It is less than two weeks since the 6th Latin American and Caribbean Forum on HIV/AIDS and STIs, organised by the Horizontal Technical Cooperation Group (GCTH, for its acronym in Spanish) in São Paulo, Brazil came to an end. This article aims to analyse the crisis in the response to the epidemic in Brazil, which perhaps went unnoticed by those who were not at the event.
You can read Anamaria Bejar’s report from the forum here. Anamaria is the Alliance’s Head of Team for Latin America and the Caribbean.
In the end, the forum took place in the last days of August as part of the National Prevention Congress in Brazil, and as we predicted, participation by our partners in the region was very limited. Those who were able to take part participated as program speakers thanks to the generosity of the Brazilian government and certain agencies. There were fewer than one hundred international grants and some countries were not represented at the Forum at all. In terms of the regional dimension of the event, there were more speakers than audience members and some networks were also noticeably absent.
It was also very difficult for the Key Correspondents (Corresponsales Clave) team to be present and provide coverage. However, with the support of one correspondent, various colleagues and by garnering information from a diverse range of sources, we have been able to put together coverage in the form of twelve articles on what happened and what didn’t happen at the event for those who could not attend.
We will not go into the much talked about crisis of the response within Latin America, the response from Latin American civil society or all of the regional and worldwide partnerships, including governments and agencies, as I believe that this has been covered enough in the articles prior to this editorial.
We already know that in regional terms, that the Forum, perhaps did not contribute much to the debate or to advancing the agenda, and gave presentations that in many cases were public confessions of what should be done, but isn’t. At least these confessions saved us having to prove otherwise. It is good that we can all make ourselves heard, reflect and gain insights.
I would like to reflect on the crisis that the response in Brazil is going through, because for those of us who have been working in this area for decades, Brazil and its multifaceted response has always seemed to be a model to follow, at times a utopia and experience to learn from greatly. For all these years I have been learning from Brazil and I think that paradoxically, with our sister nation’s ability to plan ahead, we can all learn a lot about what is going on now.
At the opening ceremony on Tuesday 28 August, the activists held up red cards, chanting and shouting out protests during each speech made by Brazilian government officials.
“Oh Dilma [Rousseff, Brazilian President], what a mess! Mixing laws with religion!” and “I have AIDS, I can’t wait, health is what matters” were some of the chants, along with banners reading “Dilma, the AIDS program is coming to its end: it hasn’t done what it was supposed to do, and it lets the Church run health policy”. State officials, in turn, made their case by calling for a multi-sector response with participation from all sectors, including activists.
One warmly received speech was that of Beto Volpe, of the National Network of People Living with HIV/AIDS (RNP+), who argued that the absence of top Government officials at the ceremony and the conference were a clear example of the current administration’s lack of interest in the issue. Volpe criticised religious fundamentalism present in government and municipal decision-making, the federal government´s veto of anti-homophobia kits in public schools, as well as major difficulties in the use of Target Action Plan (AMP) funds against the epidemic.
Rodrigo Pinheiro, the president of the NGO AIDS Forum of the State of São Paulo, , made a timely protest about overcrowding among in-patients at hospitals due to the closure of wards, and the increase in the prevalence of HIV in high-risk groups.
Jehová Pessin Frogoso of Grupo Esperanza, a social protest movement against hepatitis, argued that the disease is still ignored in Brazil, saying: “We hope that this time the hepatitis movement can really learn from the AIDS movement and we can stop being AIDS’ poorer brother”.
The Brazilian government, a regional leader, is losing interest in AIDS. The new administration stops prioritising health issues and the result is the same: more people exposed to HIV and dying. Some colleagues acknowledged off the record that this has caught them unawares, relatively demobilised, having taken for granted that the national government would always be committed to the cause.
Like many others, these great Brazilian activists are tired, unmotivated and unemployed. They had tried to imagine a reality where “there was no more AIDS”. They can hardly be blamed for this. It is hard to agree with the officials and technocrats who argue that we are close to an “end to AIDS”. Far from it, in fact, and what is happening in Brazil now is a painful reminder that even where progress is made in great strides, this can rapidly be set back.
For now, bringing an “end to AIDS” sounds more like an advertising slogan, and, as may happen with the “three zeros”, without money or commitment this may end up as simple rhetoric, nothing more than zero funding, zero new high-impact ideas to include more groups and attain greater access, and zero accountability.
We are already beginning to see the consequences of the opinions expressed by activists at the Brazilian Forum. The Health Minister, Alexandre Padilha, met on 4 September with different figures of the multi-sector response and inexplicably “uninvited” the representative of the Network of Persons Living with HIV, José Rayan. We condemn this type of action, indicative of poor policy and poor institutional framework, and we manifest our support for the RNP+.
The Brazilian case is emblematic. It is an early warning for everyone. Most of the people with HIV in the world live in middle-income countries, countries where international cooperation for development is now history and the only possible response is to “live with what we have”; namely doing advocacy work to increase national health and AIDS budgets, ensuring that there is investment in evidence-based interventions, and intensifying close monitoring.
Brazil and the Rousseff administration have clearly shown that this will prove difficult. What hope then remains for the other countries in the region? We all know the answer: a shortage of medical supplies, laws that criminalise transmission, stunted progress in research, biased judgement of cases of violence, the list goes on. This is not simply a Brazilian crisis. It has already reached our countries and the time has passed for diagnosis, self-criticism and repetitive rhetoric. The time has come for action.
Editor’s note: We are particularly grateful to our colleagues at the AIDS Brazil News Agency for information in this article. Complete coverage of the Forum and the issues mentioned here can be found at http://www.agenciaaids.com.br/