviewing the data above expressed concern that many of the estimates were outdated and did not accurately represent the current national situation in relation to the number of PWID and HIV among PWID. Where more recent alternative estimates were available, these are included in the text of this chapter. Similar concern was expressed regarding the number of NSP and OST within countries, but in most cases up-to-date figures were not available.
b Unless otherwise stated, data are sourced from Mathers B et al. for the Reference Group to the UN on HIV and Injecting Drug Use (2008) Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review, Lancet, 372( 9651):1733–1745.
c Unless otherwise stated, data on NSP and OST coverage are sourced from Mathers B et al. for the Reference Group to the United Nations on HIV and Injecting Drug Use (2010) HIV prevention, treatment and care for people who inject drugs: A systematic review of global, regional and country level coverage, Lancet, 375(9719):1014–28.
d The number in brackets represents the number of operational NSP sites, including fixed sites, vending machines and mobile NSPs operating from a vehicle or through outreach workers. (P) = needles and syringes reported to be available for purchase from pharmacies or other outlets, and (NP) = needles and syringes not available for purchase.
e The number in brackets represents the number of operational OST programmes, including publicly and privately funded clinics and pharmacy dispensing programmes. (M) = methadone, (B) = buprenorphine, (O) = any other form (including morphine and codeine).
f Estimate from 1999: UN Reference Group.
1 Nelson PK et al. (2011) Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews, Lancet 378(9791): 571–583.
