Brazil, 4th in AIDS Cases, Slow to Require Tests by Blood Banks

Peering into a malfunctioning blood bank refrigerator, state health inspector Aramir Padilha was appalled to find months-old blood contaminated with syphilis and possibly with AIDS.

Under orders to shut down blood banks that fail to test blood or adhere to minimum standards of hygiene, Padilha kicked employees out and sealed the door shut.

Hours later, an anonymous telephone caller warned Padilha he would be dead by month’s end if he continued to harass owners of Rio’s 164 legal and 40-odd clandestine blood banks.

“These people, who are completely without scruples, are more than willing to inject AIDS, syphilis and God knows what other diseases in other people’s veins, so I do not doubt for a minute that they would kill me,” the 30-year-old doctor said in an interview.

“Of course it is terrifying to work under such threats, because these people will stop at nothing to protect their interests. But the police have promised protection and we won’t let them intimidate us.”

Brazil ranks fourth worldwide in the number of AIDS cases, reporting 2,458 people who have contracted the disease, 220 of them from contaminated blood. Most health officials believe the actual number of victims is three or four times higher.

In the United States, only 2% of AIDS victims were infected by transfusions of blood or blood byproducts, but in Brazil that figure is closer to 10%. Seventy percent of the country’s 5,000 hemophiliacs test positive for the virus.

Even Brazil’s health minister, Luiz Carlos Borges da Silveira, revealed recently that only one-third of the country’s blood supplies currently are being tested for AIDS.

That means anyone who suffers a serious car accident in Brazil--and auto accidents are the country’s third-leading cause of death for 15- to 49-year-olds--has a two-in-three chance of receiving an untested transfusion.

Until recently the government did little to control AIDS, apart from warning Brazilians to refrain from sex with foreign homosexuals at Rio’s carnival. Even a program to distribute free condoms to poor people was abandoned when Borges da Silveira concluded--incorrectly--that it was mostly the middle and upper classes that suffered from AIDS.

But the death in January of Henfil Souza, one of Brazil’s most popular cartoonists, a hemophiliac who contracted AIDS from a blood transfusion, made it impossible for the government to ignore the disease any longer.

Souza’s two prominent brothers, musician Mario and sociologist Herbert, also hemophiliacs, were contaminated through bad blood supplies as well. Mario is hospitalized with AIDS but Herbert, although testing positive for the virus, has not yet shown any symptoms.

“My brother’s death dramatized this issue,” Herbert said in an interview. “People got so angry about the government’s silence that the whole thing exploded.”

Pressured by public opinion, President Jose Sarney signed a law hastily approved by Congress that makes AIDS testing mandatory for blood donations and imposes one-year prison terms on blood bank owners who fail to comply.

Federal Police Chief Romeu Tuma said the government may try to charge violators with attempted homicide, which carries a 20-year prison sentence.

“By waiting so long to make testing of donated blood mandatory, the government has committed a terrible crime,” said Dr. Carlos Bonecker, medical director of the Rio de Janeiro House of Hemophiliacs, a charity foundation. “These measures are being taken now only because the news media began to exert pressure.”

As in the United States, private activism forced the government to take a larger role. Musicians held fund-raising concerts. Rio’s state governor donated his box seats for February’s carnival parade. Politicians sponsored blood donation “pyramids,” where each person was asked to bring with him two more donors.

But the Brazilian government took years to wake up to the AIDS threat. Hemophilia associations began importing test kits to screen blood for their members in April, 1985, shortly after such tests were developed in the United States.

The health ministry waited another two years before ordering screening of all hospital transfusions, but the regulation carried no teeth and was widely ignored. Many clinics claimed they couldn’t afford the $3 for each imported test.

Now that the government has abolished a 100% import duty on the tests, compliance should improve. But many Brazilians, jaded by the frequency with which government regulations are blithely disregarded and the guilty go unpunished, say they will continue to distrust blood supplies.

“There is a huge, perverse system set up here,” Souza said. “Blood is an extremely valuable product, and unfortunately in Brazil it has spawned an industry that is difficult to regulate.”

Padilha, in charge of making surprise spot checks on Rio’s blood banks, refused to comment on frequent newspaper reports that the city’s illegal numbers racketeers run many blood banks and may have been behind death threats made against him and other health activists.

“That is for the police to investigate,” he said. “My job is to enforce the law with whatever resources I can get.”

Inspectors Increased

Until mid-January, Padilha had only four inspectors and one car. Now he has 11 inspectors and four cars, but said he needs 40 inspectors in order to keep blood bank owners on their toes.

And that does not include tracking down the dozens of illegal banks that offer beggars and drug addicts little more than a sandwich in exchange for a pint of blood.

The real solution, Padilha said, is to set up government-run blood centers in charge of collecting, testing and distributing safe supplies to hospitals.

The federal government said it plans to set up centers all around the country and ensure the testing of all blood by the end of this year. Most private blood banks, which currently provide 70% of the country’s blood supplies, will be closed.

It will take some time, however, to convince Brazilians that their country’s disorganized health system is really taking care of them.

A teen-age girl who bought a denim-covered 1988 date book the other day in a Rio bookstore immediately filled in her name and phone number on the owner’s information page, but when she came to the part asking for her blood type in case of emergencies, she hesitated.

“There is no way I’m going to fill in my blood type,” she said. “I’d rather die than catch AIDS.”