Brazil Plagued by AIDS Transmitted in Tainted Blood; New Law in Effect

Nearly two out of 10 AIDS victims in the state of Rio de Janeiro acquired the virus from contaminated blood received in transfusions, according to health authorities.

The alarming rate of AIDS contagion as a result of transfusions is largely the result of official neglect, the authorities acknowledge. And they say that belated measures are being taken to deal with the problem.

President Jose Sarney signed into law last month a measure requiring that all blood for transfusions be tested for AIDS--acquired immune deficiency syndrome--and other diseases.

In a radio message, Sarney lamented what he said was “a true calamity . . . the problem of contaminated blood used in transfusions throughout Brazil, a practice that is responsible for an alarming number of cases of AIDS, hepatitis and other diseases.”

Sarney said his government is making preparations for a “systematic, emergency attack against the criminal practices that have so harmed the health of the Brazilian people, of the ill who need blood transfusions.”

In Rio, the state health department says it is gearing up to intensify inspections of blood centers and to squeeze legal, profit-making blood banks out of business.

The health officials say they are also enlisting police help to hunt down clandestine blood banks that have been labeled “vampire dens” by the Brazilian press. The “vampires” buy blood from poor Brazilians for as little as a dollar a pint and resell it at big profits, disregarding the AIDS risk and other health hazards, officials say.

This uncontrolled traffic in blood has flourished for years, taking advantage of a neglected and weak regulatory system and contributing to the spread of many diseases. Growing public concern over AIDS has intensified concern about the problem.

Brazil, a nation of 140 million people, had registered 2,458 AIDS cases by official count in January. That ranked Brazil fourth in the world, after the United States, France and Uganda. And the Health Ministry estimated than an additional 1,500 cases were not included in the January tally because of incomplete reporting.

As in other countries, most cases of AIDS in Brazil (70.8%) are attributed to contact among homosexual or bisexual men. But contagion through blood transfusions is uncommonly high here.

Nationwide, 9% of all registered AIDS cases are attributed to transfusions received by accident victims, surgery patients, hemophiliacs and others. In the United States, transfusions are blamed for only 3% of all cases.

Highest Percentage in Rio

Of nearly 500 registered AIDS cases in the state of Rio de Janeiro, 17.8% are attributed to contaminated transfusions, the highest percentage in Brazil.

Hemophiliacs, whose inherited malady often makes them dependent on transfusions of blood and blood coagulants, have been especially hard-hit here as they have elsewhere. Three-quarters of Brazil’s 6,000 hemophiliacs are believed to carry the AIDS virus. Most of them were infected before kits to test blood for AIDS became available, but they continue to fall sick and die from the disease.

Henrique de Souza, a hemophiliac and prominent cartoonist, recently died of AIDS at age 43. Mourners at his funeral seethed with protest over negligence in blood screening.

“His death is final proof that the lack of public health care is producing a massacre in this country,” Luis Ignacio Lula da Silva, a congressman, declared.

Francisco de Souza, Henrique’s younger brother and also a hemophiliac with AIDS, attended the funeral in a wheelchair. “I am next,” he said.

Prepared to Die

A third brother, Herbert, is a hemophiliac as well and carries the AIDS virus but has not been stricken by the disease so far. Nevertheless, he said that sessions of psychoanalysis have helped him prepare for the likelihood that he will someday die of AIDS.

Thin, gray-haired and balding at 52, Herbert de Souza is a sociologist and president of the Brazilian Interdisciplinary AIDS Assn., a public-service organization he helped found in late 1986.

He said in an interview that he does not blame the government for his and his brothers’ infection with the AIDS virus, but he criticized Sarney’s administration for not doing more to prevent AIDS after blood testing kits became available in 1985. Evidencing a lack of official concern, Sarney had never publicly mentioned AIDS until his recent radio statement, Souza said.

“The attitude of the government toward AIDS is one of absolute irresponsibility,” he said. “I think the government has criminal responsibility for all cases caused by transfusions since 1985.”

AIDS Figures Disputed

Souza disputed government figures on AIDS, contending that cases of the disease are grossly under-reported. He speculated that if all cases were reported, the official number might double and contaminated transfusions would be listed as the cause of almost half.

He also questioned the government’s resolve to solve the problem of contaminated blood. Resources earmarked for that purpose this year by the Rio de Janeiro State Health Department fall far short of needs, Souza said.

“You can’t have half-measures,” he said. “You can’t put out half of a fire.”

Dr. Antonio de Carvalho, the state’s deputy secretary of health, said the government issued a regulation last May requiring all private blood banks to test for AIDS and submit complete reports to the state. The regulation has been widely ignored.

“Only 15% of the blood banks here in our state have sent in reports,” Carvalho said.

He said the health department has five inspectors to enforce regulations governing everything from the sanitary conditions of hot dog stands to testing blood for diseases. The inspectors have three vehicles. Until last March they had only one.

More Inspectors Due

The inspection force is to receive 10 more cars this month, and 15 more inspectors will be trained by March, Carvalho said. The training will emphasize the testing of blood for AIDS and other diseases.

Among their numerous duties, the inspectors will be trying to keep tabs on more than 160 privately owned blood banks that account for about 80% of the state’s medical blood supplies. The main business of private blood banks is selling blood to commercial laboratories that process it and supply it to clinics and hospitals in the form of plasma, coagulants and other blood components.

Is there official inspection at the laboratories? “There should be but there is not,” Carvalho said, adding that he can vouch only for the purity of blood handled by state-operated blood banks, which account for 20% of the total supply.

“There has been very great negligence on the part of the state,” he said.

Asked if the problem is rooted in underdevelopment or a lack of funds, Carvalho replied: “It is a problem of a late awakening by authorities to their responsibilities for control. It is not a problem of underdevelopment. It is a political problem.”

Carvalho said transfusions in Rio de Janeiro and the rest of Brazil have long been a major cause of the spread of such diseases as hepatitis, syphilis, malaria and Chagas’ disease, the latter a chronic parasitic infection. An estimated 25,000 cases of Chagas’ disease were caused by contaminated transfusions, he said.

The strategy of the present state government, which took office in March, is to reinforce state blood banks so that by the end of this year they can fully meet the Rio metropolitan area’s demand for 2,000 pints of blood a day. At the same time, Carvalho said, the state hopes that forcing private blood banks to conduct expensive testing will take the profit out of their business.

He said that even the unregistered, clandestine blood-collecting operations should then disappear. Officials estimate that 30 to 50 of these so-called “vampire dens” operate in metropolitan Rio. The fly-by-night businesses spring up on busy streets in poor neighborhoods, then disappear.

Few Sanitary Precautions

Carvalho said they extract blood with few sanitary precautions, paying donors with a free meal or as little as 100 cruzados--less than a dollar.

Brazilian newspapers have recently published unconfirmed reports in the past month that many clandestine blood banks are controlled by powerful chieftains of Rio’s jogo do bicho , a lottery that is technically illegal but officially tolerated.

Brazil’s new law requiring tests on all blood used for transfusions would be difficult to enforce at clandestine collection points, but licensed blood bank operators will risk license suspension, fines and jail terms if they fail to comply.

The testing law, which was approved by the Senate in October, 1985, was under consideration for more than two years in lower house committees before it was finally approved in January. Now the National Health Ministry must draft new regulations and standards for carrying out its provisions.

State health departments, many of them strapped for resources, will be responsible for enforcement. The Rio state health department has a budget of a little more than $1 million for its blood program this year.

Alvaro Atida, chief of epidemiology at the Rio de Janeiro state health department, expressed cautious skepticism about how much the new law will accomplish.

“The quality of blood is not changed by decree,” he said.