The history of AIDS in Brazil

The history of AIDS in Brazil

Although it was first declared a republic in 1889, Brazil spent most of the following century under a series of military dictatorships. It was under the last of these dictatorships, at a time when citizen groups and non-governmental organisations (NGOs) were expanding and becoming more outspoken in their calls for change, that the country’s first AIDS case was recorded in 1982. ⁵ Although relatively few cases of HIV were recorded over the next few years, these civil society groups made sure that the government was quick to act and did not ignore the problem. As the country moved closer to democracy, they encouraged a climate of social solidarity, allowing open and frank debate about HIV and AIDS.

Brazil's AIDS epidemic was initially concentrated in large cities such as Sao Paulo.

“We were living under the dictatorship, so little groups formed but not just political ones. They were responding to larger, deeper issues of repression, with worldwide implications. We were trapped in a symbolic prison; homosexuals had to hide, to live in very closed circles. The right to the body was bound up with the issue of democracy.” Wildenay Contrera, AIDS Prevention and Support Group⁶

In 1985, the same year that democracy was restored to Brazil, the government set up the National AIDS Program (NAP) in partnership with civil society groups. This program initially focused on distributing information about HIV and AIDS, especially to high-risk groups such as men who have sex with men (MSM), who accounted for many of the country’s first HIV infections. ⁷ In the same year, the AIDS Prevention and Support Group (known as GAPA in Brazil) was set up as the first Brazilian HIV and AIDS NGO. By this time, the rate of new HIV infections was rapidly increasing.

Several similar groups were set up in the following years, including Grupo Pela Vidda (‘Group for Life’), the country’s first self-identified group for people living with HIV. Groups such as this put pressure on politicians to improve treatment and care for people living with HIV.

“The important thing was solidarity, full participation by everyone based on respect for differences, fighting for full citizenship, not just for HIV-positive people, but for everyone facing a situation of vulnerability.” Veriano Terto, Brazilian Interdisciplinary AIDS Association (ABIA)⁸

In 1988, a new Constitution of Brazil was established, with a heavy focus on human rights. The Constitution was very significant to people living with HIV, since it included articles that gave them legal protection against discrimination and defended their right to free healthcare. Legal guidelines on how these articles could be applied to people living with HIV were subsequently established, including Legal Opinion CFM No.14/88, which set out ethical guidelines for the management of HIV/AIDS in relation to professionals such as doctors, physicians and researchers. ⁹

Despite such advances, not everyone was happy with the way that the government was handling the epidemic. In a book published in 1993, Herbert Daniel, an HIV positive activist, wrote:

Dinner at centre for People Living with HIV and AIDS.

“To this day the government has taken no significant action in response to the epidemic, continuing the five-year record of inaction and indifference of the previous administration. There is today no adequate national programme for controlling the epidemic.”¹⁰

By the second half of the 1990s, though, the Brazlilian government was being widely commended for its HIV/AIDS policies, largely due to its treatment programme. An important element of the 1988 Constitution had been the declaration that healthcare was “a right of all and a duty of the state".¹¹ When trials in 1996 showed that HAART - a form of treatment involving combinations of antiretroviral drugs (ARVs) - had significant benefits to the health of people living with HIV, activist groups in Brazil put pressure on the government to act upon this pledge. In July 1996, the Brazilian Minister of Health announced that ARVs would be provided for free to all people living with HIV that required them. ¹²

Campaigns to prevent new people becoming infected with HIV were also expanded throughout the 1990s. In the early 1990s, the World Bank had predicted that 1.2 million people in Brazil would be living with HIV by the year 2000. Due to the effectiveness of prevention campaigns, though, the actual figure was around 600,000. ¹³

While the government’s reaction to AIDS has been impressive, the involvement of civil society groups and people living with HIV has been the most outstanding feature of Brazil’s response. These groups have ensured that stigma and discrimination have been reduced; human rights have been taken into account; moral and religious views have not impeded prevention campaigns; and the government has acted swiftly.