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Background
It is estimated that 2 million people are living with HIV in Central and South America, with major epidemics in Brazil, the Andean countries, and Central America. In 2007 alone, more than 170,000 people in Latin America became newly HIV-infected. The epidemic is not evenly distributed across the region; Brazil alone accounts for 34% of all people in the region living with HIV/AIDS, with another 10% each in Mexico, Central America, Colombia, the Andean countries, and the southern cone countries. Fewer than one in ten HIV-positive individuals know their serostatus, and relatively few people are receiving HIV treatment. Stigma and discrimination related to HIV/AIDS is high, as are rates of poverty, lack of access to health care, and prejudice against homosexuality, impeding HIV prevention efforts and access to care.
Across Latin America, HIV is not (so far) becoming a generalized epidemic in heterosexual populations, but instead is highly concentrated in high-risk sexual and drug use networks. Unsafe sex between men likely accounts for the largest part of the HIV epidemic in every country. It has been calculated that at least one-third to one-half of new HIV infections in the region are among men who have sex with men (MSM), and that MSM in Latin America are more than 30 times more likely to be HIV-infected than the general population.
Sex work is also a likely driver of the HIV epidemics in the region - one study of different countries, which looked at brothel-based sex workers, found HIV prevalence rates as high as 6.3%. In Guatemala, surveillance suggests that 15% of street-based sex workers are living with HIV. Similarly, studies of cities in El Salvador found infection rates of around 16%.
Although HIV is primarily a sexually-transmitted infection in Latin America, the spread of HIV through the sharing of drug injecting equipment is also of concern, notably in the Southern Cone (Argentina, Chile, Paraguay, Uruguay), in Brazil, and in the northern part of Mexico. In 2002, it was estimated that injecting drug use accounted for 40% of new infections in Argentina and 28% in Uruguay. A 2003 survey found a national prevalence of 9.5% among Uruguay's injecting drug users. Buenos Aires has reported a 44% HIV seroprevalence among injection drug users, and in some Brazilian cities, more than 60% of drug users have been reported as HIV positive.
As in most societies around the world, in Latin America these sexual and drug-related risks are disproportionately borne by the young and the poor. Among youth, expanded health promotion and HIV prevention programs for young people both in and out of school is key, including programs that support parents in communicating their values and expectations about sexual behaviour. Unfortunately, school-based condom distribution programs and education about sexuality and gender are still relatively rare. In this context, private philanthropic funding of frank HIV prevention programs, especially those related to sexual behavior, sexuality and drug use, remains essential.
EJAF’s Latin America Initiative
Beginning in December of 2007, the Elton John AIDS Foundation stepped forward as a leading international funder to increase grant-making for HIV/AIDS prevention and advocacy in Latin America. The Foundation’s focus is on project areas that are: demonstrated to be major areas of need; not yet sufficiently supported by government funding or philanthropic efforts; and directed and supported at a local level by those who would benefit from funding.
To date, EJAF has invested $1.873 million in funding to: support community-level HIV prevention interventions throughout Latin America, including heath care access, condom promotion, condom access, and related safer sex interventions, and research to define and evaluate new HIV behavioral interventions; and support community-level advocacy to bring HIV prevention to scale. EJAF is deeply grateful to the Edmond J. Safra Philanthropic Foundation for generously supporting its Latin America Initiative with two significant gifts, which have greatly enhanced EJAF’s ability to mobilize resources and press forward with its funding agenda for this region.
Through its Latin America Initiative, EJAF has awarded grants to the following key partners:
amfAR, The Foundation for AIDS Research, New York, NY, $450,000 since December 2007 – The MSM Initiative: The purpose of amfAR’s MSM Initiative is to significantly improve access to HIV prevention, treatment and care for men who have sex with men (MSM) populations in low- and middle-income countries around the world. The Initiative does this through three core strategies: 1) Supporting and empowering grassroots MSM organizations by providing direct financial support in the form of community awards, capacity-building and technical assistance; 2) Building understanding and awareness about HIV epidemics among MSM and other groups by promoting and supporting relevant research; and 3) Advocating for effective policies and increased funding for programs that address HIV/AIDS among MSM. Since December 2007, The Initiative has awarded grants for 19 projects across 8 countries in the region that provide HIV/AIDS services to, and advocacy for, MSM. Now in its third year of delivering urgently needed community awards and technical assistance in Latin America, amfAR has had a powerful impact on the ability of grassroots organizations to help this gravely under-served population. Worldwide, the MSM Initiative has already awarded nearly US $1.5 million in small grants to more than 55 frontline organizations, and has worked to spur multi-lateral organizations and bilateral governments to take action on MSM/HIV issues and provide increased financial support.
The Collaborative Fund for HIV Preparedness, The Tides Foundation, New York, NY, $823,000 since December 2007 -- Support for Community Mobilization in Latin America: Funding from the Elton John AIDS Foundation supports advocacy, treatment literacy, and community mobilization by the International Coalition Of Activists In Treatment In Latin America (The Coalition), which coordinates all Latin American-focused activities for the HIV Collaborative Fund and the International Treatment Preparedness Coalition. The Coalition coordinates grant making to community based organizations providing health literacy, social support, and advocacy to ensure access to comprehensive HIV treatment, care and prevention services and for the protection of human rights. In Latin America, funded projects have a strong focus on improved HIV care quality and access for marginalized populations such as drug users and men who have sex with men, and a secondary focus on treatment literacy for people living with HIV/AIDS. The Coalition also implements regional and national advocacy strategies, develops and implements communications and media strategies, and provides on-going technical assistance and capacity building to its local grantees. Since 2003, the Collaborative Fund has supported over 800 HIV treatment organizations in over 75 countries.
 Aid for AIDS, New York, NY, $500,000 since September 2008 – Cuanto Sabes de VIH y AIDS? (How Much Do You Know about HIV and AIDS?) is an HIV primary-prevention initiative targeted at teenagers in the developing world. Its long-term goal is to ensure that every youth in the Caribbean and Latin America have access to effective, potentially life-saving HIV prevention education. Through this program, peer educators provide workshops in schools across the region, dramatically increasing basic knowledge regarding HIV and AIDS among young people. With funding from the Elton John AIDS Foundation, Aid for AIDS has expanded the reach of this project into new regions in Colombia, Venezuela, Dominican Republic, Guatemala, Peru, Honduras, Panama and Ecuador, bringing Cuanto Sabes to 600 schools and reaching approximately 1.2 million students.
 The U.S. Fund for UNICEF, New York, NY, $100,000 since September 2008 – Preventing mother-to-child HIV transmission in Guatemala: EJAF supports the U.S. Fund for UNICEF’s work addressing vertical transmission (mother to child transmission) of HIV in Guatemala. Programs strengthening access to voluntary testing take place together with counseling in prenatal clinics and emergency rooms of hospitals in Guatemala. Access is strengthened through procurement and distribution of needed supplies including HIV, syphilis and hepatitis B tests. Effective interventions carried out by qualified medical professionals have dramatically reduced the rate of vertical transmission in Guatemala. UNICEF is continually updating and expanding training courses to reach a wide spectrum of medical professionals including counselors, medical doctors, nurses, pharmacists, chemists and laboratory technicians. EJAF funding supports training, review, and updating of protocols; proper administration of antiretroviral treatment; treatment adherence; and psychosocial counseling training. Through field visits to hospitals, UNICEF technical supervisors provide oversight with health officials responsible for monitoring and evaluation to determine progress toward objectives. American Airlines matches EJAF's grants to UNICEF, thereby doubling the impact of EJAF's funding.
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