Stigma and discrimination against people living with HIV is commonplace in the Amazon region of Brazil. In an effort to change attitudes and increase awareness about AIDS, people living with HIV in the heart of the Amazonian territory have come together to try to encourage people to learn about the epidemic and break down AIDS-related stigma.

“In the northern region of Brazil, living with HIV is very difficult,” said Laurinha Brelaz, who has been HIV-positive for 13 years. “It is hard to get information, to show our faces and be open about our HIV status. The afro-Brazilian, native indigenous and Amazonian river people living with HIV are in constant fear of discrimination and stigma,” she explained.

Mrs. Brelaz is a member of Rede Nacional de Pessoas Vivendo com HIV/AIDS (RNP+), a Brazilian network of people living with HIV, based in São Paulo. RNP+ was created more than ten years ago and began working in the Manaus area of the Amazon State last year. The network seeks to support people living with HIV and focus on HIV prevention projects for native Amazonians.

“We want to support the Brazilian government in building public health policies. In the Amazon State, many people living with HIV are mistreated by public health staff. There are many cases of discrimination, especially towards HIV-positive women who particularly suffer prejudice. If we raise awareness about HIV in public opinion, people living with HIV will be confident enough to show their faces as part of society,” affirmed Mrs Brelaz.

According to a Brazilian Health authorities report, AIDS incidence in Amazon State increased from 3.7 cases per 100,000 inhabitants in 1994 to 15.7 in 2004. “In the Northern states the biggest challenges are related to access to health services. This is mainly due to geographical obstacles, and the need to expand the structure of health services to treat the local population. In order to strengthen the response to AIDS in the region, we need to improve health care systems, and encourage the involvement of civil society organizations,” said Mrs. Mariangela Simão, Director of the Brazilian National Programme on Sexually Transmitted Diseases and AIDS.

The response to AIDS in the Amazon also goes beyond health issues. Recently RNP+ Amazonas mobilized civil society to participate in a Workshop for Awareness of Social Actors on HIV/AIDS sponsored by UNAIDS and ILO. “In the Amazon, there is a great opportunity to scale-up access to services for people living with HIV. A successful response cannot be achieved without the full engagement and participation of people living with HIV,” said Dr. Laurent Zessler, UNAIDS Coordinator Brazil. This partnership aims to develop actions on HIV in the workplace, including support to workers living with HIV in the Amazon region. The participants received information and material on HIV from UNAIDS, ILO, the Brazilian National Programme and various NGOs. The project also received support from local and State governments and National Trade Unions in the region.

Partnerships between domestic and international actors are becoming increasingly fundamental to working on AIDS issues in inland Brazil. Mrs. Laurinha Brelaz represents the network of people living with HIV in the UN Expanded Theme Group on AIDS. “In the beginning of the epidemic, people living with HIV used to feel very alone. Nobody knew what HIV or AIDS was. So, people living with HIV built-up this network. Today, we are known internationally,” she explained proudly. “Our goals are to fully participate in the decision making at all levels, including state and municipal health councils and AIDS commissions, in order to build health policies together, fight for a high quality public health system and restore our dignity,” she said.

The work, led by Brazilian civil society in the Amazon region, still depends on strengthening their financial sustainability. “Financial issues are still the main obstacle we need to overcome. We are receiving some resources from National and local governments, but we intend to approach international sponsors as well,” Mrs. Brelaz highlighted. When asked about plans for the future, Mrs. Brelaz answered, “In the Amazon we intend to implement the same standard of quality of life for people living with HIV as in other areas of Brazil.” Now RNP+ Amazonas are planning for the next annual meeting of people living with HIV in the region.

Marcela Romero became a woman in heart, soul and body at the age of 17. This decision changed her life completely. No longer would ‘Marcelo’ (her name at birth) be the favourite uncle or pride of the family. Instead Marcela faced scorn and rejection.

“Knowing that your family wishes you had never existed or listening to the constant question what did I do to have a person like this in the family is very painful,” Marcela explained.

After having to drop out from school in Argentina due to reaction to her new appearance, Marcela was forced to sell sex to survive financially. During this time, Marcela became HIV positive.

Marcela’s experiences are typical of transsexuals in Latin America and other parts of the world as they face rejection from their families, marginalization within wider society and other forms of stigma and discrimination.

“This is the reality of the gay, lesbian and transsexual population in Latin America. We are permanently treated as fascinating objects for investigation or contempt and not as individuals with rights,” said Marcela, explaining that despite her wish to be considered a woman, she is still obliged to carry and present her male identification papers to keep within the country’s law.  In Latin America, stigma and discrimination of sexual minorities often goes hand in hand with HIV-related discrimination.

“Sexual violence is a reality for many sexual minorities and often sex work is the only viable option to make a living for transgender and transsexual people who are marginalized in mainstream society. Unless HIV prevention and stigma eradication programmes are designed by and for these communities they will continue to be more vulnerable to HIV,” said UNAIDS Head of Civil Society Partnerships, Andy Seale.

Marcela is working hard with others in the same situation as her to respond to and reduce the kind of stigma and discrimination she faces every day. As coordinator of the Latin American Transsexual Network (REDLACTRANS), she recently took part in a meeting in Brazil, in which other representatives from more than 20 Latin American countries gathered to address the issue of discrimination against sexual minorities and its effects on the AIDS response.

Within the discussions at the meeting, a strategic guidebook to help fight discrimination against sexual minorities, and reduce its impact on HIV, was presented for discussion. “This guidebook will be a useful instrument for countries, especially those that lack on legislations and laws that ensure the basic human rights to these important populations,” said Pedro Chequer, UNAIDS Country Coordinator for Argentina, Chile, Uruguay and Paraguay. More than 80 countries around the world, especially in Asia, Africa, Central America and the Caribbean, currently punish homosexuality as a crime.

The meeting was an initiative of the Horizontal Technical Cooperation Group (HTCG), that comprises more than 21 Latin American countries, and the UNAIDS Regional Support Team for Latin America.  The guidebook is expected to be ready for distribution later this year.

“We are committed to stopping the crimes and abuses against gay, lesbian and transsexual populations which can lead to a higher HIV risk. This goal can only be achieved through public policies that respect sexual orientation and human rights,” said Carlos Passarelli, HTCG’s Joint Director.

Arturo Diaz, from the Mexican non-governmental organization, Letra S, stated that this type of discrimination “affects the daily lives of the gay, lesbian and transsexual populations in personal, emotional and professional aspects, as well as health”.

As stated in the Declaration of Commitment on AIDS, UNAIDS is working on initiatives to join efforts with governments, civil society and the media of all the Latin American countries to fight stigma and discrimination through coordinated action as part of a wide response to the AIDS epidemic.

The path ahead is long, but as Marcela has seen, stigma and discrimination can be broken down gradually, moving towards the ultimate goal of total eradication. “Before only my best friend would accept me, now my Mum has started to come around as well,” she said. “Things are changing – it’s little by little, but they are changing for the better.”

---

Related links

Horizontal Technical Cooperation Group of Latin America and the Caribbean on HIV/AIDS
Letra S

PAHO - HIV/AIDS-Related Stigma and Discrimination in the Health Sector
PAHO - Estigma y Discriminación por el VIH/SIDA en el Sector Salud

PAHO - Time to Stop Homophobic Crimes in Latin America and the Caribbean
PAHO - Es hora de poner fin a los crímenes homofóbicos en AMÉrica Latina y el Caribe

Thousands of condoms pile in the corner. Buckets of paint lie on the shelf. She cuts, twists, shapes, melts, pastes, colors, crochets and sculpts, with her fingers and nails stained black. 365 hours later, a colourful elegant gown made of 6,500 condoms debuts.

Adriana Bertini, a Brazilian artist living in São Paulo, uses expired or defective condoms as raw material to make pieces of art. Her creations include ornate evening dresses, vivid bikinis, elegant shawls, flowery carnival costumes, and other plastic arts.

"I want my art to be visible everywhere, reminding people of the necessity of HIV prevention" Bertini says. “I prefer working more with the figurines, because I noticed that they make people think about the meaning of ‘Wear against AIDS’.”

Bertini started her career at Brazil's fashion houses, and made her first dress from condoms in 1997. Since then, the designer has made around 200 sculptures, 80 tapestries and 160 figurines from condoms. The most condoms she has ever used on a gown - around 80 thousand - was on one wedding dress.

"My idea is to promote condom use not as a commercial fashion but as a conceptual fashion, be it conscious or subconscious. The idea is to wear them at the right time, not just as a trend, on clothes" says Bertini.

Bertini started working in HIV prevention in 1994, after she spent time with HIV positive children as a volunteer for GAPA, an HIV prevention group. "In the beginning, I worked with condoms but not necessarily in the context of AIDS," the designer says "The AIDS issue came along with my work with children living with HIV. I realized that I could use fashion for AIDS awareness."

“I volunteered to do the HIV prevention work,” says Bertini, who at the time did not know anyone living with HIV. “Then I made friends who were HIV positive and this stimulated me even more to promote prevention.  Today, I have already lost some dear people to AIDS. I think this is the minimum I can do, being a conscientious person faced with a problem of this magnitude. ‘If you have conscience, act'.”

Bertini’s designs can be seen at fashion shows and in magazines, or are exhibited in museums. “The focus is not on wearing my gowns, but on introducing condoms into everybody’s lives, breaking taboos and giving the public a chance to ponder.”

While Bertini’s designs are often shown in Brazil, she has also had important international exposure. Her work was exhibited at the International AIDS Conference in Barcelona, Spain, in 2002, and at the 15th International AIDS Conference in Bangkok, Thailand, in 2004, among others. She has also proposed an exhibit in the cultural programme of the 16th AIDS Conference in Toronto this coming August: “I am waiting for the selection to be finalized.”

Reactions of the public to her designs vary. Some people whisper about it, others laugh or dismiss it as inappropriate, and then there are those who want to meet her and tell her their problems.

“There a lot of parents who want to thank me because it was through my art that they’ve reached out to their children to talk about sexuality,” she says.

All her material comes from condom manufacturers, and the proceeds from the sales of dresses - prices range from $700 to $5,000 - go directly to organizations involved in the fight against AIDS. Bertini and her HIV-positive apprentices do not make their living directly from their work, but instead rely on sponsors.

"I'm not doing this to make money but rather as a social act, as art aimed at others. I hope that by using condoms to create something new, I can inspire reflection, foster discussion, and challenge taboos." says Bertini who is quickly becoming well-known in international activism circles.

The 34 year-old was awarded with the Nkosi Johnson Community Spirit Award in 2004 by the International Association of Physicians in AIDS Care, Washington DC, (IAPAC) in recognition of her 10 years of artistic activism. "You understand, condoms must become as basic as a pair of jeans and as necessary as a great love," Bertini emphasizes.

Related links

Adriana Bertini official website

Packed with 750 young navy cadets, the  Rio de Janeiro’s Naval School hosted representatives from the Brazilian Ministries of Defense and Health, UNAIDS and UNFPA to launch the STD, HIV and AIDS Prevention Programme in the Armed Forces and Military Academies.

Conceived as a follow-up to the 2004 Agreement between UNAIDS and the Brazilian Government to strengthen prevention among the country’s conscripts, the project aims to enhance military capacity to plan, monitor and evaluate prevention activities.

The programme will also integrate HIV prevention in military schools curricula and Armed Forces training courses. “There is a correlation between low education, low information and HIV. Those who have more access to information are better protected” said Admiral Carlos Edson Martins da Silva, Coordinator of the Programme in the Brazilian Ministry of Defense.

With more than 310,000 personnel stretched across the country, the Armed Forces are a key actor in Brazil’s HIV prevention. Brazil’s well structured health services are available not only to military personnel, but also to civilians in remote regions otherwise without access to public health services. Brazilian Government also produces generic antiretroviral drugs that are available to the population at reduced prices.

New course materials include a training guide and a peer education toolkit, and are specifically adapted to the Brazilian setting. “Providing information alone is not enough. We need to change attitudes and you will be the agents of this change”, Dr. Andrea Boccardi, UNAIDS Latin America Regional Advisor for AIDS, Security and Humanitarian Response addressed the navy aspirants attending the launching ceremony.

HIV prevention efforts in Brazil’s Armed Forces date back to the 90’s. The research carried out between 1996 and 2000 by Brazilian Ministry of Health shows a consistent increase in the use of condoms among young conscripts, from 38% in 1997 to 50% in 2000.

For more information, please contact Naiara G. da Costa Chaves (UNAIDS - Brasil) naiara@undp.org.br

(Brasilia, 12-14 January 2006)

Lowering the prices of AIDS medicines and other essential commodities, securing additional donor support, increasing international awareness of the epidemic in the region, and reducing homophobia and gender discrimination were among the priority actions identified at the Latin America regional consultation on scaling up towards universal access.

In nearly all the Latin American countries, the highest levels of HIV infection are found among men who have sex with men.

The 1st regional consultation on Universal Access

The Latin American Regional Consultation on universal access, hosted by the Brazilian government, was organized by the Horizontal Technical Cooperation Group (HTCG) with seven civil society networks in Latin America and the Spanish-speaking Caribbean.

It brought together representatives of networks of people living with HIV, sex workers, men who have sex with men and other groups at high risk of exposure to HIV and also representatives of national AIDS authorities, the Assistant US Global AIDS Coordinator, representatives of the Catholic Church and UNAIDS Cosponsors.

Finding practical solutions at the local level

From the very first day, participants were urged to focus on solutions. “We have had a lot of plans,” said Michel Sidibe, Director of Country and Regional Support at UNAIDS. “We need more implementation,” he added.

The specificity of this international process is not only the focus on solutions but also countries’ ownership.

This means that there will be no globally set targets and that the countries, based on thorough assessment of their situation, will themselves determine what are their specific obstacles and what are the appropriate solutions to ensure that all women, men and children have access to the AIDS services that they need.

The United Nations General Assembly resolution adopted on 23 December 2005 calls for an inclusive country-driven process involving the relevant stakeholders from non governmental organizations, civil society and the private sector.

UNAIDS is actively assisting countries in facilitating this inclusive process aiming at coming as close as possible to the goal of universal access to treatment by 2010 for all those who need it.

Many national consultations are already scheduled to take place before the end of March 2006. The next regional consultation on Universal Access will take place in Tunis, Tunisia from 6 to 8 February 2006.

The III Latin America and the Caribbean Forum on HIV/AIDS/STDs (Foro 2005) and the IV Central American Congress on STD/HIV/AIDS (CONCASIDA) closed on Friday 11 November with a gathering of Presidents and other leaders from the Central America region.

UNAIDS Executive Director Dr Peter Piot attended the Presidential Summit and addressed the conference closing plenary.

At the summit, Dr Piot met with the President of El Salvador Elías Antonio Saca González, the host of the conference.

"There is momentum on leadership – made manifest in today's gathering of Presidents and other leaders from this region here today," said Dr Piot prior to the President's Summit. "Now is the time to act.  So that together we can stop the threat of AIDS in our countries."

The President of Guatamela Oscar José Rafael Berger and the President of Costa Rica Abel Pacheco also attended the gathering, as well as the health ministers from Honduras and Nicaragua.

Dr Piot underlined the significant strides that have been made in the region to increase access to treatment. But, he added, these gains in treatment access need to be sustained and extended to the whole region. With more people living with HIV than ever in some countries, Dr Piot emphasized the urgent need to simultaneously increase HIV prevention programmes that reach all people at risk of infection, particularly those most marginalized such as men who have sex with men and sex workers.

"The region must revitalize its strategies to reach people most at risk – and they must address the deeper-rooted factors that affect vulnerability, such as social exclusion and inequalities of all kinds," he said.

Dr Piot urged leaders in the region to renew and reinvigorate their commitments at the highest political level and to agree to specific measures that will translate into concrete actions to reinforce AIDS responses nationally and regionally.

"The history of AIDS has shown us that when we are united, people win. Success depends on each of us truly being committed to tackling this exceptional crisis," said Dr Piot.

As part of the Presidential Summit, a declaration of enhanced commitment to a coordinated regional AIDS response was signed.

 

---

Related links:
 

UNAIDS press release: Putting the spotlight back on AIDS in Latin America and the Caribbean

 Speech by UNAIDS Executive Director: The future of the HIV epidemics: leadership for action  

11 November 2005: Declaration of enhanced commitment to a coordinated regional AIDS response signed at CONCASIDA (Spanish only)  

Photos: View photos from CONCASIDA 2005

Foro y Concasida

UNAIDS Regional information: Caribbean

UNAIDS Regional information: Latin America

Recognizing the critical role that local organizations play in the response to HIV, five community organizations from Ghana, India, Iran, Malawi and Mexico were presented with Red Ribbon Awards at the International AIDS Conference (AIDS 2008) last night.

On the occasion of World AIDS Day the global call for nominations for the Red Ribbon Award 2008 will be announced in Mexico City. The biennial award, which will be presented at next summer’s International AIDS Conference in Mexico, will honour 25 community-based organisations for their contributions in responding to the AIDS epidemic.

United Nations agencies and programs are committed to taking all the necessary measures to intensify Central America’s response to the HIV epidemic. This announcement was made by the Regional Directors for Latin America and the Caribbean of UNAIDS and UNICEF, participating in the 5th Central American Congress on HIV – CONCASIDA 2007.

Managua, 4 November 2007––Central America is preparing to host the V Central American Congress on STI, HIV and AIDS, to be held in Managua, Nicaragua from 4 to 9 November 2007 under the theme ‘For Equality, Diversity and Non-Discrimination’. The Joint United Nations Programme on HIV/AIDS (UNAIDS) is providing technical and financial support for the meeting and welcomes the congress’ efforts to advance scientific and technical responses to AIDS in the region.