HEALTH-BRAZIL: Female HIV-Carriers, Second-Class Citizens

By Mario Osava Reprint | | Print |

Mario Osava

RIO DE JANEIRO, Jul 12 2002 (IPS) - Brazilian lawyer Beatriz Pacheco, 53, has felt like a second-class citizen ever since she tested positive for HIV, the AIDS virus, five years ago.

Due to her work as a defence attorney for people living with HIV, and to her AIDS activism, her condition became public, which led to discrimination. “Get out, ‘aidética’ (a derogatory term for AIDS patients), this is not a charity hospital!” someone wrote on the building where Pacheco used to live.

When an employee is dismissed, discrimination can only be alleged if the HIV-positive individual was already showing symptoms of full-blown AIDS.

But testing positive for HIV is enough for anyone to be denied insurance, or enrollment in a collective health plan, said Pacheco, who lives in the southern Brazilian city of Porto Alegre.

And without insurance, it is impossible to secure a loan, or a mortgage to buy a new home. “I, for example, will always have to live in a rented house, because I can’t get financing to buy a home, even though I earn enough to guarantee my payments, as a retired civil servant,” she told IPS.

HIV-positive women, especially the elderly and the poor, face the greatest obstacles in fighting for their rights, she said.

“The government keeps us alive, but society doesn’t want it to,” she said, referring to the reduction in the mortality rate among the HIV-positive population achieved by the Health Ministry’s free distribution of anti-retroviral drugs to people with HIV/AIDS.

Pacheco is an activist with the National Network of People Living with HIV/AIDS (RNP+), as well as the Positive Citizens project, which was created last year to respond to the specific problems facing female patients and the sharp increase in the number of women living with HIV in this country of 162 million since the mid-1990s.

The anti-retroviral combination drug therapy that delays the onset of AIDS and improves the quality of life of people living with HIV also has side-effects. Among women, one of the worst adverse effects is severe osteoporosis, the progressive loss of bone mass that is usually experienced by post-menopausal women.

But female HIV-carriers often suffer premature osteoporosis, for which they need special treatment, Jenice Pizao, national coordinator of Positive Citizens, told IPS.

At the age of 43, Pizao is already suffering calcium loss in the femur and the lumbar vertebrae, an indication of the early onset of osteoporosis.

“Our bones are rotting away. We are crumbling,” said Pacheco, who underwent a complicated operation on a broken arm a year ago. But first she had to find someone willing to do the surgery – one doctor refused for fear of contagion, a common reaction among physicians and dentists, she added.

Other side-effects of the anti-HIV drug regimen for women include lipodystrophy – the redistribution of fat in the body – and depression, said Pizao.

Prevention of lipodystrophy requires physical exercise and an adequate diet, which are not generally a possibility for low- income women, who end up being the direct victims of such “cruel” adverse effects, said Pizao, a retired professor of history in the southern city of Campinas, 100 kms from Sao Paulo.

Positive Citizens, which is backed by the Health Ministry, denounces violations of the rights of women with HIV or full-blown AIDS, as well as shortfalls in the medical treatment they receive. It also promotes the exchange of information, and informs health professionals of the specific needs of female HIV/AIDS patients.

Public health services, for example, only order bone mass density exams for elderly women, even though all women living with HIV need such exams even prior to menopause, in order to diagnose premature osteoporosis.

Female HIV/AIDS patients also need six-monthly pap smears, because they suffer higher rates of cancer of the uterus, said Pizao.

Healthcare personnel should be trained to respond to the specific needs of HIV-positive women – in terms of medication, and orientation on physical exercise and nutrition – which differ from those of men, she underlined.

In addition, the needs of post-menopausal women are basically forgotten, even though the rate of HIV infection among that group is rising fast in Brazil.

With the increasingly widespread use of Viagra, the drug that combats male impotence, sexual activity, generally without condoms, has increased among older people, said Pacheco, who gives AIDS prevention orientation sessions in companies in southern Brazil.

The activist also noted that while the reception of the “female condom” has been positive, it should first be distributed among men, because “they are the ones who are allowed to introduce novelties in the bedroom” since women tend to be “sexually submissive.”

The Health Ministry has purchased four million female condoms, to be distributed among the most vulnerable women – in other words, female HIV-carriers, prostitutes and intravenous drug users.

But Pacheco pointed out that the epidemic is spreading most rapidly among women in stable heterosexual relationships, who do not generally take preventive measures – especially those who are economically dependent on their partners – despite the possibility of unfaithfulness.

She lamented that prevention campaigns continue to target homosexuals, drug users and sex workers, rather than people in stable heterosexual relationships. “It takes two to spread AIDS,” she pointed out.