Brazil: Accessibility and availability of treatment to those suffering from AIDS, particularly in the City of São Paulo (1999 - August 2001)

Between 1980 and December 1999, 203,353 AIDS cases were registered in Brazil (O Estado de São Paulo 27 Apr. 2001; Coordenação Nacional de DST/AIDS 2001a). Of these, 98,545 were reported in the State of Sao Paulo (ibid. 2001b). According to the São Paulo Municipal Health Secretariat (Secretaria Municipal de Saúde), cases registered in the City of São Paulo represent roughly 50 per cent of the state's total (2001).

Numerous reports describe Brazil's efforts to combat HIV/AIDS as a model for other developing countries (The Washington Post 17 Sept. 2000; Brazzil Apr. 2001 The Des Moines Register 3 July 2001; BBC 23 June 2001; EFE 2 Aug. 2001). The Des Moines Register cited Brazil's health minister, physicians and other AIDS workers in reporting on the three principles behind Brazil's approach:

Principle one is committed political leadership from the top down, starting with President Fernando Henrique Cardoso. "It was very important that we had the support of the politicians," said Rosemaire Mumhoz, an expert on AIDS prevention who advises the Ministry of Health in the capital, Brasilia ...

Principle two is the heavy involvement of civic and community organizations, which are essential for reaching the poor and helping them take the complicated regimen of drugs. "Our cooperation with NGOs (non-governmental organizations) is really extraordinary," [Health Minister] Serra said.

At the Center for Reference and Training, an AIDS testing and treatment clinic in crowded Sao Paulo, director Artur Kalichman, talked about how NGOs help in reaching high-risk groups.

"We work with NGOs which are accustomed to working with the homeless and know how to get them to take their medicines. We work with NGOs linked with the gay movement," he said.

Such civic groups, he said, are more willing than conventional health workers to distribute "Kama Sutra cards" with images of safe sex to saunas frequented by gays, or materials with pictures rather than words to poor illiterates in the slums.

A special Brazilian quality that helps make HIV-AIDS treatment easier is an openness to talking about sex. This contrasts with many African countries, where admitting to having HIV-AIDS is still taboo and sex education in the schools is forbidden.

Education on sex and AIDS in Brazilian schools starts at 12. Packs of condoms appear in Rio hotels alongside the peanuts ...

[P]rinciple three: cheap medicine to treat AIDS patients. Brazil has distributed the AIDS cocktail free to any needy person since 1997.

This approach is possible because Brazil produces cheap, generic versions of several antiretroviral drugs – and because the country has a good public-health network.

In December 2000, approximately 95,000 individuals throughout Brazil were receiving anti-retroviral therapy through the public health system, resulting in a "striking reduction in mortality, morbidity and hospitalization rates of HIV+ patients" (Coordenação Nacional de DST/AIDS 8-11 Apr. 2001). Between 1995 and 2000, the number of AIDS-related deaths in large urban centres such as São Paulo and Rio de Janeiro fell by more than 50 per cent (ibid.; Japan Economic Newswire 26 June 2001). Furthermore, during the same period there was a 60 to 80 per cent decline in the incidence of opportunistic infections and a four-fold reduction in AIDS-related hospitalization rates (Coordenação Nacional de DST/AIDS 8-11 Apr. 2001).

As recently as September 2000, approximately 600 non-governmental organizations (NGOs) were involved in AIDS-related programming throughout the country (The Washington Post 17 Sept. 2000). Their activities include the implementation of needle-exchange programs, distribution of condoms, organization of support groups and provision of counselling (ibid.). As well, government authorities have established 133 testing and counselling centres that are also involved in the distribution of AIDS drugs (ibid.)

Within the City of São Paulo, individuals suffering from HIV and AIDS have had access to specialized services since at least the mid-1980s (Ministério da Saúde and UNAIDS 1999). At the present time, the Municipal Program for STD/AIDS (Programa Municipal de DST/AIDS), established by the city government in 1987, operates 15 STD/AIDS Reference Centres (Centros de Referencia em DST/AIDS), which offer home care, ambulatory health services and day-hospital services to those living with the disease (Secretaria Municipal de Saúde 2001). The Municipal Program for STD/AIDS also operates five Serological Orientation and Support Centres (Centros de Orientação e Apoio Sorológico, COAS), which are involved in AIDS prevention activities, anonymous AIDS and STD testing, and the provision of counselling and advice (ibid.). Other AIDS-related activities undertaken by municipal authorities include the distribution of condoms, an AIDS information hotline, and the implementation of public awareness campaigns (ibid.).

Numerous São Paulo-based NGOs are also involved in the delivery of services to individuals living with HIV or AIDS (Coordenação Nacional de DST/AIDS 2000); examples follow.

Valeriano Paitoni, a Roman Catholic priest, operates three shelters for HIV-positive adults and children in the São Paulo area (Notas da Rede Nov. 2000; IPS 11 July 2000). According to IPS, Paitoni has provided assistance to as many as 33,000 individuals (ibid.).

The Pela Vidda Group (Grupo Pela Vidda), with branches in São Paulo and five other Brazilian cities (Grupo Pela Vidda 2001a), organizes support groups, provides counselling and legal advice, as well as distributing condoms and other AIDS-related information to clients (ibid. 2001b).

The Incentive to Live Group (Grupo de Incentivo à Vida, GIV), a mutual support organization for those living with HIV or AIDS (GIV n.d.a), provides counselling in both individual and group settings (GIV n.d.b). The organization also holds personal development workshops and social events (ibid.).

Information on the degree to which AIDS treatment is accessible to infected individuals living in the São Paulo area was scarce among the sources consulted by the Research Directorate. However, under the terms of the country's 1988 Constitution, health is characterized as both a universal right and a state responsibility, which authorities should

fulfill through economic and social policies aimed at reducing the risks of illness and other health impairments, as well as through universal and equitable access to activities and services for the promotion, protection, and recovery of health within a Unified Health System (UHS) that is public, federal, decentralized, and participatory in nature and provides comprehensive care (PAHO 1 Jan. 2000).

In a 1 January 2000 report, the Pan-American Health Organization (PAHO) stated that

the public health services, complemented by private services that work under contract with the Government in the framework of the UHS, cover 75% of the population. Most inpatient hospital services are provided under a system of public reimbursement for services provided by private entities (80% of hospitals that provide services within the UHS are private). In contrast, 75% of outpatient care within the UHS is provided by public establishments. In 1995, 20% of the Brazilian population, some 34 million persons, were covered under private health insurance plans, at a total cost of US$ 6,400 million (ibid.).

According to the newspaper O Estado de São Paulo, many HIV-positive individuals, including those from economically disadvantaged backgrounds, have seen their lives extended thanks to the government's drug distribution program (15 July 2001).

Furthermore, in August 2001 the "Brazilian justice system ... granted an HIV-infected man the right to ride the Sao Paulo public transportation system for free," a benefit previously reserved only for those with physical or mental disabilities (EFE 22 Aug. 2001). The man, who is retired and lives on a US$150 pension, reportedly "won the case by arguing that he needed to go to the hospital every day for treatment" (ibid.).

At least two reports refer to problems faced by individuals in need of AIDS treatment. On 19 July 2001, O Estado de São Paulo reported, citing representatives of AIDS advocacy organizations, a "chronic and longstanding" (crônica e antiga) shortage of testing kits used in public laboratories to monitor the health status of HIV-positive individuals (19 July 2001). While activists blamed the government for the shortage, a ministry of health spokesperson claimed that the problem was due to a pricing dispute with companies involved in the manufacturing of the kits (ibid.).

In July 2001, the results of a Harvard AIDS Institute survey of roughly 1,000 women served by STD/AIDS Reference Centres in São Paulo and two other Brazilian cities were announced (ibid. 28 July 2001). The results revealed a number of weaknesses, including the centres' failure in "many cases" (muitos casos) to offer women HIV/AIDS testing or to provide them with sex-related counselling (ibid.).

This Response was prepared after researching publicly accessible information currently available to the Research Directorate within time constraints. This Response is not, and does not purport to be, conclusive as to the merit of any particular claim to refugee status or asylum. Please find below the list of additional sources consulted in researching this Information Request.

References

Brazzil [Los Angeles]. April 2001. Francesco Neves. "The Right Prescription." [Accessed 28 Aug. 2001]

BBC. 23 June 2001. "Brazil Uses Porn to Fight AIDS." [Accessed 28 Aug. 2001]

Coordenação Nacional de DST/AIDS. 8-11 April 2001. Paulo R. Teixeira. "The Brazilian Experience in Universal Access to Antiretroviral Therapy. [Accessed 28 Aug. 2001]

_____. 2001a. "Dados." [Accessed 28 Aug. 2001]

_____. 2001b. "Dados." [Accessed 28 Aug. 2001]

_____. 2000. "Instituições filiadas ao fórum de ONG/AIDS de São Paulo." [Accessed 29 Aug. 2001]

The Des Moines Register. 3 July 2001. Trudy Rubin. "Pragmatism Helps Brazil Slow Spread of AIDS Without Leadership, No Amount of Cheap Drugs Will Do Any Good." (NEXIS)

EFE. 22 August 2001. "Brazil-AIDS HIV-Infected Man Allowed Use of Public Transit for Free in Brazil." (NEXIS)

_____. 2 August 2001. "Brazil-AIDS Number of AIDS Patients Up 3.3 Percent in Brazil." (NEXIS)

O Estado de Sao Paulo. 28 July 2001. "Quando elas descobrem que têm Aids." [Accessed 29 Aug. 2001]

_____. 19 July 2001. "Disputa causa falta de kit contra Aids." [Accessed 29 Aug. 2001]

_____. 15 July 2001. Roldão Arruda. "Veja quem se beneficia com a vitória do Brasil contra os EUA na guerra das patentes." [Accessed 29 Aug. 2001]

_____. [in Portuguese]. 27 April 2001. "Brazil: Mortal AIDS Cases Drop by 50 Percent During 1995-99 Period." (FBIS-LAT-2001-0427 27 Apr. 2001/WNC)

Grupo de Incentivo a Vida (GIV). n.d.a. "Grupo de Incentivo a Vida." [Accessed 29 Aug. 2001]

_____. n.d.b. "Actividades." [Accessed 29 Aug. 2001]

Grupo Pela Vidda. 2001a. "Outros Grupos Pela Vidda no Brasil." [Accessed 29 Aug. 2001]

_____. 2001b. "Actividades do Grupo Pela Vidda/RJ." [Accessed 29 Aug. 2001]

Inter Press Service (IPS). 11 July 2000. Mario Osava. "Health-Brazil: Ban on Condom Use Divides Catholic Church." (NEXIS)

Japan Economic Newswire. 26 June 2001. "Brazil Claims Victory Over U.S. on Anti-HIV Drugs Law." (NEXIS)

Ministério da Saúde and UNAIDS. 1999. "A Resposta Brasileira ao HIV/Aids." [Accessed 28 Aug. 2001]

Notas da Rede [Brasilia]. 16-30 November 2000. Vol. 1. No. 13. "Nepaids concede pêmios em SP." [Accessed 29 Aug. 2001]

Pan-American Health Organization (PAHO). 1 January 2000. " Brazil: Basic Country Health Profiles, Summaries 1999." [Accessed 30 Aug. 2001]

Secretaria Municipal de Saúde. 2001. " Programa Municipal de DST/AIDS." [Accessed 28 Aug. 2001]

The Washington Post. 17 September 2000. Stephen Buckley. "Brazil Becomes Model in Fight Against AIDS. " [Accessed 28 Aug. 2001]

Additional Sources Consulted

IRB databases.

Internet sites including:

Brazzil [Los Angeles]. 1999-2001.

Coordenação Nacional de DST/AIDS.

O Estado de Sao Paulo. 2000-2001

International Lesbian and Gay Association (ILGA)

World News Connection (WNC)