Objective. The objective of this study was to conduct a cost-effectiveness analysis of a universal rotavirus vaccination program among children . 5 years of age in Brazil.
Methods. Considering a hypothetical annual cohort of approximately 3 300 000 newborns followed over 5 years, a decision-tree model was constructed to examine the possible clinical and economic effects of rotavirus infection with and without routine vaccination of children. Probabilities and unit costs were derived from published research and national administrative data. The impact of different estimates for key parameters was studied using sensitivity analysis. The analysis was conducted from both healthcare system and societal perspectives.
Results. The vaccination program was estimated to prevent approximately 1 735 351 (54%) of the 3 210 361 cases of rotavirus gastroenteritis and 703 (75%) of 933 rotavirus-associated deaths during the 5-year period. At a vaccine price of 18.6 Brazilian reais (R$) per dose, this program would cost R$121 673 966 and would save R$38 536 514 in direct costs to the public healthcare system and R$71 778 377 in direct and indirect costs to society. The program was estimated to cost R$1 028 and R$1 713 per life-years saved (LYS) from the societal and healthcare system perspectives, respectively.
Conclusions. Universal rotavirus vaccination was a cost-effective strategy for both perspectives. However, these findings are highly sensitive to diarrhea incidence rate, proportion of severe cases, vaccine coverage, and vaccine price.

Análisis de la relación costo-efectividad de la vacunación programada contra rotavirus en Brasil

Objetivo. Analizar la relación costo-efectividad de un programa universal de vacunación contra rotavirus en niños de hasta 5 años en Brasil.
Métodos. Se consideró una cohorte hipotética anual de aproximadamente 3 300 000 recién nacidos con un seguimiento de 5 años. Mediante un modelo de árbol de decisión se analizaron los posibles efectos clínicos y económicos de la infección por rotavirus con la vacunación programada de niños y sin ella. Las probabilidades y los costos unitarios se tomaron de investigaciones publicadas y de los datos oficiales nacionales. Para evaluar el impacto de diferentes estimados de los parámetros clave se realizó un análisis de sensibilidad. El análisis se efectuó tanto desde la perspectiva del sistema sanitario como de la sociedad.
Resultados. Se estimó que el programa de vacunación evitaría aproximadamente 1 735 351 (54%) de los 3 210 361 casos de gastroenteritis por rotavirus y 703 (75%) de las 933 muertes asociadas con la infección por rotavirus en un período de 5 años. A un precio de la vacuna de 18,6 reales brasileños (R$) por dosis, este programa costaría R$ 121 673 966 y ahorraría R$ 38 536 514 en costos directos al sistema de salud pública y R$ 71 778 377 en costos directos e indirectos a la sociedad. El costo estimado del programa por año de vida salvado sería de R$ 1 028 y R$ 1 713, desde el punto de vista de la sociedad y del sistema de salud, respectivamente.
Conclusiones. La estrategia de vacunación universal contra rotavirus presentó una buena relación costo-efectividad según ambas perspectivas. Sin embargo, estos resultados son muy sensibles a cambios en la incidencia de diarreas, la proporción de casos graves, la cobertura de vacunación y el precio de la vacuna.

The role of gender in the demand for treatment of problems associated with alcohol consumption in Mexico

Objectives. To update information available on the role that gender plays when consumers of alcohol seek help, as well as to evaluate the associations between the demand for treatment and other key variables.
Methods. Data came from 2002 National Survey on Addictions (Encuesta Nacional de Adicciones) in Mexico, which interviewed one randomly-selected individual from 12–65 years of age in each of 11 252 homes. The results of this study are based on the responses of the 5 406 individuals identified as consumers of alcohol. The demand for health care services was defined as seeking treatment for drinking-related problems during the last year. Alcohol consumers were defined as those people who had consumed alcohol during the last year. The national treatment-seeking prevalence rate was calculated by gender, consumption patterns, dependency syndrome, and other alcohol-related issues. In the logistical regression analyses, seeking treatment was used as the dependent variable.
Results. Of the total consumers, 1.4% sought treatment for drinking-related problems. For males, the corresponding percentage was 2.1%, while for women it was 0.2% (P < 0.001). For each woman with an alcohol dependency who got help, there were 49 males who did so. In the multivariate analysis, gender was significantly associated, using females as the reference, even when controlling for dependency and for absenteeism at work due to excessive alcohol consumption.
Conclusions. The probability of seeking treatment is higher among males than females who are faced with cultural, family, and treatment-related barriers. Another important predictor is work absenteeism due to excess drinking. Health care planning needs to sharpen its focus through programs designed to address the specific needs of women.

Objetivos. Actualizar la información sobre el papel del género en la búsqueda de ayuda por parte de consumidores de alcohol, así como evaluar las asociaciones de la demanda con otras variables de interés.
Métodos. La información proviene de la Encuesta Nacional de Adicciones 2002, que incluyó 11 252 hogares, en los cuales se entrevistó a un adulto entre 12 y 65 años de edad. Los resultados de este estudio se basan en las respuestas de las 5 406 personas identificadas como consumidoras de alcohol. La demanda de atención se definió como la búsqueda de ayuda por problemas de consumo en el último año. Los consumidores de alcohol quedaron definidos como aquellas personas que consumieron alcohol en el último año. Se calculó la prevalencia nacional de búsqueda de ayuda según género, patrones de consumo, síndrome de dependencia y otros problemas relacionados con el consumo de alcohol. Se realizaron regresiones logísticas utilizando la demanda de atención como variable dependiente.
Resultados. De los bebedores, 1,4% solicitaron ayuda debido a sus problemas de consumo de alcohol. El porcentaje correspondiente en hombres fue de 2,1%, mientras que en las mujeres fue de 0,2% (P< 0,001). Por cada mujer dependiente que solicita ayuda, hay 49 hombres que lo hacen. En el análisis multivariado, el género aparece asociado significativamente —usando a las mujeres como referencia—, aún controlando por dependencia y por haber perdido el trabajo debido al consumo de alcohol.
Conclusiones. Los hombres tienen mayor probabilidad de solicitar servicios de atención en comparación con las mujeres, quienes enfrentan obstáculos de tipo cultural, familiar y de los servicios. Otro importante predictor es el hecho de haber perdido el trabajo por la bebida. Es necesario enfocar más eficazmente la planeación de servicios a través de programas diseñados para atender las necesidades específicas de las mujeres.

Health indicators in the elderly: a comparison of Brazil and the United States

Objective. To identify indicators used in evaluating the population 65 years of age and older in Brazil that are comparable to those used in the United States, and to compare the situation of this age group in the two countries.
Method. This was a descriptive, cross-sectional study, based on secondary data. Brazilian equivalents to the well-being indicators employed in the United States were searched in websites published by government health or planning institutions. Data from national surveys were also employed, and when necessary, data from existing databases were reanalyzed.
Results. Of the 31 indicators used in the United States, an equivalent in Brazil was not found for only three: memory impairment, social activity, and violent crime. In the United States, the number of older individuals was greater; level of education was also higher in this age group. The two countries were similar in terms of health status and life expectancy at 65 years of age. Death rates due to cerebrovascular disease and diabetes were higher in Brazil, while death rates due to malignant neoplasms were higher in the United States. Disabilities and self-reported morbidity due to arthritis and depression were more frequent in the United States. The self-perception of health status as good was higher in Brazil, whereas the indicators related to life habits and risk factors indicated a more favorable situation in the United States.
Conclusions. If the discriminating power of the indicators is truly adequate, the health conditions of the elderly in these two countries are similar.

Objetivo. Identificar no Brasil indicadores equivalentes aos utilizados nos Estados Unidos para avaliar a população com idade de 65 anos ou mais no ano de 2000 e comparar a situação nos dois países.
Método. Este é um estudo descritivo e transversal, baseado em dados secundários. A partir de uma lista de indicadores de bem-estar empregada nos Estados Unidos, equivalentes brasileiros foram pesquisados nos sites de instituições públicas de saúde ou de planejamento. Também foram utilizados dados de pesquisas nacionais e, se necessário, foram feitas reanálises de bases de dados.
Resultados. Dos 31 indicadores que compõem a lista norte-americana, somente para três não foi encontrado um equivalente brasileiro: comprometimento de memória, atividade social e crimes violentos. Nos Estados Unidos, o número de idosos foi maior e a escolaridade desse grupo foi mais alta. Os dois países foram semelhantes em termos de condição de saúde e expectativa de vida aos 65 anos. Maiores taxas de óbito por doença cerebrovascular e diabetes foram registradas no Brasil e por neoplasias malignas nos Estados Unidos. A morbidade auto-referida por artrite e por depressão foi mais freqüente nos Estados Unidos, assim como as incapacidades. A autopercepção de bom estado de saúde foi superior no Brasil, ao passo que os indicadores de hábitos de vida e os fatores de risco revelaram uma melhor situação nos Estados Unidos.
Conclusões. Se o poder discriminatório dos indicadores utilizados for de fato adequado, as condições de saúde dos idosos no ano de 2000 eram próximas nos dois países.

Objective. Severe physical punishment of children is an important issue in international child health and welfare. This study examines such punishment in Guatemala and El Salvador.
Methods. Data came from nationally representative surveys of women aged 15–49 and men aged 15–59 residing in Guatemala (2002) and El Salvador (2002–2003). The surveys included questions about punishment experienced during childhood, with response options ranging from verbal scolding to beating. In Guatemala, parents were asked how they disciplined their children; questions allowed them to compare how they were punished in their childhood with how they punished their own children. Bivariate and multivariate analyses are presented.
Results. In Guatemala, 35% of women and 46% of men reported being beaten as punishment in childhood; in El Salvador, the figures were 42% and 62%, respectively. In both countries, older participants were relatively more likely than younger participants to have been beaten as children. Witnessing familial violence was associated with an increased risk of being beaten in childhood. In Guatemala, having experienced physical punishment as a child increased the chance that parents would use physical punishment on their own children. Multivariate analyses revealed that women who were beaten in childhood were significantly more likely in both countries to be in a violent relationship.
Conclusions. The use of beating to physically punish children is a common problem in Guatemala and El Salvador, with generational and intergenerational effects. Its negative and lingering effects necessitate the introduction of policies and programs to decrease this behavior.

Dimensiones del castigo infantil en dos países de América Central: Guatemala y El Salvador

Objetivos. El castigo físico severo de niños es un tema importante de la salud y el bienestar infantil en el mundo. En el presente estudio se analiza este tipo de castigo en Guatemala y El Salvador.
Métodos. Se tomaron los datos de encuestas representativas nacionales realizadas a mujeres de 14 a 59 años y hombres de 15 a 59 años que residían en Guatemala (2002) y El Salvador (2002–2003). Las encuestas contenían preguntas sobre los castigos que sufrieron en su niñez, con posibilidades de respuesta que iban desde regaños verbales hasta golpizas. En Guatemala se preguntó a los padres cómo disciplinaban a sus hijos; las preguntas les permitían comparar cómo ellos eran castigados en su niñez y cómo ellos castigaban a sus hijos. Se presentan los resultados de los análisis bifactorial y multifactorial.
Resultados. En Guatemala, 35% de las mujeres y 46% de los hombres informaron haber sido golpeados como castigo durante su niñez; en El Salvador, las cifras fueron 42% y 62%, respectivamente. En ambos países, los encuestados más viejos tenían una mayor probabilidad de haber sido golpeados en su niñez que los encuestados más jóvenes. Haber presenciado violencia familiar se asoció con un incremento en el riesgo de recibir golpizas durante la niñez. En Guatemala, haber recibido castigos físicos durante la niñez aumentó la probabilidad de que como padres aplicaran castigos físicos a sus hijos. El análisis multifactorial reveló que las mujeres de ambos países golpeadas durante su niñez tenían significativamente más probabilidades de encontrarse en una relación violenta.
Conclusiones. El uso de golpes para castigar físicamente a niños es un problema frecuente en Guatemala y El Salvador, con efectos generacionales e intergeneracionales. Sus efectos prolongados y negativos requieren de la aplicación de políticas y programas que permitan reducir este comportamiento.

Dietary patterns and access to food among displaced families in the municipality of Girón, Santander, Colombia

Objectives. Describe the dietary patterns and extent of access to food among families displaced by armed conflict in a locality of the Santander department of Colombia.
Methods. A descriptive study of the food consumption of 101 families living in forced displacement in the urban and suburban areas of the municipality of Girón, Santander department, Colombia. During the second half of 2003, the person in charge of the family’s food preparation completed a sociodemographic survey with questions on the monthly food expenditure, where the food was bought and with what frequency, and a log of food consumption during the preceding 24 hours. The dietary pattern was established according to the frequency of food consumption and preparation through a linear regression model that used the expenditure as a dependent variable.
Results. Of all the families, 34.7% reported not having access to food shopping and 13.9% received food donations. The average expenditure on food was 0.52 of the standard minimum wage. The only variable associated with expenditure was the number of family members working and contributing to the family budget (P = 0.037); for each working member, expenditure rose by increments of 0.07 of the minimum wage (95% confidence interval: 0.004– 0.149). No association was found between the length of time of the displacement and the food expenditure. The overall quality of the diet was deficient given that the recommended allowances of fruits, vegetables, and dairy products were not being met.
Conclusions. Food insecurity encompassed 95.0% of the study families, even though they had been living as refugees for three years. The diet quality was substandard. The principal causes were low household income and a lack of knowledge regarding how to choose nutritionally superior foods. In addition to food donations, relief programs caring for displaced families should provide practical and educational training on nutrition, and thus, successful alternatives.

Objetivo. Describir el patrón alimentario y la capacidad de acceso a los alimentos de las familias desplazadas por el conflicto armado en una localidad del departamento de Santander, Colombia.
Métodos. Estudio dietético descriptivo en 101 familias que vivían en condiciones de desplazamiento forzado en la zona urbana y suburbana del municipio de Girón, departamento de Santander, Colombia. Durante el segundo semestre de 2003, el responsable de preparar los alimentos contestó una encuesta sociodemográfica con preguntas sobre el gasto mensual en alimentos, el lugar y la frecuencia de compra, y un recordatorio del consumo de alimentos en las 24 horas previas. El patrón alimentario se estableció según la frecuencia del consumo de alimentos y preparaciones mediante modelos de regresión lineal con el gasto como variable dependiente.
Resultados. De las familias, 34,7% manifestaron no tener acceso a la compra de alimentos y 13,9% los recibía como obsequios. El gasto promedio en alimentos fue de 0,52 salarios mínimos vigentes (SMV). La única variable asociada con el gasto fue el número de miembros de la familia que trabajaban y aportaban al presupuesto familiar (P = 0,037); por cada miembro que trabajaba, el gasto aumentó en 0,07 unidades de SMV (intervalo de confianza de 95%: 0,004 a 0,149). No se encontró asociación entre el tiempo de desplazamiento y el gasto en alimentos. La calidad de la dieta fue deficiente, ya que no se cumplió la norma recomendada de consumo de frutas, verduras y productos lácteos.
Conclusiones. La inseguridad alimentaria abarcó a 95,0% de las familias estudiadas aún después de tres años de vivir en condiciones de desplazamiento. La calidad de la dieta era insatisfactoria. Las causas principales de esta situación eran los bajos ingresos familiares y el desconocimiento de alternativas nutricionales más ventajosas. Además de la ayuda alimentaria, los programas de atención a las familias desplazadas deben prever proyectos productivos y de educación nutricional para constituirse en alternativas exitosas.

Objectives. The purpose of this study was to investigate the presence and serovar identity of Salmonella, at the national level, in farmed Muscovy ducks (Cairina moschata) in Trinidad and Tobago, and to compare the relative benefits of bacterial culture to those of polymerase chain reaction (PCR) for use in the routine detection and surveillance of Salmonella in these ducks.
Methods. From March–September 2003, 110 fecal samples were collected from 82 farms across the islands of Trinidad and Tobago. Salmonella was isolated from fresh and frozen samples and the serotype of each was determined through bacterial culture. An in-house, nested PCR that detects all pathogenic Salmonella species was utilized in analyzing the samples.
Results. Five samples were positive for Salmonella by bacterial culture, whereas 44 were positive by the nested PCR. Serovars isolated were Kiambu, Orion, Uganda, and two isolates from Group E1 whose H antigens could not be fully characterized. Of the samples, 87 (79%) gave equivalent PCR results for both enrichment broths—28 were positive for both and 59 were negative for both). However, 16 samples were positive for one broth, but not for the other, with the majority (14 of the 16) resulting positive for Selenite broth. PCR results for seven samples were inconclusive due to ambiguous band size or multiple bands near the expected band size.
Conclusions. In Trinidad and Tobago, the Muscovy duck does not appear to be a significant source of S. typhimurium or S. enteritidis, but it does harbor other Salmonella species. In-house, nested PCR represents a simple, relatively inexpensive and potentially more sensitive method than bacterial culture for the routine surveillance of pathogenic Salmonella in the Muscovy duck.

Comparación de la reacción en cadena de la polimerasa y el cultivo bacteriano como métodos de detección de Salmonella en patos criollos en Trinidad y Tobago

Objetivos. Investigar la presencia de Salmonella en patos criollos (Cairina moschata) criados en Trinidad y Tobago e identificar los serotipos circulantes en el país, así como comparar los beneficios relativos del cultivo bacteriano con respecto a la reacción en cadena de la polimerasa (RCP) en la detección y la vigilancia cotidianas de la Salmonella en estos patos.
Métodos. Entre marzo y septiembre de 2003 se tomaron 110 muestras de heces fecales de 82 granjas distribuidas por las islas de Trinidad y Tobago. Se aisló Salmonella de muestras frescas y congeladas y se determinaron los serotipos mediante el cultivo bacteriano. Se utilizó un sistema autóctono de RCP anidada que detecta todas las especies patógenas de Salmonella en las muestras.
Resultados. Cinco muestras resultaron positivas para Salmonella mediante el cultivo bacteriano, mientras que 44 fueron positivas mediante la RCP anidada. Se asilaron los serotipos Kiambu, Orion, Uganda y dos aislamientos del grupo E1, cuyos antígenos H no se pudieron caracterizar totalmente. Hubo coincidencia en 87 (79%) de las muestras analizadas por RCP en ambos caldos de enriquecimiento (28 positivas y 59 negativas). Sin embargo, 16 muestras positivas en un caldo resultaron negativas en el otro; la mayoría de ellas (14 de 16) resultaron positivas en caldo selenito. Siete muestras resultaron indefinidas mediante la RCP debido a tallas ambiguas de las bandas o a múltiples bandas cerca de la talla esperada.
Conclusiones. El pato criollo no parece ser una fuente importante de infección por S. typhimurium y S. enteritidis en Trinidad y Tobago, aunque hospeda otras especies de Salmonella. El sistema autóctono de RCP anidada constituye un método simple, relativamente económico y posiblemente más sensible que el cultivo bacteriano en la vigilancia cotidiana de especies patógenas de Salmonella en el pato criollo.

Homicide mortality, socioeconomic development, and police violence in the city of São Paulo, Brazil

Objective. To analyze the association between police violence and homicide mortality rates taking into consideration the effect of contextual variables.
Methods. This was an environmental, cross-sectional study that included the 96 census districts in the City of São Paulo. The association between the variables was analyzed using Spearman’s rank correlation and simple and multiple regression analysis.
Results. Univariate analysis revealed a strong and significant association between homicide mortality coefficients and all the indicators of socioeconomic development and police violence. After controlling for potential confounding factors, the association between police violence and homicide mortality coefficients remained strong and significant. This significance was lost only after control for the size of the resident population.
Conclusion. The results indicate that police action that violates basic human rights is not the right answer to urban violence. The combination of homicides from interpersonal violence and deaths from police violence results in negative socialization and promotes further violence.

Objetivo. Analisar a associação entre violência policial e coeficientes de mortalidade por homicídio, considerando o efeito de variáveis contextuais.
Métodos. Estudo ecológico de corte transversal considerando os 96 distritos censitários do Município de São Paulo. A associação entre as variáveis foi determinada através de correlação de Spearman e de análise de regressão linear simples e múltipla.
Resultados. Nas análises univariadas, encontramos associação forte e significativa entre os coeficientes de mortalidade por homicídio e todos os indicadores de desenvolvimento socioeconômico e violência policial. Após controle dos potenciais confundidores, a associação entre a violência policial e os coeficientes de mortalidade por homicídio manteve-se forte e significativa. Apenas com o controle para o tamanho da população residente a associação perdeu a significância estatística.
Conclusão. Os resultados indicam que uma ação policial centrada na violação de direitos humanos básicos não parece ser a resposta correta para o enfrentamento da violência urbana. A combinação de homicídios que resultam de violência interpessoal com mortes por violência policial representa uma situação de socialização negativa, favorecendo ainda mais violência.

Objectives. We investigated a nationwide outbreak of severe rotavirus gastroenteritis in Nicaragua in children under 5 years old, leading to many consultations, hospitalizations, and deaths. We questioned whether a vaccine might have prevented these illnesses and deaths, sought to identify risk factors for death, and developed a clinical profile of children hospitalized with diarrhea.
Methods. We conducted a case-control study to determine whether children who died had access to routine immunizations, a proxy predicting access to a rotavirus vaccine. We identified risk factors for death among children who died in the outbreak compared with surviving age-matched controls with diarrhea. We collected stools, clinical data, and immunization data on children hospitalized for diarrhea to test for rotavirus, develop the profile, and forecast future access to a rotavirus vaccine.
Results. The outbreak from February to April 2005 caused 47 470 consultations and 52 deaths. Approximately 80% of cases and controls and 60% of children hospitalized with diarrhea had access to routine immunizations and would likely have had access to a rotavirus vaccine. With a vaccine efficacy of 85%, up to 51% of severe rotavirus cases and up to 68% of deaths could have been prevented if a rotavirus vaccine were available as part of routine childhood immunizations. Study of 35 case-control pairs indicated that severe illnesses, malnutrition, and care by traditional healers were risk factors for death. Rotavirus was found in 42% of samples from hospitalized children and was associated with severe disease and dehydration.
Conclusions. The impact of the seasonal outbreaks of rotavirus disease could be diminished with a rotavirus vaccine, improvements in oral rehydration programs, and training of traditional healers in the proper management of children with acute diarrhea.

Brote de gastroenteritis por rotavirus con alta mortalidad, Nicaragua, 2005

Objetivos. Se investigó un brote nacional de gastroenteritis grave por rotavirus en niños menores de 5 años de edad que provocó numerosas consultas, hospitalizaciones y muertes en Nicaragua. Se analizó si la vacunación habría evitado estos casos de enfermedad y fallecimiento, se buscaron factores de riesgo de muerte y se elaboró un perfil clínico de los niños hospitalizados con diarrea.
Métodos. Se realizó un estudio de casos y controles para determinar si los niños que murieron tuvieron acceso a programas de vacunación, como medida indirecta del acceso a la vacuna contra rotavirus. Se identificaron los factores de riesgo de muerte en los niños que fallecieron durante el brote en comparación con los controles con diarrea sobrevivientes, emparejados según la edad. Se tomaron muestras de heces fecales, datos clínicos y de vacunación de los niños hospitalizados con diarrea para realizar el diagnóstico de rotavirus, elaborar el perfil clínico y pronosticar el acceso futuro a una vacuna contra rotavirus.
Resultados. El brote ocurrido entre febrero y abril de 2005 ocasionó 47 470 consultas y 52 muertes. Aproximadamente 80% de los casos y controles y 60% de los niños hospitalizados con diarrea tuvieron acceso a la vacunación programada y posiblemente tuvieron acceso a una vacuna contra rotavirus. Si en los programas de vacunación se hubiera dispuesto de una vacuna de 85% de eficacia, se hubieran prevenido hasta 51% de los casos graves de rotavirus y hasta 68% de las muertes. El estudio de 35 pares de casos y controles demostró que la enfermedad grave, la desnutrición y la atención por curanderos tradicionales fueron los factores de riesgo de muerte. Se encontró rotavirus en 42% de las muestras de niños hospitalizados, asociado con la enfermedad grave y la deshidratación.
Conclusiones. El efecto de los brotes estacionales de la enfermedad por rotavirus podría reducirse mediante la vacunación contra rotavirus, el perfeccionamiento de los programas de rehidratación oral y el entrenamiento de los curanderos tradicionales en el tratamiento correcto de los niños con diarrea aguda.

Epidemiological environment and response to the HIV epidemic in Bolivia

With AIDS/HIV, early detection is of key importance to public health, as well as disseminating prevention information and providing timely and appropriate treatment. In Bolivia, at the end of 2006 approximately 50% had AIDS at the time of diagnosis, detection having occurred late in the illness. The HIV/AIDS epidemic in Bolivia is concentrated, with prevalence rates over 5% among the at-risk population, primarily men who have sex with men. From January 1984 through October 2006, the total number of HIV/AIDS cases reported in Bolivia rose to 2 190, with 1 239 HIV and 951 AIDS cases, and underreporting estimated to be over 70% country-wide. The United National Joint Program on AIDS (UNAIDS) estimated that by the end of 2006 there would be 6 700 people living with HIV/AIDS in Bolivia. In the context of this scenario, the article describes the challenges facing the HIV/AIDS program and the strategies developed to address the epidemic in Bolivia. In addition, the UNAIDS/ PAHO strategies are stressed and must get underway for HIV/AIDS prevention and control activities in the country.

El VIH/SIDA constituye, actualmente, un problema de salud pública debido a la propagación constante y continua de la enfermedad. La detección temprana de la infección es una estrategia prioritaria en salud pública para la orientación y difusión de los mensajes de prevención, y el tratamiento temprano y oportuno de la enfermedad. En Bolivia, cerca de 50% del total de personas notificadas al momento del diagnóstico (n = 2 190) se encuentran en fase SIDA, con una detección tardía de la enfermedad (1).