From: elswood Date: Sep 13 12:49:27 1992 (120 lines) Subject: Brazil REPORT FROM BRAZIL Two years ago at the invitation of some Brazilian AIDS activists, I traveled to Sao Paulo and spoke about the medical economics of AIDS to a meeting sponsored by GAPA (Group for AIDS Prevention & Assistance), the equivalent organization to our own San Francisco AIDS Foundation. This past spring I was again invited by GAPA to travel to Brazil and present an up-date on alternative treatments. Only this time, they scheduled three speeches, two in Sao Paulo (a city of almost 19 million) and one in Porto Alegre (a city in the south of Brazil). So this summer I spent seven weeks traveling in Brazil, meeting with AIDS groups and activists, and seeing more of a very beautiful country. We, in North America, know very little of our neighbors to the South. For instance, few know that Brazil is physically larger than the continental United States; that it is twice the physical size of India; that it is the largest tropical country; and that it has the eighth largest economy in the world. Sao Paulo, the industrial and cultural engine of this economy, is the second largest city in the Western Hemisphere and the third largest in the world. It also has Brazil's highest incidence of AIDS. AIDS IN BRAZIL No one knows how wide-spread HIV infection is in Brazil, since the population total is unknown but estimated at 160+ million. It is known that people are dying of opportunistic diseases we define as AIDS at an alarming rate. The spread of HIV-1 (HIV- 2 has also been detected there) predominantly has moved from the gay populations (though they are still dying fast enough) to infect the straight population. In fact, I was told by an AIDS physician that the fastest growing risk group in the country is now married straight women. Upon my asking why this is so, she told me that single women are insisting on "safe sex" (they buy condoms if they can afford them) but married women aren't, although their husbands often engaged in high-risk behaviors out-side the marriage, including bisexuality. Because of common health problems, including TB and exposure to tropical diseases, the life span of AIDS patients from initial diagnosis to death is only about six months. (Most people who die of AIDS are probably not even diagnosed with the disease.) Medical care is of poor quality, and only the rich can afford common antibiotics and medications with the important exception of AZT now being provided free to anyone at taxpayer's expense. The "free" distribution of AZT raises serious ethical questions, since the government does not even supply effective antibiotics such as Septra free. Because of widespread corruption in Brazil's federal government, it is increasingly believed that someone is receiving kick-backs from Bulloughs- Wellcome to institute this AZT distribution program. (Certainly, a federal government that can't even provide basic medical care for its population shouldn't be able to provide free of charge the most expensive and toxic medication in medical history.) DISILLUSIONMENT WITH U.S. AIDS ACTIVISTS One of the concerns repeatedly expressed to me by Brazilian AIDS activists and AIDS treatment advocates was that U.S. AIDS organizations ostensibly delivering up-to-date treatment information, such as AIDS Treatment News and Project Inform, were ignoring the Third World which has the highest incidence of AIDS. Treatments advocated and reported by John James and Martin Delaney only tend to create frustration and despair in Brazil, where the drugs reported are either not available or are too expensive to ever be obtained by those who would need to use them. These activists asked me why ATN and PI were ignoring the situation of the largest numbers of AIDS patients. I had to reply that Americans are typically very self-centered and hardly ever think of Brazil as even existing on the same planet as their comparatively much wealthier country. While I was meeting with groups in Sao Paulo, news arrived from New York and San Francisco that ACT-UP and Project Inform were now taking money from the pharmaceutical industry, including Bulloughs-Wellcome. One activist expressed his alarm at this news and said that "Caesar's wife should be above reproach". (Corruption, kick- backs, and shake-downs are an every day concern in doing business in Brazil, where, in fact, I was to discover that Burroughs-Wellcome was also traveling around with an open checkbook.) I told this activist that, as shocking as the news appeared, perhaps Martin Delaney (et al) were not simply being whores for the drug companies, but were taking the money and then climbing out the back window without ever having to do the trick. The activist then looked at me with a skepticism which seemed to have been learned from Brazil's vast experience with corruption. What Brazil and Africa (and the United States, for that matter) needs are effective and affordable treatments that don't cause their own potentially fatal side-effects, as is the case with AZT, etc. This realization is occurring in Brazil because, while AZT is now available free to everyone, people are dying faster than ever from badly treated opportunistic infections. What the Brazilians learned from my speeches (if they learned anything) is not to expect bonafide health advances from a system of corporate medicine which cares more about making profits than saving lives. All corporate medicine in America is now interested in doing in Brazil is testing their vaccines, which couldn't possibly work in preventing the spread of HIV infection. Interestingly, I was shown a copy of the contract between the Brazilian federal government and the World Health Organization regarding their proposed mass vaccine trial. One of the clauses of the contract explicitly states that the vaccines to be tested will probably not prevent sexual (mucosal) HIV spread. These WHO vaccines are produced by pharmaceutical giants, and even WHO knows they won't work! Dr. Jonas Salk at the recent International AIDS Congress also said as much.