Straight Talk: Brazil and HIV

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• SUSAN DENTZER:

  The "Carnival" scenes are classically Brazilian. The message in Portuguese is blunt: If you're having sex, wear a condom to prevent the spread of AIDS. This is just one of dozens of anti-AIDS commercials created over the past two decades by the Brazilian government. They're frank in their displays of sexuality, even homosexuality.

  When it comes to fighting AIDS, Brazil is one developing country that has defied the odds. In 1995, the World Bank estimated that there would be 1.2 million Brazilians infected with HIV by the year 2000. Today, the number of those estimated to be infected with the virus is half that amount. International public health experts say the way Brazil has stemmed the tide is an example for other nations battling the AIDS pandemic.

  That accomplishment has come about thanks to Brazil's two- pronged strategy: Free antiviral drugs and other treatment to AIDS patients, and a concerted campaign to prevent further spread of the disease.

  In its prevention efforts in particular, Brazil has set a bold course favoring an emphasis on safe sex as opposed to an emphasis on abstinence. Many public health experts say that approach is an example for other nations fighting AIDS. But at the same time, Brazil's AIDS prevention policies also represent a marked departure from other countries, that includes the United States and its policies for assisting other AIDS affected countries around the world.

  One example is the attention placed on use of condoms. The Brazilian government will purchase and give away for free nearly 400 million condoms this year. It wants to triple that number in the next three years, and is even planning to invest in a condom factory to make that possible. Discussion of the devices pervades the many government- sponsored television commercials and other "social marketing" efforts to halt the spread of AIDS.

  These AIDS-prevention messages are welcomed by Brazilians like Domingoes Salomone, 35, and his partner, Mario Carvalho, 25. They run a store in Brazil's largest city, Sao Paolo, selling socks designed by Carvalho. Salomone has AIDS; Carvalho is HIV-free. Salomone says that although the AIDS warnings arrived too late for him, they're still critical.

• DOMINGOES SALOMONE:

  In Brazil, we can see the acts of the government and in some TVs like MTV, it's directed to young people, and we can have to see the forms of prevention of HIV: To use condoms, how we can have normal relationships.

• SUSAN DENTZER:

  For his part, Carvalho credits frank talk about condoms with helping to keep him HIV-free.

• MARIO CARVALHO:

  There's no solution to HIV, just taking medicine, taking medicine, taking medicine. But if you take care and don't be contaminated with it, you won't have any problem.

• SUSAN DENTZER:

  We asked Dr. Artur Kalichman how Brazil arrived at its focus on condoms. He coordinates the program for sexually transmitted disease and AIDS in the Brazilian state of Sao Paolo. Kalichman told us that a short- lived focus on abstinence in the early 1980s failed to slow the growth of the epidemic.

• DR. ARTUR KALICHMAN:

  Abstinence could be an individual choice, and it's very respectable. I can not disagree with somebody who decides to be abstinent; it's okay, for sure and it works. But as a public health message, I don't believe that it's feasible and I don't believe it works – not ideologically, based on evidence made available all over the world.

• SUSAN DENTZER:

  Brazil is a deeply religious country where the vast majority describe themselves as Roman Catholic. The church has occasionally protested the government's prevention messages as promoting promiscuity. Dr. Humberto Costa, Brazil's health minister, says the government has pressed ahead anyway.

• HUMBERTO COSTA:

  We say to religion groups: Okay, you have your idea, but we are only thinking about health. For this reason, we respect your opinion, but we are going this way: Telling to the people to use condoms, telling to the people to practice safe sex, and I think this is the best way.

• SUSAN DENTZER:

  The government has also worked hard to get prevention messages to those most at risk for AIDS, including commercial sex workers, or prostitutes. Rosemeire Munhoz, an official with Brazil's national AIDS program, told us that partnering with non-governmental organizations to reach such groups has been critical to achieving success.

• ROSEMEIRE MUNHOZ:

  All of the work we have been doing with the vulnerable populations– men who have sex with men, drug users, and sex workers– I'm sure that we would not have so many good results if they were not with us.

• SUSAN DENTZER:

  Those communities include intravenous drug users, a population deemed especially crucial to reach. Sao Paolo state AIDS coordinator, Dr. Kalichman.

• DR. ARTUR KALICHMAN:

  During the '80s, the main cause of infection was male-to- male relationship, infection in gay men population, homosexual and bisexual. In the late-'80s, the IV drug users became a very important problem, and in the '90s IV drug use became the main cause of infection in the state of Sao Paolo.

• SUSAN DENTZER:

  That included women like Rosana Bento Teixeira, age 30. She's blind in one eye from an AIDS-related infection. She was undergoing treatment when we met her at Sao Paolo's Emilio Ribas Hospital. She told us she'd contracted the disease from her first husband, who died before she became aware she was infected.

• ROSANA BENTO TEIXEIRA (Translated):

  In the beginning, I was very, very angry. I thought that if he was alive, I would try to kill him. Then my family took me to church, and I forgave him. He used to do drugs, so he knew it could happen to him, but I didn't know it could happen to me. People who deal drugs or use drugs, people who are bisexual, they know they can get the disease, but I didn't.

• SUSAN DENTZER:

  As drug users spread HIV into Brazil's heterosexual population, AIDS has increasingly infected women like Teixeira. So the Brazilian government and 16 state governments have set up special "harm reduction" programs for drug users. These typically include free needle exchanges to halt HIV transmission via shared needles. That's a contrast with the United States, where Congress has prohibited any federal expenditures on needle exchange programs since 1998.

  Another group that the Brazilian government has worked hard to reach are the nation's prostitutes. The sale of sexual favors by one person to another is legal in Brazil, although operating a brothel or similar facility is not.

  GABRIELA SILVA LEITE, Prostitution Civil Rights and Health (Translated): We have an estimated 170,000 prostitutes in Brazil, and a rate of 6 percent are infected with AIDS according to our latest research.

• SUSAN DENTZER:

  Gabriela Silva Leite is a retired prostitute. She runs a Rio-based organization called Prostitution Civil Rights and Health. She says a key breakthrough occurred when her organization helped to persuade the government to hand out free condoms to prostitutes.

• GABRIELA SILVA LEITE (Translated):

  The government has been donating condoms for many years now. We've been receiving them in large quantities actually. But now our work mainly is concerned with the awareness of prostitutes, that they also have to be responsible for buying condoms because this kind of donation is not going to last forever, and it's part of our responsibility of prevention to buy condoms.

• SUSAN DENTZER:

  Brazil's successful prevention outreach to prostitutes may now be off- limits to other AIDS-affected countries, since it conflicts with current U.S. government policy. For example, this memo was sent recently under the signature of Secretary of State Colin Powell to foreign missions of the U.S. Agency for International Development. It warns against directing American taxpayer dollars to any anti-AIDS organization condoning prostitution.

  AIDS activists fear the policy effectively bars the 14 nations targeted for assistance under President Bush's new global AIDS initiatives from using U.S. dollars to fund programs like Brazil's. There's little doubt that Brazil's prevention efforts have paid off. New infections have leveled off among homosexual men and they've fallen among intravenous drug users.

  Yet two forms of new infections are still on the rise: Those stemming from heterosexual transmission, and those passed along from mother to infant. Rosana Bento Teixeira told us it was an act of divine providence that her two young sons were born HIV-free. Her youngest son, Marco, age nine, was born several years before she learned she was infected.

• ROSANA BENTO TEIXEIRA (Translated):

  I believe it is a miracle. My doctor said he almost certainly should have been born sick. I nursed him for ten days and only stopped because I had an infection. He was supposed to be born sick, and he is not, so it is a miracle.

• SUSAN DENTZER:

  Now Brazil hopes to spark many more similar miracles by ensuring that millions of its people will live their lives free from AIDS.