BRASÍLIA DIARIST
Sexual Healing
by Jonathan Cohn
New Republic
06.30.03
Although President Bush has pledged $15 billion to fight global AIDS over
the next ten years--an impressively generous sum, assuming his tax cuts
don't swallow up the money before it's spent--he clings to a very specific
idea about how AIDS -prevention money should be spent: on teaching
abstinence. That's why he and his supporters constantly talk up the success
of Uganda. Ten years ago, 15 percent of the country's population had AIDS .
Today, just 5 percent do. And a major reason for the drop is an AIDS program
that conforms to White House notions of propriety. As Ari Fleischer
explained recently, Uganda puts "an emphasis where emphasis belongs, which
is on abstinence."
A few weeks ago, I got a glimpse of a very different AIDS success
story--Brazil's--when officials there arranged a tour for a group of
journalists. The Brazilian initiative dates back to the 1980s, and it is
perhaps best understood through some of the public service commercials that
have aired on television since then. In one, dancers from Carnival, costumed
in ancient Roman garb, remind viewers that condoms have a long,
distinguished history: "In Rome and ancient Egypt, no one knew who they
slept with. Marco Antonia used to wear it. ... Cleopatra demanded and
believed in it. ... Hey, put on a condom." Another spot you might describe
as "Father Knows Best" meets "Queer as Folk" takes place in a suburban home
and preaches the virtues of tolerance toward gays as well as safe sex. Some
ads play out like soap operas, such as the one in which a man cheats on his
wife, picks up the AIDS virus, then gives it to his spouse. This commercial,
too, promotes condom use.
It's easy to see why Bush and his conservative supporters don't talk about
Brazil. But its results have been impressive. Brazil estimates that just
600,000 of its citizens are HIV-positive today--about half of what the World
Bank had predicted. The death rate from AIDS has fallen, too--by more than
70 percent in the last decade.
Of course, there's a lot more to the story than just condoms. As in most of
the developing world, few Brazilians have enough money to buy the
anti-retroviral drugs that keep AIDS from becoming a death sentence. Nor
could the debt-strapped government afford to finance those purchases on its
own, at least as long as the drugs were available only at market prices. So,
a few years ago, Brazil announced it would break existing patents and
manufacture generic versions domestically if the drug-makers didn't lower
their prices voluntarily. Once the Clinton administration dropped its threat
of trade sanctions against Brazil--threats made at the behest of the drug
industry--the pharmaceuticals gave in. The United States agreed to recognize
that developing countries had a right to break drug patents in order to
fight a deadly public health crisis, while the pharmaceutical companies
discounted a few medications. As a result, today every Brazilian who
qualifies medically for AIDS therapy can get it. (Even more impressive, a
recent study in the journal AIDS suggested that the rate of HIV-positive
Brazilians who have developed resistant strains of the virus compares
favorably to the United States and most of Europe. That would mean
Brazilians aren't just getting the drugs; it would mean they're taking them
properly, too--proof that, contrary to the assertions of pharmaceutical
companies, patients in less developed countries can be counted on to follow
the rigid regimen the medications demand.)
Brazil's progress is particularly remarkable given its government's
inability to combat both the country's vast economic inequality and its
truly frightening rate of violent crime. And, given that 75 percent of the
country is Catholic, it's no less amazing that the population has
countenanced such frank talk about sex--and that the aggressive response
dates back even to the epidemic's early days, when it primarily affected
gays and prostitutes. But the Brazilians I met all found this state of
affairs normal. The Brazilian wing of the Catholic Church has a long history
of progressive views--in part because its lineage lies with the Portuguese
Church, always more open-minded than its Spanish counterpart. More
important, though, Brazilians seem unusually determined to separate church
and state--or, at least, religion and public policy. Brazilians don't want
public health policies that pretend people don't have sex, sometimes
promiscuously, nor do they want government moralizing. So they're happy to
let elected officials mandate sex education in the public schools,
distribute clean needles to drug addicts, and even underwrite a condom
factory in the Amazon. (Brazilian officials are particularly proud of the
condom factory, which they tout as a policy trifecta: It fights AIDS ;
brings jobs to poor, rural communities; and saves the rainforest, since
latex is harvested from live trees.) When I asked Paulo Teixeira, director
of Brazil's AIDS program, about political resistance to such initiatives, he
seemed positively baffled: "No federal official has ever lost a job because
of offending public sensibilities on sex."
Alas, that's not the case here. Just ask former Surgeon General Jocelyn
Elders, forced out in 1994 for discussing masturbation. Even today, that
sensibility undermines U.S. policy on AIDS . Last week, the Centers for
Disease Control and Prevention (CDC) threatened to rescind its funding of a
San Francisco program called stop AIDS . In order to attract more
participants, the organizers mixed in some "better sex" tips with "safe-sex"
talk, prompting religious conservatives to attack it as promoting
promiscuity. As an office ostensibly dedicated to science, the CDC should
judge programs strictly on their results. But the stop AIDS decision is part
of a wider campaign to audit all federally funded AIDS -prevention programs
and steer them toward abstinence training. Never mind the studies suggesting
the limits of that approach in the United States--or that, even in Uganda,
it hasn't been quite the elixir conservatives would have us believe. The
White House has its own story about AIDS . And it's sticking to it.
Jonathan Cohn is a senior editor at TNR and a Kaiser Family Foundation media
fellow.
Copyright 2003, The New Republic