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  • Title: The epidemiology of AIDS and HIV infection in Costa Rica.
    Author: Elizondo J, Shultz JM, Baum MK, Herrera G.
    Journal: Bull Pan Am Health Organ; 1993; 27(2):145-50. PubMed ID: 8339112.
    Abstract:
    This article describes and assesses the epidemiology of AIDS and HIV infection in Costa Rica. A total of 283 AIDS cases were reported in the country between 1983, when the first cases were diagnosed, and the end of August 1991. This placed Costa Rica third among the seven Central American countries--both in terms of cumulative AIDS incidence and the cumulative number of cases. Despite a continued small number of hemophilia and transfusion-associated AIDS cases, screening of blood and blood products has provided a high degree of safety for the blood supply. The high male:female ratios of reported AIDS cases (11:1) and HIV infections (14:1) and the high proportion of AIDS cases (72%) transmitted by male-to-male sexual contact give grounds for considering Costa Rica to be a Pattern I country--one where the disease is transmitted, primarily among homosexual/bisexual males. However, increasing numbers of heterosexual and perinatal cases, high rates of HIV infection among pregnant women, and existing patterns of bisexuality are consistent with a possible shift toward a Pattern I/II epidemic. In Costa Rica, the Department of AIDS Control and Prevention of the Ministry of Health (MOH) in San Jose maintains AIDS case surveillance data and HIV seroprevalence data for the entire country. As of August 1991, 283 people had developed AIDS, for a cumulative incidence of 9.3 cases/100,000 residents in Costa Rica compared to 8.4 cases/100,000 for all Central America. 65% (183) of the AIDS cases had died. The annual incidence rate for 1990 was 2.5 cases/100,000 (77 cases). Most of the AIDS cases were concentrated in marked the first reported AIDS cases. In 1983-84, hemophiliacs were the only AIDS cases. In 1985, homosexuals joined the rank of AIDS cases and, beginning in 1986, represented the largest risk group (50-79%). The first heterosexual AIDS case was in 1986. There were no new heterosexual AIDS cases in 1987, but there were 3-5 cases each year thereafter, intravenous drug use, and perinatal transmission. 92% (260) of all 283 cases were males (male:female cumulative AIDS cases ratio = 11:1 as of August 1991). 78% (221) of all cases acquired AIDS via sexual transmission. As of August 1991, 568 people were infected with HIV (male:female ratio = 14:1). The MOH has conducted sentinel surveillance studies (sexually transmitted diseases patients, tuberculosis patients, pregnant women, HIV counseling clients, health center clients, slum residents) and population-based studies (blood donors). Currently Costa Rica holds to a classic Pattern I transmission (bisexual/homosexual transmission predominates), but the data indicate that it may eventually become a Pattern I/II epidemic (increasing numbers of heterosexual transmission cases of HIV infected pregnant women with continued presence of homosexual/bisexual transmission).
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