HIV prevention in Brazil

HIV prevention in Brazil

Sexuality and sexual expression are integral to Brazilian culture and are discussed openly. While some cultures associate sex with shame and corruption, many Brazilians see it as something that should be celebrated, and this social climate has made it much easier to carry out HIV prevention work.

“Brazil’s sexual culture is very different from the puritanical tradition in [countries such as] the United States. Our AIDS programs have also been radically different. The denial and the stigma that you find attached to sexual health issues in so many places isn’t found in Brazil” Sonia Correa, Brazilian AIDS activist⁵⁵

Condom use

In 1986 it was estimated that only 4 percent of the Brazilian population used condoms during their first sexual encounter. By 1999, the level had increased to 48 percent.⁵⁶ Both female and male condoms have been widely distributed and promoted by the government, and there has been a dramatic increase in condom sales. In 2009, a total of 466.5 million male condoms and 2.06 million female condoms were distributed.⁵⁷ In 2005, a study of Brazilian adults revealed that 35% used a condom during the previous year, compared with 24 percent in 1998. ⁵⁸ The increase in condom use has not only occurred among the general population, but also among HIV-positive people.⁵⁹ However, despite this overall increase data for the period 2004-2008 indicates condom use is declining.⁶⁰ For example, those who reported using a condom regularly with casual partners declined from 51.5 percent to 46.5 percent and those who reported using a condom regularly with a stable partner declined from 25 percent to 20 percent.⁶¹

Condom distribution at the Carnaval de Olinda, Brazil.

The Brazilian government has vigorously promoted the use of condoms through media campaigns, adverts and other prevention initiatives. Around 45 million are handed out a month with more handed out at big events such as carnivals, which are linked with increased sexual activity. During the 2009 carnival season, for example, a further 20 million condoms were distributed.⁶² Condom use has also been promoted by NGOs working in the favelas (shanty towns), where young people have been educated about AIDS and encouraged to act as ‘information spreaders’, passing information on to their peers. ⁶³

Brazil’s aggressive efforts to promote condom use, as part of its fight against AIDS make it the world’s largest importer buying 1.2 billion in 2009.⁶⁴ Furthermore, a state-run factory began producing 100 million condoms a year from Amazon rainforest rubber in 2008. The move was designed to reduce the reliance on foreign imports and to preserve a large area of tropical rainforest.⁶⁵

Media campaigns

HIV prevention messages have been promoted through a variety of media, including television, newspapers and public spaces such as billboards and bus shelters. The messages conveyed by these campaigns are among the most explicit that any government has put forward, causing controversy among some groups. They address issues such as homosexuality, the rights of HIV-positive people, the stigma surrounding HIV and AIDS, and condom promotion. A number of Brazilian celebrities have helped to get these messages across, such as athletes, entertainers and models. For example, in one media campaign, the famous pop-singer Kelly Key tells her teenage audience “Show how you’ve grown up. This carnival, use condoms.” ⁶⁶

Telenovelas (television soap operas) are very popular in Brazil, and have also been used to educate people about HIV/AIDS. The program ‘Malhaçã’, for instance, has featured characters living with HIV and has demonstrated how ARVs should be taken. ⁶⁷

Preventing mother-to-child transmission (PMTCT)

The first recorded case of HIV being transmitted from a pregnant mother to her child in Brazil occurred in 1987. Since then a number of measures have been taken to reduce the rate of mother-to-child transmission (MTCT).

These include the routine recommendation that HIV-positive mothers do not breastfeed (which can result in HIV being transmitted), the provision of infant formula (a replacement for breast milk) to all children with HIV-positive mothers, the introduction of rapid HIV tests in maternity units, and the routine recommendation to all pregnant women that they should be tested.⁶⁸

The introduction of ARVs in 1996 had a significant impact on the situation, as women who take ARVs during pregnancy are much less likely to pass HIV on to their baby. At the end of 2005, more than half of HIV-positive pregnant women in Brazil were receiving ARVs.⁶⁹ While this means that large numbers of pregnant women are still not accessing treatment, particularly in poorer areas, the availability of ARVs has made a big impact. In São Paulo state, the area of Brazil hit hardest by AIDS, the rate of MTCT fell from 16% in 1995 to 2.4% in 2002.⁷⁰ The national rate fell from 8.6% in 2000 to 6.8% in 2004 - a 20% decline - and in 2007 the Operational Plan to Reduce Mother-to-Child Transmission of HIV and Syphilis was launched aiming to reduce the rate even further by 2011 through coordination between the different levels of government.