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BRAZIL: Getting Beyond the Taboo to Fight STDs

Fabiana Frayssinet

RIO DE JANEIRO, Sep 22 2009 (IPS) - Although Brazil has the reputation of being more sexually liberal than its Spanish-speaking neighbours, Brazilians suffer their own fears of stigma when it comes to sexually transmitted diseases (STDs) – the target of a new public health campaign.

Infectious disease specialist Dr. Karla Ronchini comes up against that reality on a daily basis in the Graffe Guinle teaching hospital in Rio de Janeiro, where she treats STDs like syphilis, trichomoniasis, human papillomavirus (HPV), gonorrhea and herpes, and hears explanations like “I caught this in a public bathroom” or “I got this sitting on the bus.”

“Unfortunately, Brazil is an extremely ‘machista’ country where people are ashamed of talking about sex,” she told IPS. “They don’t know how to deal naturally with the issue, and STDs are precisely where the problem manifests itself.”

The Health Ministry reports that around 10 million people – including 6.6 million men – in this country of 190 million have symptoms of an STD. But “the most alarming” aspect is that 18 percent of the men and 11 percent of the women with symptoms of STDs have not sought out treatment, it says.

However, “this is not unique to Brazil,” says psychoanalyst George de Gouveia, head of the non-governmental Grupo Pela VIDDA, an anti-AIDS group. “The difficulty of dealing with sexuality is inherent to all societies, because sex has been a taboo subject since time immemorial. It’s the issue that people aren’t allowed to touch or talk about.”

The new Health Ministry campaign is based on a study of sexual behaviour in Brazil, “Knowledge, attitudes and practices among Brazilians between the ages of 15 and 64”, which points out that the problems caused by STDs can multiply 18-fold the risk of catching HIV, the AIDS virus.


The campaign, “Muito prazer, sexo sem DST” (Much pleasure, sex without STDs), especially targets men. The aim is to raise awareness by helping people identify the symptoms of the different STDs and encourage them to inform their past and present sex partners if they were exposed to an infection.

Fabiano Zortea, a young business administrator from the southern Brazilian state of Rio Grande do Sul, told IPS that around 20 percent of his friends “admit they have a problem of that kind,” but don’t seek treatment because of shame or the fear that they will be stigmatised.

The campaign includes the distribution of millions of pamphlets, as well as a jingle taped by popular folk singers like the Chitaozinho and Xororó duo, broadcast by radio stations around the country.

A web site created for the campaign, www.aids.gov.br/muitoprazer, provides general information on the prevention and treatment of STDs.

The most controversial aspect of the campaign are the online postcards available on the web site, that can be sent anonymously to notify previous sex partners that they may have been exposed to an STD and should be tested.

“Hi, I don’t know if this is the best way to tell you this…But I discovered that I have an STD (sexually transmitted disease). I went to a health clinic, found a doctor and am now receiving treatment. I think you should do the same,” say the e-cards, which on the other side have a sexy drawing of a woman or man.

Mariángela Simao, director of the Health Ministry’s STD and AIDS department, says the anonymous e-mail notices are a good idea because of “how difficult it is for many people to say that they are infected.”

The e-cards offer people an easy way to tell sex partners that they may have caught an STD, while avoiding any possible stigma, shame or public exposure, she said.

Gouveia said any method is valid if the aim is to prevent the spread of STDs which “are generally the gateway for HIV.”

“Tackling the question of STDs is an indirect way to prevent HIV,” said the AIDS activist.

What he questioned was the “perhaps poor taste” of the online notices, at a time when there are so many other communication technologies available to inform someone of the risk of an STD, like cell-phones or e-mail.

Ronchini and Gouveia worry that because the cards are anonymous, they could be used as a sort of practical joke, to take revenge on former partners, or they could be mistaken for spam or be filtered out as possibly carrying a virus – but of the computer kind.

Dr. Ronchini advocates an ongoing, year-round effort that takes a “bolder” approach by teaching children from the earliest ages, in a natural, matter-of-fact, and age-appropriate manner, about sex and how to prevent, identify and treat STDs.

Another potential problem is that e-cards can lead people to self-medicate rather than seek out medical advice. According to the Health Ministry report on the sexual behaviour of Brazilians, 99 percent of women seeking treatment for STDs go to a doctor first, but one quarter of men seek help in a pharmacy.

In addition, Brazilian men are 30 percent more likely to present symptoms of an STD in their lifetimes.

At especially high risk are men who have sex with men, who are more than twice as likely to have a history of STDs, while people who have had more than 10 sex partners are 65 percent more likely.

The campaign also points out that STDs are easily treated and curable, with medication available at any public health facility. Visitors to the web site can click on their state for a list of clinics where they can find treatment.

 
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