HIV/AIDS: the pandemic hits the 'sleeping giant' (1).

Author:da Cruz, Jose de Arimateia
Position:Human Immunodeficiency Virus /Acquired Immune Deficiency Virus. Brazil - Case study


Today, Brazil is home to more than half of all known HIV/AIDS cases in Latin America and the Caribbean. (2) As one of the world's five leading causes of death, the devastating impact of this disease is forcing government officials, political institutions, and civic organizations to recognize the seriousness of the problem. This study discusses the HIV/AIDS pandemic in Brazil by examining both those who have contracted the disease and the measures being taken by the government to minimize its consequences.

HIV/AIDS is an pandemic that has spread rapidly over the last two decades, causing massive human death and suffering, particularly in the developing world. (3) There is a growing recognition that HIV/AIDS is not only a serious health issue but also a major developmental catastrophe threatening to dismantle the social and economic achievements in all developing countries, including Brazil, of the past half-century. (4) According to the World Bank, HIV/AIDS is a unique disease due to its seven attributes. First, it spreads quickly. Second, those who contract HIV/AIDS may remain infected for years without showing any symptoms or knowing that they have the virus. This significantly increases the chances of spreading the disease. Third, HIV/AIDS reduces life expectancy, which is positively related to savings, productivity, and education. Fourth, HIV/AIDS primarily affects young people, ages fifteen to forty-nine, who are in the prime of their lives as workers and parents. Fifth, people infected with HIV/AIDS suffer repeated and prolonged illnesses, imposing great costs on households and health systems. Sixth, HIV/AIDS breaks down social cohesion, challenges value systems, and aggravates deeply rooted and sensitive gender inequalities. Lastly, there is no current cure for the disease. (5)

Statement of the Problem

In 1992, the World Bank estimated that by the turn of the century approximately 1.2 million Brazilians would be infected with HIV/AIDS. At the beginning of the twenty-first century, the government reported that there are 650,000 Brazilians infected with HIV/AIDS (See TABLE 1)--less than half of the World Bank's projection. (6) Of those living with HIV/AIDS, most are between the ages of fifteen to forty-nine, which constitutes 0.7 percent of Brazil's population. Since these individuals are considered the most productive members of society, Brazil must act quickly to curb the spread of HIV/AIDS in order to prevent an economic, political, and social catastrophe. (7)

To effectively respond to this pandemic, HIV/AIDS must be treated as both an emergency and a long-term developmental issue. In other words, governments must resist the temptation to view the disease as simply another of the world's many problems. The tenacity and the easy transmission of HIV/AIDS requires a response that is flexible, creative, energetic, and vigilant. (8) It must be treated as one of the greatest health crises the world faces today. As former U.S. Secretary of State Colin Powell declared, HIV/AIDS is the "greatest weapon of mass destruction on the earth." (9) Despite such recognition of the deadly nature of this disease, for the past twenty years few academicians and policy makers have debated the social, political, and economic impact of HIV/AIDS. Instead, most have ignored the problem or denied it completely. (10)

In its 2004 Report on the Global AIDS Epidemic, the Joint United Nations Program on HIV/AIDS (UNAIDS) presented a depressing but realistic picture of the world fight against the disease. It estimated that 4.8 million people became newly infected with HIV/AIDS, up from two million in 1999. This represented the largest number of newly infected cases recorded in a single year. Today, some 37.8 million people are living with HIV/AIDS, a disease that killed approximately 2.9 million people in 2003 alone, and over twenty million since the first cases of HIV/AIDS were identified in the early 1980s. (11) The human, social, and economic toll of the pandemic has been profound in Latin America and the Caribbean where two million people currently live with HIV/AIDS. Over the last two decades, nearly 600,000 people in the region have died from AIDS; approximately 567 people in Latin America and the Caribbean are infected with the HIV virus every day. (12)

The devastation caused by HIV/AIDS not only has a human cost, it also has a serious social impact on every nation-state touched by this disease. AVERT, an international HIV/AIDS charity involved in efforts to prevent the spread of the disease, reports that HIV/AIDS can devastate whole regions, knock decades off national development, widen the gulf between rich and poor nations, and push already stigmatized groups closer to the margins of society. (13) In Latin America and the Caribbean, the pandemic is heavily concentrated in groups which engage in high-risk sexual behavior--commercial sex workers (CSWs), men who have sex with men (MSM), and injecting drug users (IDUs) (14)--but it is spreading rapidly among the general population. In Brazil, the most populous country in the region and home to more than one in four of all those living with the disease across the globe, the national prevalence rate is well below one percent. (15)

There is no accurate number of people living with HIV/AIDS in Latin America. This is due, in large part, to underdiagnosis and underreporting of the disease in countries throughout the region. In Latin America, it is believed that the pandemic probably includes thirty percent more cases of AIDS and forty percent more cases of HIV than currently estimated. (16) The key reason for the discrepancy in these figures is the fact that in most Latin American countries men who have been infected with the disease through sexual contact will rarely admit it. They are more likely to attribute their infection to transmission from female prostitutes rather than sexual contact with other men. (17) In doing so, they wish to avoid the stigma and guilt associated with the term de risco (of risk; at risk) which often leads to ostracism from family, friends, community, and even loss of job. (18)

Another area of great concern in the battle against this disease is the so-called "feminization of the epidemic." Although the majority of those in Latin America infected with the disease are men, the gap between the rate of infection among men and women is quickly shrinking, leading many to declare that HIV/AIDS has become feminized. Brazil is experiencing this "feminization of the epidemic" first-hand, especially among young females in large urban centers such as Sao Paulo and Rio de Janerio, where the epidemic is most severe (See TABLE 2). This increase in the number of women with HIV/AIDS in Brazil is part of a larger trend. UNAIDS reports that sixty-seven percent of newly infected individuals in the developing world are young people between the ages of fifteen and twenty-four; sixty-four percent are women and girls. (19) Consequently, the rise in the number of woman with HIV/AIDS is now a global concern.

According to UNAIDS, HIV/AIDS intensifies the "feminization of poverty," particularly in hard-hit countries, where women are disempowered and have few options in the labor market. When their husbands/partners die, many fall into poverty. Anytime poverty among women increases so too does the rate of poverty among children. Based on what is known in terms of the nexus of HIV/AIDS--that those most vulnerable are typically the marginalized and poor--governments can no longer afford to view poverty, especially how it impacts women in qualitatively different ways from men, as an issue separate from formulating strategies to fight the disease. Entire families are effected when women's time caring for the sick takes away from productive household tasks. (20)

Another important, but often overlooked, issue in addressing the HIV/AIDS pandemic in Latin America is the number of street children who are highly vulnerable to contracting the disease. An estimated forty million children, mostly boys, live on the streets of Latin America. These boys and girls frequently survive by engaging in sex-work and drug use. (21) Commercial sex-workers (CSWs) are not only at high risk of acquiring and transmitting the disease but also act as a vector between high-risk groups and the general population. (22) A study of female juvenile prostitutes between the ages of eighteen and twenty-one who worked in Ribeirao Preto found that all subjects demonstrated knowledge of...

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