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BRAZIL: Full Frontal Attack on AIDS Among Gays

Fabiana Frayssinet

RIO DE JANEIRO, Apr 14 2008 (IPS) - The poster, reminiscent of the film “American Beauty,” features a nude young man in a sensual pose lying on (and partly covered by) masses of pink condoms, with the legend “Do whatever you want but do it with a condom.” It is part of a new Brazilian campaign against HIV/AIDS aimed at gays.

The Health Ministry’s Epidemiological Bulletin indicates that in 1996, in the 13 to 24-year-old age group, men who have sex with men made up 24 percent of all AIDS cases, compared to 41 percent in 2006. In the 25 to 29-year-old age group, 26 percent of those living with HIV were men who have sex with men in 1996, and 37 percent in 2006.

In contrast, in the 30 to 39-year-old age group, the proportion of AIDS cases represented by men who have sex with men fell slightly, from 30 percent to 28 percent, over the same period.

The difference between these indicators is attributed to behaviour changes in younger men, according to Julio Moreira, head of HIV prevention programmes in the non-governmental organisation Arco-Íris (Rainbow), which defends gay rights.

“With the availability of the anti-retroviral AIDS drug cocktails and the longer survival of people with AIDS, the new generation have not seen their friends die and haven’t experienced the pain of the loss of someone very close, so they have become careless about using condoms,” the expert told IPS.

He also links the expansion of AIDS to increased consumption of drugs and alcohol. “Substance abuse also leads to carelessness and the failure to use condoms,” he said.

But Alexandre Chieppe, the coordinator of the AIDS and sexually transmitted diseases programme of the health department of the government of Rio de Janeiro, clarified that the figures do not indicate that the number of cases of HIV/AIDS have increased more rapidly among gays.

“Actually, the trend towards more AIDS cases in the young gay population is generally the same as is seen among heterosexual men of the same generation,” he said.

“Among the general population the AIDS epidemic is stabilising, but cases are still increasing among young men in general and, within that group, gays,” he said.

Although the epidemic is behaving similarly among heterosexuals and homosexuals, its consequences are different, according to a study of sexual behaviour quoted by the Brazilian Health Ministry.

The survey of sexual knowledge, attitudes and behaviour carried out in 2004 estimated that in Brazil there were almost 1.5 million gays and men who have sex with other men, including transvestites and bisexuals, aged between 15 and 49.

Based on this estimate, the incidence of HIV/AIDS in this population group was calculated to be 226.5 cases per 100,000 people. This was more than 11 times higher than the incidence in the general population, which was 19.5 cases per 100,000 population in this country of 188 million.

Gay men “are 18 times more likely to develop AIDS than the heterosexual population,” Moreira said, explaining why a campaign aimed specifically at homosexuals is necessary.

“I think the state had a long-standing obligation to respond to this need, and there is also a concrete demand,” Claudio Nascimento, human rights secretary for the Rio de Janeiro state government, said in an interview with IPS, referring to the new focus of the campaign.

Nascimento said that, from the didactic point of view, “a target audience can be reached by segmenting the population and very directly addressing the target group.”

For example, the campaign makes itself perfectly clear when it gives advice such as “always use a water-based lubricant gel.”

“The gay community was the first to act against HIV infections in this country, and in practice there hasn’t been a specific campaign to recognise its efforts,” added Nascimento, one of the country’s best known gay rights activists.

Anthropologist Sérgio Carrara, a professor at the Institute of Social Medicine in the State University of Rio de Janeiro (UERJ), agrees.

“We had a certain moralism and homophobia that prevented AIDS campaigns from being directed specifically at gays,” he said.

Similarly, according to Carrara, “it is necessary” to refer directly to transvestites, who are “ordinarily invisible” in campaigns against AIDS and other sexually transmitted diseases.

Homophobia is one of the key targets of this government campaign. In the public system, said Nascimento, “homophobia is still one of the largest causes of violations of the rights of the gay, lesbian and transvestite community.”

In public hospitals, anti-gay prejudice is shown “in lack of respect, poor care, negligence, and taking decisions not to give differentiated care,” he complained.

“The public service, which ought to offer care without any kind of discrimination, ends up reproducing social homophobia,” he said.

These prejudices, according to the activist, “increase the gay population’s vulnerability to HIV.”

Factors like rejection by their family, social prejudice and violence are reflected in “low self-esteem among gays,” and consequently they are less able to look after themselves, he said.

“Treating AIDS as a public health issue is extremely important, so that people go back to regarding it as a chronic disease, which doesn’t kill as much as it used to, but which continues to be a serious problem,” said Chieppe.

As part of the campaign, the government will distribute some 100,000 posters, stickers and 500,000 leaflets with information about AIDS, other sexually transmitted diseases, and instructions for the correct use of condoms.

Posters and leaflets will be placed in public health institutions, but they will also be distributed to bars, night clubs, parties and other places frequented by gays, and to civil society organisations.

Other strategies will be discussed in Brasilia in June, at the First National Conference of Gays, Lesbians, Bisexuals, Transvestites and Transsexuals.