Where Prostitutes Also Fight AIDS

A number of other countries, especially in Africa and the Caribbean, have experienced high levels of HIV transmission through prostitution, but no other government has taken Brazil's unorthodox approach to the problem.

Brazil has also found itself at odds with the United States on AIDS treatment, but for different reasons. Brazil has led an international fight against pharmaceutical companies to allow countries to break the patents on AIDS medications, which would let governments produce the drugs at a much lower cost. The United States, where several of the large drug companies are based, says the patent protections encourage the companies to innovate. Without the financial benefit, they argue, there is no incentive for companies to develop new medicines that could improve patients' lives.

"Brazil has been using threats of breaking patents as a bargaining tool to negotiate lower prices with drug companies," said Michael Bailey, a senior policy analyst with Oxfam, an international nonprofit development aid group, speaking from its headquarters in Britain. "A lot of other countries are watching Brazil very closely to see what it does. This is very, very big business."

About two-thirds of Brazil's AIDS program budget -- or more than $400 million annually -- goes to buy antiretroviral medications, which the government offers free to anyone infected.

The loss of U.S. funding adds more financial pressure to Brazil's AIDS programs, though health officials here say the loss isn't crippling. Some nongovernmental organizations report recent lags and shortfalls in the government's distribution of condoms, but they don't attribute it to the loss of U.S. funds.

To help manage costs and keep up with the demand for condoms, Brazil later this year expects to become the first country directly involved in the condom business. It plans to open a state-run condom factory in the western city of Acre, producing condoms made from latex tapped from the region's wealth of rubber trees.

Gabriela Leite, 54, said she hopes the project will help condom supply meet demand. A former prostitute, she now runs an advocacy group for prostitutes that serves as a link between the government and sex workers. Her last government shipment included only 11,000 condoms -- about one-fourth the usual batch. Because the prostitutes aligned with her organization handed out large numbers of condoms at street parties during Carnival, she's afraid the supply will be quickly exhausted.

When asked if she believes such an approach is a better way to battle AIDS than promoting abstinence, she said she was certain of it. She also said she has made a point of trying to persuade activists and officials in other countries to join Brazil in refusing to go along with U.S. ground rules, even if the United States is easily the biggest provider of funding help in the world.

"It's strange, this attitude of the United States that says its way is the best, even in another culture that is completely different," said Leite, who said she retired from prostitution in 1979. "If that's the way it's done in your culture, that's fine. But it's different here, and we'll do it our way."