[Ip-health] U.S. and Brazil's HIV Prevention Programs

[Andre De Mello E Souza]

Brazil, Not U.S., May Lead World's Fight Against HIV

News Analysis, Marcelo Ballve,
Pacific News Service, Jul 21, 2003

Both Brazil and the United States have launched major HIV-prevention
initiatives, and many observers say Brazil's programs are more bold.
Right-wing politics may hamstring U.S. efforts to fight the disease at
home and abroad.

Brazil's new HIV testing campaign: Be in the Know

Two nations this year, Brazil and the United States, announced new HIV
prevention strategies with sharply divergent styles. Politics and ideology
account for the differences.

Both Brazil and the United States have stabilized the number of new HIV
cases per year. But reversing the spread of the stubborn virus is a
different challenge altogether.

On his recent tour of Africa, President Bush touted his $15 billion plan
to fund HIV prevention and treatment in that continent and the Caribbean.
But examining U.S. and Brazilian records on prevention raises questions
about how effective the U.S. approach will be abroad or at home.

Brazil's approach to the HIV challenge is bold and direct. The government
produces frank HIV awareness messages, broadcast nationally, that often
contain a touch of humor. A recent spot featured parents rallying around
their homosexual son, who was trying to get over a relationship with a
former boyfriend.

"The Brazilian attitude around sexual activities is a lot more flexible
than in many countries," says Paulo Teixeira, the longtime director of
Brazil's National Coordinating Office for AIDS.

Teixeira says Brazil's government has long pushed public opinion to
confront prejudices in a multiracial and predominantly Catholic society.
It continues to call on constituencies like women and homosexuals to
assume strong roles on controversial issues such as AIDS.

The national treatment program, which provides free HIV drugs through
Brazil's free public health care system, reinforces the message that
prevention is a collective responsibility.

Teixeira, who earlier this year was tapped by the World Health
Organization to apply Brazil's treatment and prevention strategies on a
global scale, is not shy about questioning the U.S. approach to HIV/AIDS.
"We are concerned about the conservative policies adopted by this (U.S.)
government on safe sex and intravenous drug users," he says.

Teixeira is referring to recent White House statements advocating sexual
abstinence as its preferred strategy for prevention. Public health
researchers say the U.S. government seems reluctant to fund HIV prevention
programs that deal explicitly with drug use, anal sex or prostitution.

The two countries' approaches to HIV/AIDS differ not only in content, but
in communications strategies.

Brazil combines sophisticated mass marketing with the force of its federal
communication apparatus to give HIV prevention mass appeal in a diverse
nation of 170 million people.

Before a recent run of print and television ads pushing HIV testing, the
government flew its health minister to the country's biggest fashion show
in S=E3o Paulo to launch the campaign.

There, Humberto Costa enlisted the help of the most effective opinion
makers in any society -- celebrities.

The next day, Brazilian television and newspapers carried images of leggy
models sporting miniature tees emblazoned with the new HIV testing logo.
Designed by a 22-year-old college student, the design is of a winking
smiley face with a plus and a minus sign for eyes, symbolizing the two
possible results of an HIV test.

But the $13 million campaign, known by its slogan "Fique Sabendo,"
Portuguese for "Be in the Know," is not just about hip marketing. The ads
emphasize that, of 600,000 Brazilians estimated to carry the HIV virus,
roughly 400,000 do not know they are infected.

In the United States, where an estimated 200,000 people don't know they
have HIV, the prevention drive has unfolded differently -- if anyone ever
noticed.

In mid-April, the U.S. Centers for Disease Control announced a new, $35
million HIV prevention strategy that, like Brazil's, emphasizes expanded
HIV testing.

To make a splash, the CDC called a teleconference with medical reporters.
It announced it was encouraging doctors to give HIV tests more routinely,
and was increasing funding for rapid HIV testing. HIV-positive people, it
said, would be targeted with more prevention programs to minimize the
spread of the virus.

But reporters asked more questions about SARS than about HIV, and the
shift in HIV prevention strategy received relatively little national
attention.

The new CDC prevention campaign will not include any television
advertising on a national scale. The CDC says that it is best to give
local governments and community-based groups control over HIV prevention
campaigns.

"We are very interested in assuring that our focus for HIV prevention
continues to address populations and communities that are the most heavily
affected by HIV," including minority communities, said CDC Director Dr.
Julie Gerberding in an April press conference.

U.S. HIV prevention programs are fragmented, with federal funds channeled
mainly through state and local agencies, which tend to focus on high-risk
groups.

Although Brazil does targeted prevention work with groups such as IV drug
users, health specialists are beginning to question an overemphasis on
risk groups. Arthur Raichman, head of HIV programs in S=E3o Paulo state,
speaks of an "epidemic of prejudice" that fuels global HIV. "I think this
concept of a risk group helped create this epidemic," he says.

The Washington D.C.-based National Association of People Living With AIDS
attacked the CDC campaign in an open letter to CDC director Gerberding:
"Major parts of this initiative appear to respond more to political
pressure from the far right than the prevention needs of communities
threatened by HIV/AIDS."

The letter said focusing prevention messages on HIV-positive individuals
and high-risk groups, rather than communicating with a broader swath of
the population, would fail to create "the sense of shared responsibility
for prevention that is essential."

Marcelo Ballve (ballve@hotmail.com) is an associate editor at Pacific News
Service.







Andre de Mello e Souza

Ph.D. Candidate
Department of Political Science
Stanford University
417 Galvez Mall
Encina Hall Central -- Office 433
Stanford, California   94305-6044
United States