We want to thank the entire regional and international HIV/AIDS community for the support given to the Brazilian AIDS movement in relation to our last appeal concerning the shifts in funding being proposed by the Ministry of Health (click here to read the NGOs note). We would also would like thank UNAIDS for its immediate reaction in respect to the problem we have raised.
The Ministry of Health has recently responded to our concerns in a public note to both the national and international communities (click here to read the MoH public note). While we welcome this manifestation we also would like to express our view that that the current debate on the strengthening the Brazilian AIDS response within the public health system is based on facts and requires more transparency in regard to transitions being proposed in regard to financial incentives for the implementation of HIV/AIDS policies at local levels. Furthermore the specific changes being proposed must be placed against a broader context, whose main features can be synthesized as follows:
• While Brazil has grown economically, has reduced poverty levels reduced and gained status as a global player, inequality, in it various forms, remain unacceptably high and we are witnessing the continuous growth of moral conservative influences in legal reforms and policy design, in ways that put at risk sexual and reproductive rights broadly speaking as well as in relation specifically to the intersection between human rights and HIV/AIDS.
• Public funds available for financing civil society organizations activities in advocacy and prevention are limited. Most principally, its channeling is submitted to new strict bureaucratic rules that most NGOs are unable to comply with. Public funds rule do not allow for the contracting of permanent personnel and sharply restrict the percentage allowed for administrative expenditures, in ways that have made organizations weaker. New funding rules are also bound by vertical guidelines determining what kind of activities can or not are financed. In many cases these rules have created a widening gap between demands and needs identified at ground levels and the ability of NGOs to respond to them. The gradual withdrawal of key international donors from Brazil exacerbates these difficulties and, in consequence, many organizations are closing down altogether.
• The crisis experienced by civil society organizations must be placed against the epidemiological reality of the epidemic, which on the one hand is concentrated in MSM, gay and trans populations, sex workers, people who use drugs and the prison population, while it is still imply morbidity and mortality in the population at large as exemplified by the unacceptable rates of vertical transmission. The role of NGOs cannot be dismissed as key channels of access to these groups but also as voices that sustain public awareness in relation to these patterns. Even today NGO work reaches out to places where the State is absent to do the job that the State fails to do. The silencing of voices of NGOs as persistent watchers of the HIV/AIDS response is also to be seen as a democratic loss or deficit.
• Furthermore it is important to reiterate that the Ministry of Health is still proposing that funds transferred under the aegis of the incentives policy for anti-AIDS actions up to December 2011 that have not been used (around 80 million dollars) are freed to be used to general epidemiological surveillance. Unfortunately we have not reason to believe that this fund will be predominantly used for HIV/AIDS. Suffice to recall that had not been used before when they had been earmarked.
In view of these many challenges and risk we are calling for a full re-assessment of the Brazilian National AIDS response within a frame that will allow to objectively Asses epidemiological data and the social reality of the epidemics. Despite many years of work, discrimination and prejudice continue to be a reality faced by people living with HIV and AIDS everywhere. Each year 12,000 thousand people die of AIDS and 34, 0000 new cases are registered; vertical transmission has not been eradicated– around 500 news cases per year; access to and quality of services, especially in the South, North and Northeast regions is still problematic; while rapid testing is rapidly expanding as an effect of the Ministry of Health campaigns, the public health network does not have the capacity to absorb the inevitable increase in demand for HIV/AIDS services creating by testing strategies.
The AIDS movement is not dormant. We have been mobilizing unceasingly since the beginning of 2012 and have put forward a number of proposals aimed at overcoming the problems here identified. We have made efforts to mobilize public opinion, organized acts of protest and voiced our concern in the relevant spheres of dialogue between the government and civil society, such as the meetings of the National AIDS Commission and of the Commission for Articulation among Social Movements, which took place in October. We have also carried our concerns to the highest social accountability mechanism of the public health system, namely the National Health Council. In its 239th ordinary meeting held on November 9 and 10, the National Health Council, in due exercise of its powers legally, has decided that:
1. ” The Variable Minimum Funding determined for Health Surveillance associated to the Incentives for STD/AIDS and Viral Hepatitis related health actions shall be maintained; guidelines, norms and regulations shall be established to govern the use of such incentive funds for the purpose of the implementation of STD/AIDS and Viral hepatitis related health actions, duly respecting established priorities, epidemiological parameters, local differences and specificities, civil society participation and the needs of those populations most vulnerable to STD/AIDS and Viral Hepatitis.
1. 2. Funds allocated up until 2011, as foreseen in the provisions of Ordinance 2313 of 2002, that have been transferred to States and Municipalities under the aegis of the Fund to Fund arrangement shall be integrally re-invested by each sphere of administration in the year 2013 in direct actions to confront the STD/AIDS epidemic and the respective plan shall be inserted in the overall Health Plan and include those funds that are passed on to finance actions executed by Civil Society Organizations
Furthermore, in clear recognition of the urgent need to improve the current response to HIV and AIDS in Brazil the National Health Council went on to recommend that:
1. “The Ministry of Health in articulations with the States, Municipalities, civil society and the academic sector should undertake an analysis of the AIDS epidemic, including in regard to prevention policies and related actions and the expansion of diagnosis and the quality of the care designed to address the epidemic in Brazil, making it possible to re-assess their significance and thereby support the definition of goals and actions to be implemented, in the light of the current context and in harmony with the regulatory norms in force in the Unified Health System -SUS “.
Thus it is our we wish that World AIDS Day 2012 was not merely a moment of commemorations, but a critical moment for reflecting on what is required to be improved or changed in our current and future efforts to consistently respond to the HIV/AIDS epidemic in Brazil. We are decidedly alert and fully expect that the decisions of the National Health Council, the highest body with powers of deliberation in the field of public health policies in Brazil, be implemented with no delay. Furthermore, we will continue to mobilize and will keep open the dialogue with spheres of authority as to ensure the strengthening of effective, equitable responses that also imply a full commitment to solidarity, in our persistent quest to overcome HIV and AIDS.
Yours in Solidarity,
ABGLT- Associação Brasileira de Lésbicas, Gays, Bissexuais, Travestis e Transexuais (Brazilian Association of Lesbians, Gays, Bisexuals, Transvestites and Transsexuals)
ABIA- Associação Brasileira Interdisciplinar de AIDS (Brazilian Interdisciplinary AIDS Association)
Associação Alternativa Terrazul (BlueEarth Alternative Association)
CUT – Central Única dos Trabalhadores – Brasil (Brazilian Trades Union Confederation –CUT)
Fórum de ONGs de São Paulo (São Paulo NGOs Forum)
GESTOS- HIV, Comunicação e Gênero (GESTOS- HIV, Communication and Gender)
GRAB-Grupo de Resistência Asa Branca- GRAB (Asa Branca Resistance Group)
Grupo pela VIDDA/RJ (Group for Life –RIO)
Grupo pela VIDDA/SP (Group for Life –São Paulo)
Grupo de Incentivo à Vida – GIV (Incentive for Life Group)
Rede Feminista de Saúde Direitos Sexuais e Direitos Reprodutivos (Sexual and Reproductive Rights Feminist Network)
Relatoria Nacional do Direito Humano a Saúde Sexual e Reprodutiva da Plataforma Dhesca Brasil (National Human Right to Sexual and Reproductive Health Monitor of the Dhesca Brazil Platform)
Rede de Pessoas Vivendo com HIV e AIDS – RNP+ Brasil (National Network of People Living with AIDS – Brazil)