HEALTH-BRAZIL: Older Women at Higher Risk from AIDS

Mario Osava

RIO DE JANEIRO, Feb 13 2009 (IPS) – The HIV infection rate in women over 50 in Brazil has more than tripled since 1996, making this population group the prime target of the government s HIV/AIDS prevention campaign during the carnival festivities.
A survey by the Health Ministry found that 55.3 percent of Brazilian women aged between 50 and 64 regularly have sex, but only 28 percent practise safe sex including condom use with casual contacts, that is with men who are not their regular partners.

It is worrying, said Health Minister José Gomes Temporão, because infections are rising in this female age group, as well as among young men who have sex with men, although in the general population the number of HIV-positive people has stabilised, at around 630,000 people. Brazil has a total population of 190 million.

In 1996, only 3.7 AIDS patients per 100,000 population were women over 50. Ten years later, there were 11.6 cases per 100,000 in this group.

Consequently, the campaign launched on Friday is aimed at mature women , seeking to empower them to insist that their partners use condoms, and also raising awareness among men and promoting the democratisation of sexuality within relationships , the health minister told foreign correspondents at a press conference.

Sex has no age limit. Neither does protection, is the slogan to be broadcast on television and radio spots and in printed matter in the coming weeks. One 30-second video shows a group of women aged 50-something encouraging women not to tolerate men who refuse to use condoms not even if it s just a fling .
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The campaign is not only about casual sex, according to Maria Luiza Pereira, of Maria Mulher, a non-governmental Afro-Brazilian women s organisation.

In stable couples, women find it difficult to negotiate the use of a condom. They believe the stability of the union makes for safe sex, but infidelity may still occur, Pereira told IPS in December, when the rising trend of HIV infections in older women first emerged.

Another factor that makes older women vulnerable is the lack of pregnancy risk, which reduces concerns over not using condoms, she said then.

While investigating the background for a story on this issue, IPS found that many statistical sources on AIDS disregarded the upper age range.

The most recent report by the Joint United Nations Programme on HIV/AIDS (UNAIDS) said that an estimated 1.9 million people in Latin America are infected with the AIDS virus, 210,000 of whom were diagnosed within the past year. The UNAIDS statistics for adults are limited to 15 to 49-year-olds.

This month, when carnival fever spreads parties, dancing, hedonism and sensuality throughout Brazil, the Health Ministry will distribute 55 million condoms, 10 million more than the usual monthly supply, said Mariángela Simão, the head of the ministry s National Programme on Sexually Transmitted Diseases (DST) and AIDS.

The prevention campaign reaching out to older women comes in the wake of a similar crusade in December 2008 to raise awareness among men over 50 of the need to practise safe sex.

Brazil usually carries out two AIDS prevention campaigns a year. Their results can only be assessed after several years, because behavioural change takes time, and older people in particular are more resistant to changing their habits, said Simão.

Young people are used to condoms, but the older generation is not, Minister Gomes Temporão said.

That the total number of HIV-positive people in this country has stabilised indicates the success of the campaigns, as does the fact that 96 percent of the adult Brazilian population now knows how the virus is transmitted.

Of the 630,000 people living with the HIV virus, some 255,000 do not know that they are HIV-positive because they have not been tested. A rapid diagnostic test has been developed in Brazil and is available to test people who are in doubt about their HIV status.

HOMEMADE AIDS MEDICATION

Another way to combat AIDS is to lower the cost of the antiretroviral medicines that fight the infection. The Brazilian AIDS programme is internationally recognised as an example in the field of treatment, as it was one of the first countries to provide free antiretroviral medication to all who need it.

One milestone in the fight against the disease was the decision, in 2007, to break the patent on Efavirenz, a drug used by 85,000 out of the 200,000 HIV/AIDS patients who were taking the cocktail of antiretroviral drugs which drastically reduces mortality and improves quality of life.

Less than two years after decreeing compulsory licensing of the patented drug, made by the U.S. pharmaceutical company Merck Sharp Dohme, the Rio de Janeiro-based Oswaldo Cruz Foundation succeeded in producing the generic version, chemically identical to Efavirenz.

This year, half of the 30 million pills consumed in Brazil will be produced in-country.

The compulsory licensing imposed on Efavirenz does not deprive Merck of the royalties for its patent, which represent 1.5 percent of the cost of the pills, but the government saves around 60 percent of the price Merck was previously charging for them.

The cost of the Brazilian generic version is a little higher than that of the equivalent drug imported from India since the patent was bypassed, but the main thing is that the technological capacity of the country to manufacture its own generics has been proven, Gomes Temporão said

This could be important in future for fighting tropical illnesses that do not attract much interest from the transnational pharmaceutical industry (because profits would be meagre), such as malaria, leishmaniasis and Chagas disease, he said.

Eight of the 17 drugs used to treat AIDS in Brazil are manufactured within the country.

The health minister said that the global financial crisis will not affect the health budget, which is protected under the constitution . He is guaranteed at least the same level of resources for 2009 as for last year, with additional funding index-linked to inflation and the country s economic growth.

The AIDS Programme, including distribution of antiretroviral treatment to all those who need it and medical care provided by the public health system, costs 1.4 billion reals (600 million dollars) a year, Simão said.

Brazil is using its experience to help some African countries, especially Portuguese-speaking nations like Guinea-Bissau, Cape Verde, and São Tomé and Príncipe, to deal with their own AIDS problems.

Guinea-Bissau treats 3,000 AIDS patients with Brazilian aid, Simão told IPS. Technical cooperation and medical training have been stepped up in other countries, and the Oswaldo Cruz Foundation is transferring technology to Mozambique to set up a drug manufacturing facility there, she said.

Simão said that, regrettably, Brazil s accumulated social experience in AIDS prevention and mechanisms to ensure successful treatment, like promoting organisations for HIV-positive people, are difficult to transfer to Africa, the continent most afflicted by the AIDS pandemic, because of the great cultural gap between them.