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Brazil's grass-roots fight against AIDS

By REESE ERLICH
Published January 8, 2006

RIO DE JANEIRO, Brazil - At first, Cleidejane Araujo didn't want to become a prostitute. But her philandering husband had given her AIDS, and she was desperate to support her two young children. So she reluctantly became a streetwalker in a working-class area just outside Rio.

The doctors told her she was HIV-positive in the early 1990s, but she didn't understand the diagnosis. Because she didn't have any symptoms, she didn't seek treatment. Araujo says she doesn't know how many men she may have infected.

In 1996, she says, "I got all the diseases associated with HIV: tuberculosis, herpes and pneumonia. They all came together at once."

Araujo almost died. She credits the medical staff at the Rio federal hospital for saving her life and helping her become an AIDS activist. Today, she heads a small nonprofit, HIV Vida, that educates poor people about AIDS prevention and treatment.

Araujo's experiences paralleled those of many Brazilians until the mid 1990s. AIDS was largely ignored by the government, and antiretroviral drugs were expensive and hard to obtain. Under pressure from AIDS groups, the government changed its policies and now provides free treatment and a full regimen of medications to anyone who is HIV-positive.

These days, Brazilians receive better AIDS treatment than some people in the United States, according to John Iverson, co-founder of the AIDS group ACT-UP in Oakland and Berkeley, Calif. In some states, patients must exhibit AIDS symptoms before they qualify for free care. As of September, 2,187 people in nine states were qualified to receive free drugs but were on waiting lists because of a lack of government financing.

"In Brazil, the treatment is more universal than it is in the United States, where there are waiting lists for AIDS drug-assistance programs," says Iverson. AIDS activists in the United States and Brazil have been exchanging information and supporting one another's struggles to improve treatment in both countries, he says.

In Brazil in the 1980s, as in the United States, AIDS was considered a "gay plague," says Veriano Terto, executive director of the Brazilian Interdisciplinary AIDS Association, or ABIA. But then Herbet de Souza, a well-known intellectual better known as Betinho, contracted AIDS through a blood transfusion. His two brothers, also hemophiliacs, contracted AIDS. "When Betinho declared himself as HIV-positive, that was very important to change the visibility of AIDS in the country," says Terto.

Betinho formed ABIA, which became one of the earliest advocacy groups. Gays and progressive groups pressured the government to provide free AIDS drugs. Brazil was ruled by the military from 1964-85, so the AIDS movement joined with prodemocracy advocates. "We demanded democracy, social and political participation in governmental decisions," says Terto.

In the 1990s, international experts told Brazilian doctors that little could be done for their hundreds of thousands of AIDS patients. In 1992, the World Bank wrote that AIDS cases in Brazil could reach 1.2-million by 2000. But the combination of free health care, free medications and grass-roots prevention campaigns defied those predictions. Since 1996, the government has reduced AIDS mortality rates by half and reduced hospitalization for AIDS by 80 percent.

Dr. Mauro Schecter, a professor and AIDS expert at the Federal University of Rio de Janeiro, says governments in many other developing countries have failed in the fight against AIDS. "Our government was sensible enough to yield to the grass-roots pressure," he says.

In Brazil today, nonprofit groups take the AIDS prevention message to schools, youth hangouts and streets where sex workers ply their trade. Former prostitute Araujo says female sex workers take a tough line about safe sex. "Some men want to pay more not to wear condoms," she says, but the women say "either use condoms or no sex." Araujo admits that transvestite sex workers present a more difficult problem. Transvestites work the same streets as female prostitutes, but they are less likely to use condoms, according to Araujo.

The transvestite sex workers tend to think "if I get it, I'll be treated," she says. "They don't realize all the side effects of the drugs and treatment."

The Brazilian Ministry of Health constantly struggles to pay for AIDS medications. Two-thirds of its AIDS budget is spent on just three drugs manufactured by Merck, Abbott Laboratories and Gilead Sciences. Brazilian health ministry officials have demanded that the drug companies lower their prices for AIDS drugs. Under international law, Brazil can declare a health emergency and manufacture the drugs as generics, paying a minimal royalty to the patent holder.

The drug companies and the Bush administration strongly oppose such a move, however, saying it would violate the drug companies' intellectual property rights. The Bush administration has threatened trade sanctions should Brazil issue such compulsory licenses.

After tough bargaining that ended in early October, Abbott Labs agreed to reduce by nearly half the price of its AIDS drug Kaletra. Negotiations continue with the other two companies.

American activists, following the Brazilian example, say the U.S. government should also demand lower prices for AIDS drugs and then distribute them free. AIDS hits U.S. minority communities particularly hard. In 2003, of the 406,000 Americans living with AIDS, 20 percent were Latino and 42 percent were African-American.

Getting antiretroviral drugs "is a civil right," says Anne Christine d'Adesky, executive director of the group AIDS, Medicine and Miracles. "Brazil has opened the eyes of the world to the issue of access to medicine."

Ironically, AIDS activists in Brazil worry that their government receives too much praise for its programs. Brazil must improve its health care system and needs ongoing international aid, they say.

"We wouldn't say Brazil produced a model," says ABIA's Terto. "It has an interesting experience with some good results because of the universal distribution of antiretrovirals."

[Last modified January 7, 2006, 00:24:01]