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David A. Wheeler, MD; Eduardo G. Arathoon, MD; Michael Pitts, MBBS; Rolando A. Cedillos, MD; T. Efrain Bu, MD; Guillermo D. Porras, MD; Gisela Herrera, MD; Nestor R. Sosa, MD

JAMA. 2001;286:853-860.

Central America is an area with a growing human immunodeficiency virus (HIV) epidemic, but with marked limitations in its health care infrastructure. Estimated adult HIV infection rates range from 0.20% in Nicaragua to 2.01% in Belize. Hospitals and clinicians with experience in HIV care exist mainly, if not only, in capital cities and principal economic centers. Nationally sponsored social security systems in each country consistently offer a wider range of services than do ministry of health systems. Estimated access to the social security system ranges from 0% in Belize and 10% of the population in Honduras to 95% in Costa Rica. Combination antiretroviral therapy is not available through the ministries of health and zidovudine is only sporadically available for prevention of perinatal transmission. Combination therapy is available through the social security system in the countries of Guatemala, Panama, and Costa Rica only. A wide variety of antiretroviral agents are available through private pharmacies in all countries except Belize. With the exception of Costa Ricans, most people with HIV infection in Central America have limited access to HIV-specific health services and limited or no access to antiretroviral agents.

Author Affiliations: Infectious Diseases Physicians, Annandale, Va (Dr Wheeler); Hospital San Juan de Dios, Guatemala City, Guatemala (Dr Arathoon); National AIDS Program, Belize City, Belize (Dr Pitts); Hospital Rosales, San Salvador, El Salvador (Dr Cedillos); Hospital Escuela, Tegucigalpa, Honduras (Dr Bu); Hospital Bautista, Managua, Nicaragua (Dr Porras); Hospital Calderon Guardia, San Jose, Costa Rica (Dr Herrera); and Complejo Hospitalario Metropolitano Arnulfo Arias Madrid, Panama City, Panama (Dr Sosa).

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