From: Billi Goldberg <bigoldberg@igc.apc.org>
Subject: Brazil and AIDS
Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed.
Archive-Number: 6180
Organization: unspecified
Date: Mon, 14 Sep 92 08:57:03 PDT

This report was from B. Elswood. He does not have access to sci.med.aids 
but can be reached at belswood@mcimail.com or I will forward responses.

I am only posting this and the opinions stated are Elswoods.

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 Burroughs- 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. 

Newsgroups: sci.med.aids