Jamie Gross 304171845 11 March 2013 Abstract: The prevalence of HIV/AIDS in Brazil, while only 0.

6% of the total population, remains at an unwarranted 10.5% among men who have sex with men (MSM). Enacted in 1996, the Brazilian governments National AIDS Program (NAP) aims to alleviate the threat of HIV/AIDS through a comprehensive prevention, treatment, and human rights-based approach. The purpose of this research paper is to evaluate and assess the effectiveness of Brazils National AIDS Program on the vulnerable population of men who have sex with men. While improvement has been made in the dissemination of safe-sex practices and access to free antiretroviral therapy, MSM continue to confront a disproportionate risk for infection, as well as societal prejudice and discrimination that impede the access to HIV and AIDS health services.

Gross 2 Brazils National HIV/AIDS Program Human immunodeficiency virus/acquired immunodeficiency syndrome is a global epidemic, affecting approximately 34 million people worldwide (WHO 2012). Since AIDS was first identified in the early 1980s, UNAIDS reports that more than 30 million people have died from the disease, and an estimated 1.7 million people died from AIDS in 2011 alone (UNAIDS, 2011). Presently, there is no cure for the disease; however, HIV can be prevented, and those living with HIV can take antiretroviral drugs to delay or prevent the onset of AIDS. While many middle-income and developing countries have struggled to control the spread of HIV and to treat those infected with AIDS, the Brazilian government, through the National HIV/AIDS, STI and Viral Hepatitis Department of the Ministry of Health, also called the National HIV and AIDS Program (NAP), has managed to reduce the number of new incidences of HIV/AIDS, decrease AIDS mortality, and increase life expectancy of its citizens living with HIV. Brazil has a concentrated HIV/AIDS epidemicwhile only 0.6% of the general population is infected with HIV, the disease has spread rapidly in multiple subpopulations. Particularly, among men who have sex with men (MSM) in Brazil, the HIV prevalence rate remains at a staggering 10.5%, according to the Joint United Nations Program on HIV/AIDS (UNAIDS, 2011). The group MSM includes homosexual and bisexual men, as well as heterosexual males who have sex with other men. According to AVERT, an international HIV and AIDS charity, men have sex with men not only due to attraction or pleasure, but for a variety of reasons including experimentation, financial motives, and environmental conditions (i.e. prison). Men who have sex with men face a proportionately higher risk of contracting HIV. The Brazilian Ministry of Health estimates that MSM are around 11 times more likely to become

Gross 2 infected with HIV than heterosexual people. MSM remain especially vulnerable to HIV and AIDS for several reasons. From a biological perspective, unprotected anal sex carries a far greater risk for HIV infection than unprotected vaginal sex (AVERT, 2009). Additionally, if a man already has a sexually transmitted infection (STI), this can be an extra biological factor that increases his risk of becoming infected with HIV. Behavioral factors common among MSM, such as having multiple partners and not using condoms consistently, further augment their risk for infection. For example, AVERT reports that condom use among MSM remains low, with only 48.3 percent reporting condom use during their last intercourse with a casual partner (AVERT, 2009). Finally, social and cultural factors may discourage men who have sex with men from seeking sexual health services. Stigma and cultural intolerance of same-sex relations inhibit MSM from informing themselves about HIV and AIDS and from obtaining critical HIV/AIDS testing, prevention, treatment, and counseling. Providing HIV and AIDS services to those who are most at risk can be greatly beneficial to a whole countrys approach to HIV and AIDS. Therefore, governments and international programs must pay special attention to providing access to HIV-related support to men who have sex with men. In 1983 the first case of AIDS was discovered in Brazil and over the next two decades the number of cases grew dramatically. However, responding quickly in order contain the epidemic, the Brazilian government established a National AIDS Committee in 1986, leading Brazilian Health Minister Roberto Santos to create the National AIDS/STD Control Program (NAP), a groundbreaking health care program concentrated on both the prevention and treatment of HIV and AIDS. Through the National AIDS Program, in 1996 Brazil become the first country to introduce free, universal antiretroviral treatment to HIV and AIDS, contributing to a decline in

Gross 2 HIV/AIDS infections and deaths. In 2007, the NAP included in its agenda a policy of prevention and care to combat the AIDS and STD epidemic specifically among gay men and MSM. More than twenty years later, Brazils national AIDS program has evolved into today's multifaceted strategy for treatment and prevention of the disease. In terms of prevention, an integral component of Brazils initiative includes the dissemination of information, education, and communications (IEC) materials, as well as mass media campaigns. In 2008 and 2010 the NAP launched public service announcements on radio and television stations to actively and openly promote safe sex among high-risk and vulnerable groups, especially men who have sex with men. For example, television advertisements featured gay men advocating safe-sex practices, thus generating positive visibility of the gay community. The campaign also places posters with HIV/AIDS prevention messages in public areas, such as bus stops and train stations. The free distribution of condoms to MSM and other individuals who engage in high-risk sexual behavior has always been a part of the NAPs policy for preventing the spread of HIV. Lastly, testing campaigns are essential to the prevention element of the National AIDS Program. Concerning the treatment of HIV and AIDS victims, the Brazilian government provides free antiretroviral drugs to its citizens. In 1996, the Congress passed a federal law mandating the universal provision of antiretroviral medication. According to the Ministry of Health, national spending for ARV medications in Brazil grew from 25 million reais in 1996 to more than a billion reais by 2009 (Bacon, Pecoraro, Galvao & Page-Shafer, 2004). Through contentious policies, such as aggressive negotiations with pharmaceutical companies for discounted drugs and locally producing generic ARVs, the NAP has controlled the high cost of providing free treatment to HIV and AIDS patients.

Gross 2 Equally important to the extension of prevention and treatment of HIV and AIDS is that the Brazilian National AIDS Program has committed to defending the rights of previously marginalized groups. Organizations representing gay, bisexual, transgender, and other populations particularly affected by the epidemic have received significant funding from the program. The annual Gay Pride Parade in So Paulo has received regular financial support from the NAP, as well as other LGBT activities. In short, the campaign against discrimination, stigma, and homophobia is essential to the response to HIV/AIDS, and it has been pursued by Brazils National AIDS Program through partnerships with nongovernmental and civil society organizations. While Brazilians are generally accepting of the gay community, 75% of gay men and other MSM in Brazil report having been discriminated against due to their sexual orientation (Bacon, Pecoraro, Galvao & Page-Shafer, 2004). Homophobia and prejudice towards MSM and LGBT groups, combined with conservatism in the Brazilian government, have impeded legislative progress in regards to the rights of LGBT people in Brazil. If Brazils National AIDS Program, a governmental organization, strives to achieve greater progress in decreasing the prevalence of HIV/AIDS among MSM, it must combat continuing prejudice within the government and the country at large. Brazils National HIV/AIDS Program has produced perhaps the largest and broadest response to HIV/AIDS of any developing country through a human rights-centered, aggressive approach to HIV prevention and treatment. According to the National Institute of Health, the Brazilian government estimated that in 2005, since its launch in 1996, the program reduced AIDS mortality rates by nearly 50 percent among the general population, saving more than $2.2 billion in direct hospital costs since the crisis began. The program is revolutionary in combining the provision of free antiretroviral therapy to Brazilians suffering from HIV and AIDS with

Gross 2 prevention initiatives targeting at-risk populations such as men who have sex with men. Nevertheless, despite increases in life expectancy and the number of Brazilians receiving treatment, MSM continue to have the second highest prevalence of HIV infection, behind injection drug users (Ministry of Health, 2010). Furthermore, outreach programs in Brazil have been developed to meet the specific needs of men who have sex with men, yet only 1% of HIV spending is directed towards the vulnerable group (PAHO, 2008). Evidently, these programs lack sufficient means to providing high quality health services to MSM. While Brazils National AIDS Program has succeeded in curbing the threat of HIV and AIDS to its general population, men who have sex with men continue to face an excessively higher risk for infection. In order to reduce the prevalence of HIV and AIDS among the MSM subgroup, the NAP must create more culturally and socially specific programs, support groups, and incentives for MSM to get tested for HIV. Furthermore, Brazils National AIDS program should oppose all discrimination and stigmatization against homosexuals because this only leads to postponement of testing and treatment. Most significantly, advocacy for increased tolerance of the MSM community by all members of society is urgently needed in order to reduce barriers to prevention services. Although human rights are reflected in NAP policies, no specific nondiscriminatory laws exist that protect men who have sex with men. As a governmental program, it is the responsibility and duty of Brazils National AIDS Program to not only ensure adequate treatment, care, and access to HIV services to vulnerable populations, but also to support men who have sex with men through legislation that grants them safety from all forms of discrimination.

Gross 2 Works Cited AVERT. "HIV & AIDS in Brazil." AVERTing HIV and AIDS. AVERT, n.d. Web. 03 Mar. 2013. <http://www.avert.org/aids-brazil.htm#contentTable6>. Bacon, O., J. Galvao, M. L. Pecoraro, and K. Page-Shafer. HIV/AIDS in Brazil. MSMGF, n.d. Web. 25 Feb. 2013. <http://www.old.msmgf.org/documents/LatinAmerica/Government/BrazilCuntryAIDSPli cyAnalysisPrject.pdf>. Murray, L. R., J. Garcia, M. Munoz-Laboy, and R. G. Parker. "Strange Bedfellows: The Catholic Church and Brazilian National AIDS Program in the Response to HIV/AIDS in Brazil." National Institutes of Health. US National Library of Medicine, 27 Jan. 2011. Web. 8 Mar. 2013. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3080842/>. PAHO. "HIV/AIDS in Brazil." HIV/AIDS in Brazil. PAHO, n.d. Web. 03 Mar. 2013. <http://www2.paho.org/hq/dmdocuments/2010/PAHO%20English%20MSM%20Summa ry%20Electric.pdf>. UNAIDS. "HIV and AIDS Estimates." UNAIDS. UNAIDS, n.d. Web. 25 Feb. 2013. <http://www.unaids.org/en/regionscountries/countries/brazil/>.