BRAZIL: 
Status of HIV/AIDS:
Epidemiology and Treatment
Brazil, known for its sexual liberality and it orthodox Catholicism, has been faced with the obstacles of race, class, and gender barriers in its attempt to overcome its rising prevalence of AIDS. When the first cases of the disease began to appear in 1982, newspapers called it a "gay plague." Similar to the U.S., the heterosexual population looked the other way. Today, however, the HIV/AIDS epidemic in Brazil is unavoidable.
With more than 45,000 cases reported by the end of 1993, Brazil has the world's fourth-highest number of persons with AIDS and the highest number in Latin America. Researchers estimate that some 750,000 Brazilians are infected with HIV. The World Health Organization has noted,as in many other countries, the disease has spread rapidly beyond homosexuals and intravenous drug users to other groups, including heterosexual women and their children. The primary modes of HIV transmission, as of 1995, have been homo/bisexual with 44.3% of cases being attributed to such risk factors. Intravenous drug use is also a common mode of transmission at 25.8%. Contraction of the virus from a contaminated blood supply has been problematic throughout Brazil. Seen as a commodity, the poor have been selling their blood to commercial distributors for many years. In Brazil the rate of contraction from a contaminated blood supply was 14 percent versus 2 percent in the U.S. More than half of the country's 6,000 hemophiliacs were infected with HIV that year, mainly from contaminated blood.
Brazil's ubiquitous poverty conditions affect an estimated 32 million people. In the favelas, or slums, of Brazil, conditions such as malnutrition, illiteracy, drug use, and prostitution foster the spread of AIDS. Prevention and education efforts are occuring through the creation of educational and prevention projects by linking AIDS-focused nongovernmental organizations (NGOs) and public agencies ranging from municipal health ministries to universities.

Since 1641, the most traditional popular celebration in Brazil, carnival unites the nation. For four days (at least officially, in many cities it's more than a week), the joyful feeling spread over the streets and squares, from North to South, from East to West. Covered by the anonymity, working class and businessmen, judges and maids dance together. Continuing efforts are being made, from NGOs to celebrities, to promote condom use during this celebration, well-known for its sexual promiscuity.

Prevention and Education:
The tremendous impact of the epidemic hit Brazil in the late 1980's. Since that period community based organizations have been forced to battle the disease with little government assistance. The Brazilian government has been struggling to restore democracy after a military dictatorship and has been occupied with efforts to restore economic growth. As they develop new methods of education and prevention to reflect Brazil's diverse social and cultural mix, many of these groups are changing the public's perception of AIDS and reaching vulnerable populations early government campaigns had missed.

GAPA was the first nongovernmental organization (NGO) in Brazil to address HIV and AIDS. Founded ten years ago, a group of citizens saw the growing need to promote HIV prevention measures and lobby for adequate health services for those living with HIV. With 18 affiliate offices throughout Brazil GAPA is primarily a political organization. Its goals are to acquire effective public health policies related to HIV/AIDS and improved medical, psychological and social services for people with AIDS. Recognizing the stigma attached to those with the disease, GAPA is also trying to combat discrimination against people living with HIV and AIDS. The organization also provides HIV counseling and peer and outreach education.

Formed in 1986, the Brazilian Interdisciplinary AIDS Association (ABIA) has grown to become the largest and most utilized reference center on AIDS in Brazil. ABIA is determined to "democratize" knowledge about AIDS by bringing information to every sector of society, from the most isolated of the poor to the highest-ranking public official. Their main goals are to overcome to social, economic, religious, and sexual barriers which have inhibited preventative efforts from the start. ABIA now has at its disposal, a diverse network of medical experts, attorneys, activists, and researchers lending their expertise.

Another community-based organization, Grupo Pela VIDDA's mission is to combat the prejudice and discrimination that leads to what founder Herbert Daniel calls morte civil (civil death), the utter disregard for a person's civil and human rights while he or she is living with HIV and AIDS. Today, with branches working independently in five other cities besides Rio, Grupo Pela VIDDA is a support group which provides a place where persons with HIV and AIDS can share experiences. The organization keeps a close watch over government AIDS policies and draws public attention to such issues as employment discrimination against HIV carriers, blood screening, and privacy rights.

Unlike the United States, where a well-established gay community has produced strong networks of AIDS outreach organizations, in Brazil the lack of a similar community of homosexuals has seriously hindered education and prevention efforts. Although there are no laws prohibiting homosexuality, public condemnation of it is strong and violence against gays is rampant. Organizations such as the Gay Group of Bahia and the gay rights group Atobá, based in Rio, routinely report beatings and even killings of homosexuals. Atobá recorded 40 murders of homosexuals in Rio in the first half of 1993. The percent of cases as a result of homosexual or bisexual risk factors in Brazil was 44.3.1

In combination with a troubled economy and increasing number of HIV cases, the rising cost of AIDS in Brazil has drawn attention from several international organizations. The World Bank loaned the government $160 million for an extensive program of prevention, treatment, and control of the disease. In addition, organizations like the Ford Foundation and Macarthur Foundation have allied with community-based organizations through Brazil.

Misappropriation of funds
Logistics of prevention efforts
Efforts of NGO's
IDU prevention program
Indigenous peoples threatened by HIV/AIDS
 

Women and HIV/AIDS in Brazil:
Ten years ago, women accounted for one in 15 cases of HIV. Today the ratio is one in four. In collaboration with such organizations as Mulher, Cidadania, y Saúde (Woman, Citizenship, and Health), a feminist group based in São Paulo, ABIA and Pela VIDDA are working to find answers to such problems as how to overcome deeply rooted gender inequalities in Brazilian culture. Living in a male-dominated society, women must continually fight the power relations existing in sexual relationships. These groups attempt to educate women in ways to insist that their male partners use condoms. The prevalence of unprotected bisexual behavior among men in Brazil has also extended risk factors for both men and women. In Brazilian culture, "men do not consider themselves gay if they have sex with both women and men, and so they don't take precautions."2

Prevention education amongst sex workers
Children displaced by AIDS deaths

Treatment and Healing:
Faced with extraordinary inflation rates and long-standing poverty condition, there is little room for cross-class benefit of biomedical drug therapies. Only the most wealthy are able to benefit of the promising combination therapies which are raising hopes in Western nations. Several cases of HIV-1 subtype C have been found in Brazil which indicates that it may be more easily heterosexually transmitted than other strains. As of yet, vaccine research has been primarily conducted on subtype B.

With medical treatment just becoming accessible to some of the population, there has been little opportunity to explore alternative medical treatments as a complementary healing source. With religion being instrumental in the daily lives of the majority of the Brazilian population, the beliefs and spirituality of those HIV/AIDS patients have been of much assistance as a healing modality.

In addition to spirituality, touch therapy techniques have been recognized by a small population of Brazilians. Acupuncture is one of those modalities which have long-standing roots in conjunction and independent of the biomedical community. In addition, oriental medical doctors, massage therapists, and chiropractors are in existence in Brazil but in extremely few numbers. Present efforts have been limited to very basic and instumental biomedical treatments due to the economic and political limitations which have plagued the preventative efforts from the start.

The followers of the Afro-Brazilian religion Candomble go to houses of Candomble to solve health problems. Religious rituals involve individual and sometimes mass scarification with the use of a pocket knife. Since the religious leaders have good standing in the community joint efforts have been made between Candomble leaders and the Department of Health. There has been discussion as to how to train other leaders to make the rituals safe.

ALTERNATIVE HEALING:
International Directory
Essential Alternative Healing Link
The Body
Spirituality and AIDS
BIOMEDICAL TREATMENT:
HIV InSite
Virtual Library

Epidemiology:
Regional line graph
Brazilian demographic figure
Alphabet search on HIV/AIDS
Clickable regional map

Community Based Organizations:
Nucleo de Estudios Para a Prevencao da AIDS
Universidade de Sao Paulo
Av. Prof.Mello Moraes 1721
Cidade Universitaria-IPUSP
Sao Paulo
Tel: (55-11) 813-3222 x 2701
Information, sex education, safer sex workshops, HIV/AIDS counselling, training, research, workshops, media campaigns, public policy development, anti-discrimination, and human rights campaigns.

Grupo Pela Vidda
Caixa Postal 54063
01296 Sao Paulo SP
Organization for those affected by HIV/AIDS. Safer sex workshops for gay men and teenagers.

Nucleo de Investigacao em Saude de Mulher
Instituto de Saude
Rua San Antonio 590/2 andar
Bela Vista
Sao Paulo SP CEP 01214
Tel: (55-11) 35-90-47 x 234
Research in reproductive health issues including the risk of HIV infection among women. Preparation of educational material and safer sex workshops offered.

Associacao Brasileira Interdisciplinar de AIDS (ABIA)
Rua Lopes Quintas 576
Jardim Botanico
Rio de Janeiro 22460
Tel: (55-21)239-5171
One of the first community based organizations to address the HIV/AIDS epidemic in Brazil.

Apoio Religioso Contra a AIDS
Instituto de Estudos da Religiao
Ladeira da Gloria 98
Gloria
Rio de Janeiro 22211
Tel: (55-21) 265-5747
A network of professional health workers, non-governmental organizations, churches, pastors, and community members all fighting against the AIDS epidemic.
 
 

REFERENCES:
1.Ford Foundation
2.Ford Foundation
3. Berger, M. (1993). Women and HIV/AIDS. London, England. Harper Collins.