AIDS: A GLOBAL ASSESSMENT : LATIN AMERICA : Church Values vs. Content of Educational Programs

Rio de Janeiro’s pre-Lenten carnival celebrations are traditionally an occasion for freewheeling partying, sexual promiscuity and in recent years, it is thought, transmission of the AIDS virus. But this year health officials in Brazil hoped that things would be different.

Thousands of tourists arriving at Rio’s international airport in February for carnival season received Health Ministry leaflets recommending that they abstain from casual sex or that they use condoms. The government also sponsored newspaper and television advertisements urging Brazilians to guard against AIDS by using “Venus shirts” or “little shirts,” the national euphemisms for condoms.

But the media campaign soon foundered; its budget was cut from $2 million to $600,000. The powerful Roman Catholic Church objected to some of the sexually explicit material, such as a television spot demonstrating the handling of a condom by showing it being rolled onto a finger.

“It came down to a lack of resources,” said Dr. Pedro Chequer, chief of epidemiology in the Health Ministry’s special AIDS task force, adding that the church’s objections also “mutilated the content of the campaign.” Government authorities “are more worried about other things than this,” he said.

Brazil has reported more AIDS cases than any country in the world except the United States, and it is the only Latin American country with a notable incidence of the disease.

But its short-lived educational blitz against AIDS illustrates many of the difficulties of fighting the disease in Latin American countries, where homosexuality is rarely acknowledged and Catholic values are strong.

In Mexico, for example, Secretary of Health Guillermo Soberon surprised television viewers this spring when, in the course of a special program on AIDS, he called for the use of condoms to prevent the transmission of the disease.

Now, the Health Ministry distributes matchboxes containing a condom and the admonition, “I don’t play with fire.” But it has had to cope with Catholic church criticisms of the campaign as “immoral” and as a “promotion of homosexuality and prostitution.”

Brazil’s 1,835 reported AIDS cases are concentrated in the large gay communities of Sao Paulo and Rio de Janeiro, the nation’s most populous cities.

Throughout the rest of Latin America, fewer than 1,000 AIDS cases have been reported, about 350 elsewhere in South America, about 500 in Mexico, and about 100 in Central America.

Although Sao Paulo and Rio de Janeiro are two of the few places in all of Latin America where homosexuality is tolerated and practiced openly, many Brazilian AIDS patients or their families ask physicians to diagnose their illnesses as something other than AIDS. And some private doctors do not want it known that they have treated AIDS patients.

As a result, reporting of AIDS is much less complete than in the United States. “It is probable that there are 25% to 30% more cases,” Chequer said. “People see AIDS as they saw leprosy a short time ago.”

Chequer’s pessimistic view is shared by Paulo Cesar Bonfim, president of the Support Group for the Prevention of AIDS in Sao Paulo. Bonfim, a medical technician, complains insistently about the “precarious” level of treatment available to AIDS patients and an almost total lack of research about the disease.

“Beds are lacking, medicine is lacking, adequately trained persons are lacking to attend the cases,” he told The Times. As an example, Bonfim estimated that only 200 hospital beds are available for AIDS patients in all of Brazil, compared to the 1,000 he said are needed.

One reason for these shortages is Brazil’s other pressing public health priorities. Millions of Brazilians suffer from such serious contagious diseases as sleeping sickness, schistosomiasis (a chronic worm infection that can destroy the kidneys, liver or other organs) and leprosy.

There are, however, some recent signs of progress. AIDS antibody testing is beginning in blood banks. The Health Ministry is planning to test 100,000 volunteers, including prostitutes, prisoners and gays, to better define the number of infected individuals. And a nationwide AIDS education program will begin in Brazil’s secondary schools next year.

Elsewhere in Latin America, Mexico may be the next country to develop a significant AIDS problem.

Within the last year, the Mexican view of AIDS as primarily an American problem has been replaced by a growing realization that the AIDS virus menaces Mexicans as well.

With 487 reported AIDS cases in a nation of 78.5 million, Mexico has counted less than 5% of the number of AIDS patients in the United States on a per capita basis.

But some physicians believe the true extent of Mexico’s AIDS problem is much greater. Estimates range up to 2,000 cases. They blame contaminated blood supplies throughout the country and homosexual transmission of the AIDS virus in Mexico City, where about half the cases have been concentrated.

Mexico has established a national committee on AIDS with a $1-million annual budget to coordinate educational programs. Two AIDS hot lines in Mexico City receive a total of 360 calls a day.

AIDS antibody testing is required for all blood donations, although screening for AIDS-infected blood at private blood banks, which pay cash for blood, is considered spotty. Proposed reforms to the health law would ban such payments.

The lingering perception of AIDS as a disease imported from the United States also brings sporadic calls for the testing of all tourists; the idea, however, is deemed unrealistic. One magazine recently used as its cover a map of the United States and Mexico, with a black ooze dripping down onto Mexico that was labeled, “Pressures, Debt, Drug Dependency, and AIDS.”

Strong anti-American sentiments are also being voiced in Central America, where many nations are taking their first steps to control the spread of the disease.

Panamanians seem more wary of casual sexual contact with the country’s large American community, while health officials in El Salvador express concern that the disease will become more prevalent with the return of thousands of Salvadorans from the United States as a result of the new American immigration law.

Throughout the region, intravenous drug use is rare, so authorities believe the disease is most likely to be transmitted by sexual contact or through contaminated blood products.

In Costa Rica, where 31 AIDS cases have been confirmed, there is compulsory testing for foreigners seeking residence visas. In addition, 750 female prostitutes, who are licensed by the government, receive AIDS antibodies blood tests every three months.

In Nicaragua, the Sandinista government has begun an AIDS prevention campaign, centering on full-page newspaper ads outlining procedures for safe sex, accompanied by propaganda that labels AIDS a disease of “Yankee imperialism.”

Officials insist that there are no AIDS virus carriers among Nicaragua’s 3 million people, but they worry that the disease could be transmitted in the country’s small gay community or by the 150,000 foreigners who visit each year as tourists or volunteer workers. No restrictions, however, have been placed on foreigners.

“We think there must be cases of AIDS here in incubation,” said Dr. Leonel Arguello, a member of Nicaragua’s AIDS Control Commission. “All the theoretical conditions exist.”

Compared to the United States, relatively little attention is being paid to AIDS-related confidentiality concerns throughout Central America. For example, the Health Ministry in Nicaragua is quietly urging businesses to provide information on the sexual activity of homosexual, bisexual and promiscuous heterosexual employees.

In Costa Rica, hospitals routinely give health authorities the names of patients they feel should be talked into taking blood tests for AIDS antibodies. All test results are supposed to be confidential, but those who test positive are asked to provide as many names as possible so the Health Ministry can persuade their sexual contacts to submit to testing.

AIDS IN SOUTH AMERICA Argentina . . 89 Brazil . . 1,835 Bolivia . . 1 Chile . . 28 Colombia . . 57 Ecuador . . 18 French Guiana . . 58 Guyana . . 2 Paraguay . . 10 Peru . . 9 Suriname . . 3 Uruguay . . 8 Venezuela . . 69 TOTAL CASES 2,187