By Claudio Oliveira *
On November 29, 2010 representatives of Brazilian civil society organizations – – the Brazilian Interdisciplinary AIDS Association (ABIA), the Community Association of the Urubu Slum Area (AMAMU), Centre for Health Promotion (CEDAPS), the prostitute’s NGO Davida, and also Sexuality Policy Watch (SPW) — participated in a meeting with an UNAIDS mission that visited Brazil to mark the International Day of Struggle against HIV/AIDS and pay a tribute to departing President Lula.
The mission included the current executive director of UNAIDS, Michel Sidibé, but also Dr. Mohamed Mostafa ElBaradei (winner of the Nobel Peace in 2005 and former Director-General of the International Atomic Energy Agency), Dr. Festus Mogae (Botswana’s former President and current President of the “Champions for an HIV-free Generation”), who are both members of the recently created UN Commission on HIV and the Law. Other members were: Abdoulie Janneh (Executive Secretary of the UN Economic Commission for Africa) and Kirsten Nematandani (President of the National Football Association of South Africa), and the representative of UNAIDS, in Brazil, Pedro Chequer, who for many years has directed the Brazilian National Program on HIV/AIDS.
The first speaker was the president of ABIA board, Dr. Richard Parker who briefly recaptured the trajectory of the Brazilian response to HIV/AIDS, in which he stressed the importance of struggle performed by NGOs and people living with HIV/AIDS in the creation and improvement of the Brazilian federal program on HIV/AIDS:
The affected communities have responded quickly to the epidemic, most principally the gay and prostitutes movements. In the 1980’s the AIDS movement also counted with the engagement of progressive sectors of the Catholic Church and other religious denominations.
Parker highlighted, as well, the key role played by: principles of solidarity; the constitutional right to health, enshrined in the 1988 Constitution; and political mobilization and advocacy that characterized the Brazilian civil society response to the epidemics:
ABIA is, for instance, one example of this trajectory. Founded by Betinho, a Brazilian great progressive leader who had also created another key NGO named IBASE (Brazilian Institute of Social and Economic Analyses), ABIA has never focused in the provision of services, but rather it established a line of work centered in the production and dissemination of information, advocacy, the monitoring of public policies and the constant interaction with a wide variety of social movements.
Parker ended his intervention underlying that, despite gains, there are good reasons to have concerns about the future of this type of work, or to say it differently he is worried about the very sustainability of the institutions that for many years have fueled this ongoing struggle for better public policies. Among other threats, in is view major changes are underway in the domain of international cooperation to fight AIDS. For instance, private foundations such as MacArthur and Ford either have left the country or do not fund anymore this area work. The World Bank loan is now being phased own and Brazil has not been successful to access the Global Fund. “Great challenges in term of sustainability lay ahead,” he added.
Gabriela Leite, who is the founder of the Brazilian Network of Prostitutes and of Davida emphasized the critical role played by sex workers in the construction of Brazilian prevention strategies, referring to the diminishing prevalence of HIV amongst this particular population. But she also reminded that despite these gains, stigma against prostitution has not fully disappeared. Moreover, she underlined current debates and policy interventions regarding trafficking in persons are being used in Brazil and elsewhere to directly attack prostitution. In her view:
It is necessary to separate voluntary prostitution from trafficking for sexual purposes, otherwise this debate and the policy measures that it provokes will be biased by conservative morality and will totally erode a sexual rights perspective.
Speaking on behalf of the Center for Health Promotion (Cedaps), Kátia Edmundo called attention to the historical background of social and economic inequality and segregation in Brazil that, among other, translate into the marginalization experienced by slum communities. She then spoke about voluntary social interventions developed by people living in Rio’s slums, which include HIV/AIDS prevention work being done in areas controlled by drug lords. Kátia reminded that although it is possible to develop prevention activities, in many of these areas people living with HIV/AIDS have been forced to leave by dominating gangs and could therefore be considered internal displaced groups.
Sonia Regina, from the Women’s Association of the Urubu Slum area, spoke next. It should be said that the community of Urubu was originally scheduled to be visited by the UNAIDS mission. But the field trip was cancelled in result of security crisis affecting all slum areas as a spill over from the law enforcement underway in the Complexo do Alemão, since November 25, 2010. Sonia highlighted the key importance of grass root prevention work and explained how this work is being performed:
We constantly reinvent ourselves in the slum areas, as we must permanently search for alternatives to our problems, which are many. One main challenge we face is that despite the continuous work we perform at these frontlines, we still lack adequate health services on spot to respond to the need of the population.
The next speakers were Sonia Corrêa – the Co-chair of the Sexuality Policy Watch (SPW) – and ABIA General Coordinator, Cristina Pimenta. Sonia briefly talked about activities being developed by SPW, emphasizing the cross–cutting nature of the work, which aims at building bridges between researcher and activists engaged with a variety of issues: LGBT rights, HIV/AIDS, but also abortion. Then she developed some ideas about challenges in the area of criminalization of sexuality, in which SPW is planning to invest more in the near future:
We think we may contribute to this ongoing debate through the examining of forces and causes that underlie the logic of criminalization, such as the permanence of colonial or pre-democratic laws, the growing influence of religious dogmatism on legal reforms and the public policies, but also the tendency witnessed in recent decades of security forces prevailing over the respect and promotion of human rights. And it does not seem excessive to say that the events that occurred in Rio this week are also an effect of this trend.
In closing the interventions by civil society representatives, Cristina Pimenta presented few projects currently been developed by ABIA and highlighted how in Brazil the partnership between NGOs and the government has been crucial in the fight against HIV/AIDS in Brazil. She also emphasized the urgent need to ensure equal access to prevention and health care, as a way to redress the great inequalities that persist in Brazilian society. Lastly she listed few challenges that remain to be addressed in responding to the epidemics:
It is vital to openly address issues related to the cost of medicines, intellectual property, production of generic drugs, and the fight against discrimination and criminalization. We are also challenged to think and act both locally and globally, but at the same time avoiding to simply replicate initiatives that come from the global North that quite often do not make sense for our realities.
In the debates that followed Dr. Festus raised a question about the Brazilian experience in relation to the World Bank loan. In responding Dr. Greco explained that the World Bank loan represented only 4 percent of domestic expenditures with the national HIV/AIDS program. “Today, he said, the loan amounts to 56 US million dollars, while the full Brazilian health budget is of roughly 35 billion US dollars”. In the sequence Dr. El Baradei made an intervention that addressed both the question of global inequality and aspects relating to stigma in relation to HIV/AIDS that hamper the response to HIV/AIDS.
When thousands people die per day in Africa because they can not buy drugs, it is a sign that we are failing. On the other hand it is important to leave behind moral stigmas and emphasize the right to health. We should persuade governments that more important than judge peoples behavior is to ask why some can survive and others not. We should ask while people in the North have access to drugs and health care and people in the South do not.
In reacting to his considerations, Gabriela Leite said that she recognized the need to be pragmatic in crafting national responses to the epidemics and that, in light of that, it is important to call for the right to health. On the other hand, she recalled it is impossible to circumvent stigma and discrimination: “It is not easy or possible to isolate the right to health from moral stigmas. No prostitute, for instance, will engage effectively in prevention and use condoms when their rights as citizens and persons are systematically denied, when they continue to be harassed, imprisoned and violated.” As the debate headed to its end Cristina Pimenta, seconded Gabriela by emphasizing that human rights are indivisible and should not be used selectively.
* ABIA Communinaction Officer. Translation by Marina Maria and revision by Sonia Corrêa.