Brazilian Women Gaining Equality--in Rate of AIDS

Adriana Dorta easily recognizes the stunned, terrified faces of women walking through the doors of the AIDS foundation where she counsels new patients. In this quiet city in the heart of southern Brazil’s fertile, coffee-growing region, the number of women infected with the virus that causes AIDS increased tenfold during the 1990s. Many of them, like Dorta, 29, were the loyal wives of unfaithful husbands.

They lived in a world of denial. Dorta let her hair fall out, dropped to less than 70 pounds and became paralyzed on her left side before agreeing to be tested for a disease she believed afflicted only homosexuals, prostitutes and intravenous drug users.

“Housewives have become accustomed to denial in this macho country where we pretend that our husbands’ love affairs--and, in my case, the beatings my spouse gave me--aren’t really happening,” Dorta said.

After receiving treatment, she has recovered her lustrous black hair and regained some of her lost mobility. But she knows the infection remains. Her husband of 13 years died of AIDS-related complications in 1999.

“I laughed when the doctor first told me I had AIDS,” she said. “I thought, what a ridiculous man this is! AIDS doesn’t happen to married women who are faithful to their husbands. But it is happening. My Lord, is it happening! It’s becoming an epidemic within an epidemic.”

Although Brazil, Latin America’s largest country, has one of the world’s most progressive anti-AIDS programs, women--housewives in particular--are becoming infected at an alarming rate. A recent government survey showed the number of new AIDS cases reported among women shot up 75.3% from 1994 to 1998, compared with a 10.2% increase among men. The vast majority of women catching the virus are heterosexual and do not use intravenous drugs. Although some are prostitutes, experts say many are married or in long-term relationships.

The trend in Brazil mirrors the devastating toll AIDS is taking on women worldwide. In 2000, women made up 47% of the world’s 34.7 million adults living with the AIDS virus, compared to 41% in 1997, according to a United Nations report. U.N. specialists predict the number of women with AIDS will equal or surpass men by next year.

In Brazil and the rest of Latin America, the rate of infection among heterosexual women is growing faster than in any other group. Experts say the culture of machismo makes it difficult for powerless women to insist on condom use. Many men, particularly among the poor, consider it emasculating to accede to a woman’s request for safe sex. And a certain measure of acceptance of the straying husband puts wives at even greater risk.

The stigma of AIDS as a gay disease has led some infected men to seek treatment without telling their wives and families, or simply to refuse to be tested. Cultural pressures against homosexuality, especially outside big cities, have led many gay and bisexual men to marry women.

It’s a deadly problem for women in Brazil, a country lauded worldwide for its aggressive government program to develop generic versions of AIDS drugs and distribute at no cost the AIDS “cocktail” used to treat patients. Several state and municipal governments pass out free condoms and have launched AIDS-awareness classes in schools.

But health officials concede that it’s been a major challenge to change the cultural norms in a society well known for sensuality and male chauvinism. Until this year, newly married men had the right to divorce their wives if they discovered they were not virgins. For decades, Brazilian men who murdered their unfaithful wives routinely used a “defense of honor” argument to win reduced or deferred sentences. The Supreme Court abolished that practice in 1991.

“One of our biggest enemies in AIDS prevention is machismo,” said Paulo Roberto Teixeira, secretary of Brazil’s AIDS program. “We need to empower women, especially those living in poverty who have even less ability to negotiate sex with their partners. But we also need to educate wives of all classes, who often don’t see themselves with any risk factor. The solution will go hand in hand with feminism and women’s liberation. It is the only way.”

The government is trying to address cultural pressures by sponsoring AIDS-education classes taught in corporate offices and community centers by women living with AIDS. But changing Brazilian sexual habits is no easy business.

During one class offered to phone company managers in Porto Alegre, a city of 2 million, women listened closely while men tended to laugh off the warnings.

“We have so far to go,” said instructor Maria Beatriz Pacheco, who contracted AIDS from her ex-husband. “Even if a wife knows her husband is cheating, it is more likely he will accuse her of infidelity for just suggesting he use a condom. We are trying to change that, but it will take a long time.”

In the more conservative countryside, many patients are diagnosed only after their cases have advanced enough to warrant hospitalization. In Londrina, an agricultural city of 500,000 about 300 miles southwest of Sao Paulo, women now make up about 40% of the 1,200 known AIDS cases, compared to less than 10% in the early 1990s. But there are many more who fear being tested, and may die quickly as a result.

Women who are more open about their condition are ostracized. One is Silvana Gomes, 38, who contracted AIDS from her late husband of 12 years.

“People know me in town now, and when I get on a crowded bus, everyone moves away from me and I sit alone,” said Gomes, who heads a support group for women with AIDS. “Other women see that response, and their fear of getting tested grows even greater. I just hope it also makes them press their husbands to use condoms.”

Married women who do face up to the disease find themselves dealing with a jumble of emotions. Some grow to despise their husbands. Others opt to forgive them.

Sao Paulo nurse Catarina de Madeira, 49, discovered her unfaithful husband had infected her in 1997. She moved to Londrina, away from their friends and family, to care for him until he died last March.

“I feel a lot of emotions, but not anger and hate,” she said. “I loved my husband until the end. I don’t blame him; we are all human. But I suppose I made the choice to forgive largely because I don’t want to spend the rest of my life giving in to bitterness and rancor. Life is too short.”