Brazil's AIDS Fight Falls Victim to Success
(Bloomberg View) -- From graft to homicide, Brazil these days has no dearth of homemade misery. Now a spike in illnesses inflicted by a deadly virus has unveiled yet another, crueler facet of Brazil's woes: that it can be punished even for success.
Data from the public health ministry released early this month shows that AIDS -- a scourge Brazil appeared on track to beat -- is on the rise among some demographics (young men) and regions (the north and northeast). Yes, fatalities from the virus continue to retreat, and illness among young and elderly women has risen only slightly. (Because reporting HIV infections became compulsory only in 2014, the ministry bulletin did not report trends for new detections of the virus.)
Yet new AIDS cases are soaring among young males, with reported illnesses nearly tripling from 2006 to 2016 among teenage men aged 15 to 19, while doubling among young adult males aged 20 to 24.
While many developing countries -- and most of Brazil’s continental neighbors -- face far worse, the persistence of HIV and AIDS in Latin America’s biggest nation is troubling. Starting in the 1990s, Brazil led the fight against the epidemic, showing how a developing nation could treat the sick while also taking on drug companies and their legal eagles. Its efforts drew Big Pharma's ire but accolades from world policymakers, inspiring developing countries ravaged by what was then still a poorly understood epidemic.
Rewriting the rules for fighting a frightening pandemic, Brazil made the once-contested universal preventive “test and treat” strategy a global best practice. “Today the World Health Organization and the United Nations endorse test and treat, a protocol the World Bank opposed 20 years ago,” Draurio Barreira, an epidemiologist at the World Health Organization who used to oversee Brazil’s HIV/AIDS program, told me.
Brazil demanded that drug companies sell cutting-edge retrovirals at deep discounts or risk seeing their patents breached in the name of national health. Officials in Brasilia even turned down a fat AIDS prevention grant because the United States Agency for International Development demanded that the country condemn prostitutes -- a critical demographic in the national disease prevention strategy.
Brazil won the public relations battle by pioneering a program to give away cheap, generic antiretroviral drugs to AIDS victims. In 2014, the benefit was extended to anyone who tested positive for HIV. The offensive was a statement that public health was also politics, and that the campaign to contain HIV and AIDS was also a contest for hearts and minds.
As a result, the number of infections plummeted. So did the number of fatalities. Suddenly, HIV in Brazil was no longer a monster, but a manageable condition. And therein lay the peril.
Sure, plenty of factors contributed to HIV’s comeback, from increasing drug resistance by a wily virus to the rise in global travel, where every visitor is a potential vector. (Look no further than the 2015-16 Zika virus outbreak, triggered in part by international travelers.) But as health wonks have warned, a battlefield win against infectious disease can also numb authorities and the public into complacency.
First, the end of the emergency allowed people to lower their guards, just what pathogens like. Enter a new generation of sexually active teenagers and young adults, who grew up with the illusion that the worst was behind them, even as the digital age offered hook-up opportunities unforeseen by official safe-sex marketing strategies hatched a generation ago. “With universal access to health care, treatment at no cost, and plunging fatalities, many young people started to minimize HIV,” Adele Benzaken, who runs HIV and AIDS policy at the Brazilian health ministry, told me.
Brazil’s economic plight only worsened the condition, draining resources from public health and other social programs. Recently, the health ministry introduced an innovative therapy, known by its medical shorthand PrEP, designed to prevent HIV infection through a once-daily pill. But distribution is still incipient, limited to 7,000 targeted users to date.
One new obstacle to beating the contagion that lies beyond the bureaucrat’s brief is the rise of Christian evangelicals and social conservatives, who have mounted the bully pulpit just as the conversation over gender and sexual diversity has hit the media, campuses and the street. “The right wing is thwarting initiatives to raise awareness,” Mario Scheffer, a public health expert at the University of Sao Paulo told me. “It’s difficult to talk about sexuality and AIDS to young people with all the calls for censorship and pushback.”
Brazil sorely needs to reboot its strategy. Fortunately, health bureaucrats are quickly, if belatedly, overhauling their prevention protocols. They know that the traditional marketing strategies of pamphlets, television spots and condom giveaways at carnival have limited reach in the age of raves, Tinder and Snapchat.
Now the health ministry is preparing to blitz social media with slick safe-sex messages, and reintroduce campaigns for reproductive health in the classroom that had been suspended, after right-wingers howled that “sex education was the same as encouraging sex,” Benzaken said.
Brazil knows how to fight back. “We’ve never had so many tools to combat HIV and AIDS as we do today,” said Scheffer. All that’s needed now is to put these tools to use, quell the yahoos, and keep the country inoculated against the deadly scourge of complacency.
This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.
Mac Margolis writes about Latin America for Bloomberg View. He was a reporter for Newsweek and is the author of “The Last New World: The Conquest of the Amazon Frontier.”
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