Where Prostitutes Also Fight AIDS
Thursday, March 2, 2006
RIO DE JANEIRO -- Paula Duran is an outreach worker with a style of her own. That style -- heavy on fishnet, tattoos and suggestive poses -- is at the heart of an ideological disagreement between Brazil and the United States over the best way to fight AIDS.
Duran, 35, is a prostitute in Villa Mimosa, a red-light district in this seaside city where an estimated 3,500 sex workers lounge in the doorways and lean out the windows of scarred, decaying buildings.
Each time she snags a customer, she fishes in her purse for a government-supplied condom. Often she repeats information on disease transmission that she learned at a state-funded workshop for prostitutes around the corner.
"I'm always telling people that they should never do anything without a condom," Duran said. "A lot of the young people who come around here don't know anything about it, so I try to teach them whatever I can."
But the U.S. government strongly disapproves of such unorthodox methods. Two weeks ago, Brazil received a letter from USAID declaring the country ineligible for a renewal of a $48 million AIDS prevention grant. The United States requires all countries receiving AIDS funding help to formally state that prostitution is dehumanizing and degrading, and Brazil last year -- alone among AIDS aid recipients -- was unwilling to do that.
A working partnership with prostitutes, health officials here say, is a key reason that the country's AIDS prevention and treatment programs are considered by the United Nations to be the most successful in the developing world. There are at least 600,000 people infected with HIV in Brazil -- but that is only half the number predicted by the World Bank a decade ago.
"When we started in the 1980s, our projected AIDS rates were exactly the same as Africa's, but now it's a completely different story," said Mariangela Simao, deputy director of Brazil's national HIV-AIDS program in Brasilia. "I'm convinced it's a result of the way the government has responded. We provide information and resources, and don't enter into moral or religious issues."
Brazil's annual Carnival, the rowdy pre-Lenten festival where clothes and inhibitions are mostly considered optional, began last weekend. At parades and block parties attended by millions throughout the country, the government's approach to AIDS and reproductive health appeared as unrestrained as the revelers themselves.
In Rio, free condoms were passed out like candy as part of a national goal to distribute 25 million of them before Carnival ended Tuesday. At a suburban bus stop, pamphlets distributed by the Health Ministry advertised a character called "Maria Without Shame," a cleavage-flaunting cartoon prostitute who reminds sex workers to take pride in their jobs and tells people that condoms should be used without guilt.
At celebrations in the northeastern city of Salvador, health officials also planned to pass out morning-after pills, according to local newspaper reports.
Brazil has more Roman Catholics than any other country, and the church at times voices mild complaints about the government's programs. But church leaders haven't pressed the issue. The idea of emphasizing abstinence as the basis of prevention efforts -- a stand the United States has officially adopted -- hasn't taken hold here.
"Brazil's sexual culture is very different from the puritanical tradition in the United States," said Sonia Correa, an AIDS activist in Rio who is also the co-chair of the International Working Group on Sexuality and Social Policy. "Our AIDS programs have also been radically different. The denial and the stigma that you find attached to sexual health issues in so many places isn't found in Brazil."