August 8, 2003

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

By Marcelo Ballve

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 São 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 emphasise 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 São 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.”

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