Brazil HIV/Aids strategy needs new focus, campaigners say

Mara Moreira lives in a country where the policy for combating Aids has won international acclaim. But 18 years after she was diagnosed as HIV positive, she is deeply worried.

Mrs Moreira, 36, believes Brazil has lost its way in the struggle against Aids and that the current strategy is flawed.

"We are facing a crisis," she says. "Because of the false idea that the epidemic is under control and that all is well."

She is not alone, with many campaigners and analysts raising concerns both about the effectiveness of treatment and sexual health awareness campaigns.

In 1996, Brazil was the first developing country to commit to free and universal access to the anti-retroviral drugs needed to treat HIV. It has also challenged patents on key treatments to ensure access to cheaper generic medicines.

With high-profile safe sex campaigns and free distribution of condoms at events such as carnivals, Brazil was praised for its approach.

The World Bank predicted in 1992 that Brazil would have 1.2 million cases by 2000, but in fact the authorities report approximately half that number today.

Sources: Brazilian Health Ministry, UNAids, PAHO

However, with Aids patients living longer and the number of people infected still growing, critics say the provision of anti-retroviral drugs is not enough.

According to government estimates, 250,000 Brazilians are unaware they are HIV-positive.

Pedro Chequer, UNAids co-ordinator in Brazil, says Brazil must increase its efforts to reach these people while there is still time to treat them.

"The Brazilian Aids Programme must be revisited. If we stay on the same path, there is no way we will reach universal coverage," he said.

Campaign groups also say that patients do not always receive the regular health checks and support required to ensure proper care.

"We have Aids drugs and that is great. But when we need any other medicine or social assistance, it's very difficult," says Jose Luis da Silva, diagnosed with HIV four years ago.

Mr Silva, who is 47 and unemployed, has been sleeping in Rio's bus station for the past four months, surviving on a 70 reais (US$35; £22) monthly government allowance.

Eduardo Barbosa, one of the directors of the government's department for combating Aids, defends the record of Brazil's national programme.

He says the government recently bought more than three million test kits to improve the rate of diagnosis.

"One of the reasons for Brazil's successful response to the epidemic is that the federal government is working alongside local government and campaign groups," Mr Barbosa said.

The government is also adapting, he said, "to a new reality where HIV-positive people have an indeterminate life span".

However Mr Barbosa admits: "More and more people go into the public health system each year and some hospitals are overcrowded."

Eduardo Gomez, an assistant professor at Rutgers University in Camden, New Jersey, says Brazil's "success story" started to decline in the last four years, in part due to less international aid.

"Brazil used to be perceived as a receiver, but started to donate towards the work of tackling Aids.

"Lula [Brazil's former president] was very committed to marketing Brazil as a strong power that contributed to Africa and tackling disease abroad. So the international community started to shift attention to Africa and other parts of Latin America."

Brazil invests an average of 1.2bn reais a year ($US580m; £378m) in its Aids programme and no longer depends on international help.

But campaigners say the lack of foreign aid has weakened the very groups who used to raise public awareness, while the government is toning down its message.

President Dilma Rousseff's government recently replaced two television campaigns aimed at promoting safe sex among gay men, one of which showed two young men flirting at a bar. A fairy brought them a condom when they were about to kiss.

It was meant to air during Carnival, but was replaced at the last minute by a video with statistics about Aids and no gay couples.

Mr Barbosa says there was no "veto", only a change in marketing strategy.

But Veriano Terto Junior, co-ordinator of the Brazilian Interdisciplinary Aids Association, says the change was due to pressure from religious groups in Congress.

"The government has lost its boldness and is faltering in its ability to produce a firm, calm message to get to the people it must reach," he says.

At the International Aids Conference, being held this week in Washington, the director of Brazil's Aids Department, Dirceu Greco, insisted the country is constantly seeking to improve treatment for people with HIV.

Mr Greco says the Brazilian Aids programme is consistent, and not susceptible to changes depending on who is in office.

But it seems many of those whose lives are directly affected by HIV and Aids are not convinced.