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Last Updated: Monday, 14 July, 2003, 20:00 GMT 21:00 UK
Brazil's pioneering Aids programme
By Mariana Timoteo da Costa
BBC Brazilian Service

Bertrand Delanoe and FH Cardoso (right) at Paris Aids conference
Mr Cardoso said celibacy and fidelity campaigns were confusing
Twenty years ago, Brazil and South Africa registered their first four Aids cases: in Sao Paulo and in Johannesburg. The eight victims were male homosexuals.

But the evolution of the disease has been very different in the two countries. While in South Africa the government neglected the spread of HIV for many years - and where 20% of the population is now infected - Brazil developed an internationally renowned Aids programme.

Today, the programme provides free treatment to about 125,000 people, more than any other country in the developing world. A further 300,000 people are constantly having their HIV levels monitored.

Total living with HIV/Aids: 610,000
Aids deaths in 2001: 8,400
Total population: 178.4 million
Source: UNAids 2002; UN 2003
According to UNAids (the UN programme against HIV/Aids), one third of people with HIV in developing countries who receive satisfactory treatment live in Brazil.

The number of deaths from the disease has dropped by 80% in recent years in Brazil. The government thinks that is a significant achievement, considering that the World Bank predicted in 1992, that, by 2002, 1.2 million Brazilians would be HIV positive.


Last year, before handing over to Luiz Inacio Lula da Silva, then President Fernando Henrique Cardoso said that the Aids programme was one of Brazil's greatest recent achievements.

"We could prevent around 600,000 infections," said Mr Cardoso.

The same man this week criticised - at an Aids conference in Paris - the campaigns that preach celibacy and fidelity in tackling the disease.

According to Mr Cardoso, these campaigns only serve to confuse people.

Prevention campaigns are stepped up during carnival time
The former president used the example of Brazil, where infection rates had grown among married woman who contracted the disease from their husbands.

"The women didn't wear condoms because they had one partner, but got the disease. That is a contradiction," he said.

In South Africa, for example, it is common to hear an argument that the population is "not educated" enough to follow either treatments or prevention campaigns.

The Brazilian programme co-ordinator, Paulo Roberto Teixeira, says that is not true: "Some parts of Brazil are as poor as South Africa, and the rate of people who learn with prevention campaigns or infected people who follow treatment can be as high as among wealthier people."

For UNAids, the success of the Brazilian programme is due to investment in prevention campaigns (among young people and sex professionals, in particular); the production of generic antiretroviral drugs and also the mobilisation of civilians in pressuring the government to adopt new policies, as well as working with the public sector.

'Information spreaders'

Recent research showed that about 900 NGOs work with the Aids programme in Brazil.

They work in the communities, distributing condoms and booklets about Aids prevention produced by the government. They also counsel patients and families.

Poster from Brazilian HIV campaign
Campaigns work only if they have a clear message, says Brazil's Aids coordinator
The NGOs also work in the favelas, or slums, teaching mainly youngsters how to use a condom and also promoting events like plays where the children act as "information spreaders" - using the plays to teach the other children in their community.

Prevention campaigns are mainly produced by the government, using TV, newspapers, radios and the local community centres (as local public clinics) to spread the message.

The campaigns for condom use are stepped up during carnival time, due to the increased sexual activity linked with the festivities.

Despite being very strong in Brazil, the Catholic Church does not interfere in the campaigns.

"In Brazil, where sex is responsible for the majority of Aids cases, we have the clear view that those campaigns work only if they talk about sex with a clear message," says Dr Teixeira.

Brazil's strategy merely disguises the problem, and might even make things worse in the longer term
C Hunter, England

Another success achieved by the programme has been the distribution of antiretroviral drugs.

Brazil is one of the pioneers in producing generic drugs to fight the disease, saving the country's Aids programme millions of dollars a year.

The creation of a company called Farmanguinhos, that produces most of the generic drugs in Rio de Janeiro, has been fundamental for the policy to work.

The authorities recognise that there is still a lot to be done - in particular regarding the price of the newest drugs which are protected by patents, and also the price of tests used to detect the disease, that still have to be imported.

But Brazil thinks that the first battles against the disease have been won.

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Country profile: Brazil
05 Jul 03  |  Country profiles


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