- Gerardo Lissardy
- BBC World, Brazil
Artur Timerman knows what it is to see AIDS up close. As an infectious disease doctor in Sao Paulo, he monitors hundreds of patients with HIV, the virus that causes the disease. And he admits that he is «very worried».
«Patients tell me that the situation here in Brazil is similar to the one that occurred at the beginning of the epidemic, that in gay saunas they don’t even know who they have sex with without condoms,» he says. «That’s a day to day.»
The most recent data support the concern of this specialist from the Edmundo Vasconcelos Hospital.
New HIV infections in Brazil increased by 11% between 2005 and 2013, according to estimates released last month by Onusida, the UN agency specializing in the subject.
This contrasts with the image that Brazil gained as an exemplary country in the fight against AIDS, and also clashes with the global trend: new HIV cases fell 27.5% in the world during the same period.
Also in Latin America, new infections decreased by 3%, with a fairly sharp drop in some countries. In Mexico they fell 39% and in Peru 26%.
«Brazil is contrary to what is happening in the world,» warns Timerman. «We have to understand why.»
According to UNAIDS figures, some 730,000 people infected with HIV live in Brazil, which represents 45% of the cases in Latin America and 2% of the world total.
It is estimated that last year alone there were 44,000 new infections in the country. This figure is equivalent to half of the new cases estimated in 2013 in the United States, Canada, and Western and Central Europe, where the overall drop compared to 2005 was 4%.
Fábio Mesquita, director of the department that fights AIDS in the Ministry of Health, believes that the global reduction in infections responds to the efforts that in recent times have been invested in sub-Saharan Africa to contain a generalized epidemic.
In his opinion, in other places with concentrated epidemics such as Brazil, the approach to the problem between 2005 and 2013 was less intense than in the 1980s and 1990s, when AIDS emerged as a terrible and deadly disease.
«To a certain extent the epidemic was trivialized, it stopped being a threatening thing due to the very advances in science, technology and treatments,» Mesquita told BBC Mundo.
«The newer generation did not pass that moment. So today you have what we consider a second wave of the epidemic in countries (…) that have it concentrated,» he adds. «And Brazil is part of that same situation.»
preservatives and medicines
But other specialists noted errors in Brazil’s strategy against AIDS.
One of the most frequent criticisms is the elimination of campaigns in schools and on television to promote the use of preservatives. Many attribute the change to pressure from the mainstream Catholic and evangelical churches.
«This thing from the government to prohibit campaigns in the area of education is a setback, an absurd thing,» says Euclides Ayres de Castilho, a medical expert in epidemiology who worked for UNAIDS.
In his opinion, the increase in infections in Brazil is logical not only because of the lack of protection in sexual relations but also because of universal access to medical treatment and the longer life expectancy of carriers.
Nearly 350,000 HIV infections in the country received free antiretroviral treatment by the end of 2013, a health policy that has been pointed out as a reference by the UN itself.
However, Timerman points out that almost the same number of Brazilians with the virus also «should be treated and are not.»
He adds that in Brazil there is a lack of epidemiological studies that can more accurately detect who is becoming infected and which groups were not treated more effectively.
«One of the best forms of prevention is to treat the infected person early,» he says.
From the Ministry of Health, Mesquita refutes the criticism. She says that Brazil is one of the first countries to adopt antiretroviral treatment for HIV carriers as a prevention mechanism.
It also points out that it is the nation that buys and distributes the most condoms per year (600 million) and that there have recently been strategic changes, for example, focusing actions on groups that concentrate the epidemic instead of targeting the general population.
Mesquita anticipates that the first impact of these changes will be seen in late 2015 in the numbers of AIDS-related deaths, which last year reached 16,000 according to UN estimates.
«Everything is redirected so that in the coming years we have a change in the profile of the epidemic,» he says.