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

Thanks to the diligent work the Programa Nacional ITS/VIH/SIDA y Hepatitis Virales did in Bolivia; we are able to present a good overview of the HIV situation in Bolivia. HIV (Human Immunodeficiency Virus) can lead to Acquired Immunodeficiency Syndrome (AIDS). The bad news is that it has been on the rise 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. (see Map 1 below).

Map 1: HIV prevalence in 2017, by country

However, it has been rising steadily during this century. According to UNAIDS’ global data, for Bolivians between the ages of 15 and 49 the HIV prevalence rate has increased from 0.1% in the 1990s, to 0.2% in the early 2000s, to 0.3% in the first trimester of 2019 (see Figure 1, and notice that the figure is interactive, making it easy to add any country for comparison).

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

0.3% of the population aged 15 to 49 corresponds to 0.15% of the total population, taking into account that the total of this group amounts to about 52% of the country’s population. In that regard, 0.15% is equivalent to 1,500 per million inhabitants, which is how we measure HIV prevalence in Bolivia.

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 the number of new HIV cases is increasing steadily. With almost 10 thousand new cases detected between 2014 and 2017, it is no longer a negligible risk. Thus people must 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 the average annual HIV incidence per municipality for the period 2014-2017. More than 200 municipalities have registered no cases of HIV at all and are coloured in green. Municipalities coloured in red show the highest incidence and imply a higher 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 incidence between 2014 and 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)

Nevertheless, just a handful of municipalities concentrate more than three-quarters of all new HIV cases registered between 2014 and 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 is for the group comprising the ages between 14 and 19. 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[1]. 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 picked up again in the last few years. The situation is very different in the Department of Cochabamba, which had a low AIDS prevalence in 2004 (26 people with AIDS per million inhabitants), increasing 16-fold to reach 410 cases in 2017. By far the latter accounts for the highest rate in any of Bolivia’s Departments and shows no sign of slowing down.

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, these are not working equally well in all regions. One municipality that stands out in the detailed data 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 ranks 11th in terms of absolute numbers measuring new cases between 2014 and 2017; but because particularly young girls have been struck. Girls aged 15 to 19 account for only 6.3% of new HIV cases in the rest of the country, in Puerto Villarroel on the contrary, they account for 45.1% of the cases.

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* Sustainable Development Solutions Network – Bolivia.

The Sustainable Development Solutions Network (SDSN) in Bolivia is currently preparing the Atlas of the SDGs in Bolivia at the municipal level. It is a significant collaborative effort involving many different institutions. However, the viewpoints expressed in the blog are the responsibility of the authors and may not reflect the position of the associated institutions. Readers are encouraged to provide feedback to the overall coordinator of the Atlas, Dr Lykke E. Andersen, Executive Director of SDSN Bolivia at Lykke.E.Andersen@sdsnbolivia.org.

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  1. Territorial units equivalent to Federal States.

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