A Case for Guarded Optimism: HIV/AIDS in Latin America
Smallman, Shawn
NACLA REPORT ON THE AMERICAS ................................ O A Case for Guarded Optimism: HIV/AIDS in Latin America...
...ThesepipeswerethemselvesanHIV-transmissionrisk, becausetheylefttheusers’mouthsburnedand cut...
...In 2005 I interviewed drug addicts in a São Paulo favela and found that most used crack cocaine...
...Sadly,themigrantsarestigmatized,bothintheUnitedStates and in Mexico, which, combined with their mobility, makes it hard to conduct outreach campaigns with this population...
...On the other, the government began masstesting the entire population, which undermined individual human rights...
...She quickly fell into sex work to survive, joining a world shared by other transgender youth...
...The challenge is similar in Argentina, where drug use blossomed after the end of the military dictatorship...
...IN 2004 I INTERVIEWED EVA, A TRANSGENDER former prostitute in Oaxaca, Mexico...
...While the trend may be positive, the pandemic is the sum of diverse sub-epidemics, so it is hard to speak of a single experience of the disease...
...In Spanish-speaking South America, each country’s position in the drug trade has shaped the epidemic...
...3 To study the AIDS pandemic, I traveled widely in Latin America...
...But after years in which despair and denial sapped hope, it now seems that humanity could reshape HIV’s future...
...Various doctors and other health “experts”intheregionopinedthatbecausetheUnitedStates had much more drug use and homosexuality, the epidemic could not arrive in Latin America...
...It would be hard to discuss safe sex on the first night...
...Other countries considered such a policy, but Brazil stood out because of the size of its national pharmaceutical industry, which gave it the technical capacity to produce the drugs...
...When her mother became ill, Eva brought her into her own home and took care of her...
...The return to democracy in 1985 created a space for civil organizations to flourish, but it was not until the discovery of highly active antiretroviral therapy (HART) in 1996 that Brazil decided to make medications available to all HIV-positive citizens...
...The nation’s early history with HIV/AIDS was marred by the same discrimination and lack of will that characterized many other nations’ responses...
...This recognition came too late to stop doctors and authors in the United States fromspeculatingthatHaitihadintroducedthediseasetotheAmericas...
...The government has produced drugs for effective therapy since 2001, largely inspired by the Brazilian example, and HIV mortality rates in Cuba have plummeted...
...Away from the small communities of their birth, some men experiment withdrugsandsex,andafractionbecomeinfectedwithHIV...
...Sexual transmission accounts for perhaps 90% of HIV casesinMexico,mostlyamongmenwhohavesexwithmen...
...International pharmaceutical companies responded by asking the U.S...
...The most recent study of HIV’s molecular biology suggests and Atlantic Coast, striking nations as diverse as Haiti, Honduras, andGuyana,whilepassingoverothers?Furthermore, how is it that Latin America has largely avoided the disaster of Southern Africa, despite its own struggles with poverty and inequality...
...They are stressed and find a nation with different sexual customs...
...HIV-positive Cubanswereconfinedforlifetosanatoriums,wheretheyreceived a salary, many services, good food, and the necessary medicines...
...Why has HIV circled around the Caribbean Sea the latin american pandemic is the sum of diverse subepidemics, so it is hard to speak of a single experience of the disease...
...And she was HIV-negative...
...The NGO leaders I met who worked in these communities— some of them crack users themselves—had shifted their efforts from drug use prevention to harm reduction...
...She was an attractive 28-year-old with long brunette hair, stylish black glasses, and simple but chic clothes...
...While in some cases they wanted to join their HIV-positive spouses in the sanatoriums, the majority were young men known as roqueros, members of a subculture that adored U.S...
...Majormedicaljournalspublished letters and articles speculating that voodoo rites might have infected people and wondered if Haiti’s water supply was so contaminated that it permitted the virus’s spread.5 Unsurprisingly, this fed hysteria in the United States, further fueled by the equation of HIV with poverty and blackness...
...AIDS first appeared in Haiti and the United States at virtually the same moment in the 1970s, although this would not be recognized until years after the disease was described as a distinct ing a “mosaic of infection...
...True, a vaccine remains elusive, and political disasters from South Africa to Russia allow HIV to flourish...
...Like the appearance of the virus in Haiti, any discussion of Cuba’s HIV/AIDS policy is inevitably politicized...
...The history of HIV in the seven countries of Central America seems to have been shaped by the warfare in the region during the 1980s...
...Haitian immigrants in the United States suffered terrible discrimination, while Haiti’s tourism industry collapsed...
...But the situation is changing, and more women are now HIV-positive.Intheearlyyears,HIVwasconcentratedinthe nation’s capital and in the border areas in the north...
...Thispolicycontainedthevirus—Cubamayhavethelowest prevalence of HIV in the hemisphere—but it also led to the self-injection movement...
...The drug’s hold on peoples’ lives seemed too strong to make going sober the only goal...
...Ifthemeasureofsuccessispreventingthesocialdisaster that swept over its Caribbean neighbors, as the Cubans suggest,thenthenation’spolicymightappearsuccessful.On the other hand, given Cuba’s high literacy rate, ubiquitous healthcaresystem,andpublicinformationresources,thevi NACLA REPORT ON THE AMERICAS report: hiv/aids rus might have been contained without violating individual rights...
...military personnel or by Contra fighters...
...In Oaxaca, Mexico, I spoke with gay leaders, political activists, doctors, and government employees, and in São Paulo, Brazil, I interviewed crack addicts, intravenous drug users, drug traffickers, NGO members, doctors, and government officials...
...For this reason, the International AIDS Conference, meeting for the first time in Latin America in Mexico City in August, should be the most optimistic gathering since 1996, when researchers announced the development of triple therapy, a combination of drugs that represented the first effective treatment for the disease...
...Some nations, like Belize and Costa Rica, escaped the fighting, while El Salvador, Guatemala, and Nicaragua witnessed sustained violence...
...He is Vice-Provost for Instruction and Dean of Undergraduate Studies at Portland State University in Oregon...
...For example, HIV-positive people in Argentina are 170 times more likely to be drug users than their counterparts in Bolivia.9 In Colombia, ongoing violence makes it hard to trace the virus’s GuILLermo JoNes / LaTINPHoTo.orG JULY/AUGUST 2008 a giant pink condom covers the Buenos aires obelisk, in an aIDs-awareness effort co-sponsored by the city government and a radio station in 2005...
...The United States was not the only nation where fear led to a problematic response to the virus...
...They follow well-established pathways to the United States, where they often do not have any family, but do have more income than at any point in their lives...
...No place better illustrates the fractured nature of the epidemic than Latin America, which Marcos Cueto and others have described as hav had stronger immune systems because they were frequently exposed to germs, while the Andes supposedly formed a geographic barrier that would shield Chile from this northern plague...
...There is no question that fighting and fear hamper AIDS outreach efforts and leaves internal refugees vulnerable to sexual exploitation...
...Mysteriously, one country in Latin America may have a high rate of infection, while its neighbor—with the same language, culture, religion, and history—does not...
...Brazil has had much more impact on global HIV/AIDS policy than its Caribbean counterpart...
...Many may have believed that a vaccine would be soon found, while others wanted the food, television, and leisure to be found in the sanatoriums...
...South Africa has had the resources to make these medications available, but the government has lacked the will to do so...
...There are now such large investments being made to treat AIDS in developing countries that some have begun to question whether part of the money would not be better spent on other priorities, like EVAN ABRAMSON FOR THE CHILDREN AFFECTED BY AIDS FOUNDATION JULY/AUGUST 2008 report: hiv/aids basic health care and clean water.2 Combined with the political victory that Brazil and other developing nations won by asserting their right to produce generic drugs against HIV, both developing nations and international grantors now view treatment in poor countries as feasible...
...O A Case for Guarded Optimism: HIV/AIDS in Latin America...
...In November 2007, the United Nations reduced the estimated global number of people infected with the virus from 39.5 million to 33.2 million.1 Well-doneepidemiologicalstudieshavealsoshown that infection rates are lower than had been feared inbothChinaandIndia,andinsomenationswhere the epidemic has seemed the most desperate, such as Haiti, the prevalence may be decreasing...
...government to invoke clauses in the World Trade Organization’s agreement, which would prevent nations like Brazil and India from producing generics...
...Whichever candidate wins the White House in November, it seems possible that President Bush’s original $15 billion commitment to the President’s Emergency Plan for an AIDS Response (PEPFAR) could be increased to $50 billion for the next five years...
...Now it is spreading to small towns in rural areas, where young men, many of whom are indigenous, are migrating to the United States in large numbers...
...She told me that her father had kicked her out of the family home after realizing that his son perceived himself as a woman, and his mother had accepted this...
...Today, Cuba’s experience of HIV seems much more likethatofothernations,withthestateemphasizingprevention and treatment rather than quarantine...
...In the late 1980s and early 1990s, as Julie Margot Feinsilver’s work suggests, Cuba’s leaders viewed themselves as being in a health competition with the United States...
...In principle, the Mexican government provides medication—but not the necessary tests—for free, but not all HIV-positive people receive treatment...
...The fact that the first reported cases of hiv occurred in the United States meant that in the early 1980s, people in Latin America associated the disease with what they thought of as the moral failings of their northern neighbor...
...In the end, Brazil and its allies (both other developing countries and international NGOS) won...
...By then, several yearshadpassed.Evahadleftthesextradeandremade her life, eventually getting a job and finding a home...
...Cuba responded quickly to the virus’s appearance, with such steps as the mandatory testing of the blood supply and the destruction of all imported blood...
...Mexicans, some argued, that perhaps Haiti did first receive the virus, as the island’s close ties to Africa in the 1960s and 1970s might suggest.6 But because of this sad history, the question remains painful and political...
...government and some pharmaceutical corporations, on the one hand, and developing nations and international nongovernmental organizations (NGOs) on the other...
...This success changed the terms of the debate about fighting HIV globally, by proving that it is possible to provide universal treatment in developing countries...
...On the streets, Eva had begun to drink heavily and experiment with drugs...
...On the one hand, these measures prevented the disaster that swept over hemophiliacs in the United States...
...In the years that followed, many of her friends left for Mexico City, where life was hard, and some were HIV-positive when they returned...
...For most, it was also an act of futile rebellion.8 After Cuba’s economic crisis of 1992, the rising power of the international gay movement, together with the media coverage of the roqueros, forced the Cuban government to stop confining HIV-positive people to the sanatoriums...
...In the United States and Europe, it is common to think of Andean countries as cocaine producers that export their product to the developed world...
...She continued to go out with her friends, but none of them drank...
...Brazil declared that the right to life for HIV-positive peo ple outweighed the patent rights of drug companies and threatened to produce generic drugs if the pharmaceutical companies didn’t lower their prices...
...How does development shape a nation’s experience of HIV...
...the disease represented an opportunity to prove the superiority of their society.7 Within a decade, almost the entire population of the island had been tested for the virus...
...One can imagine the situation of a young housewife in the Mixtec Alta of Mexico’s Oaxaca state, whose husband returns for a saint’s day celebration after a six-month absence...
...At the start of 2003, 11 sex workers, 208 housewives, and 263 migrants, “of whom only seven were women,” had tested positive for the virus in Oaxaca.10 Despite Mexico’s success containing the virus, the concern remains that the country still may see rates of HIV similar to those in some of its southern neighbors, given the many similarities between these regions...
...Until then, it had appeared that there would be two epidemics: one in Northern nations, where patients might pay $15,000 a year for treatment, and a second epidemic in the Global South, where only a small minority could afford the medicines...
...By the time I visited Cuba in 2004, most people who recently tested positive would enter the sanatoriums for only a few weeks to receive a health evaluation and education...
...In Central America, Mexico, andsomeotherLatinAmericannations,HIV-positivepeople or the government might pay $2,000 for a year’s treatment, wellabovepricesinBrazilorsomecountriesinAfrica,where it might cost $160...
...Between 1989 and 1992, more than200Cubanyouthsdeliberatelyinjectedthemselveswith HIV-infected blood...
...This experience shaped subsequent discussions of HIV’s history, as epidemiologists tried to determine whether HIV flowed from the United States to Haiti or vice versa...
...In cocaine-producing nations like Colombia, Bolivia, Peru, and Ecuador, there are not generally large numbers of drug users, the prevalence of HIV is lower, and the epidemic is less diverse, since it tends to be more concentrated in young gay men...
...The self-injection movement faded...
...To answer these questions, we must examine the epidemic’s complexity by describing its course in different subregions...
...Her story reflects the relativesuccessofpublichealthinLatinAmerica,a success that ought to give us cause for hope when we consider the future of the AIDS pandemic in the region...
...One question frequently raised is whether the sad and wasteful Contra war of the 1980s may explain the relatively high rate of HIV in Honduras early in the epidemic, perhaps because the virus was introduced by U.S...
...In Brazil, journalists wrote that the first case of AIDS proved that their country was “sophisticated” enough to have the disease, which oddly recast northern immorality as linked with modernity.4 But this association of HIV/AIDS with northern development and moral decadence changed as the Centers for Disease Control and Prevention announced the discovery of heterosexual cases of HIV among Haitian men...
...In these nations, HIV and the drug trade will have to be addressed holistically...
...An immense political struggle ensued between the U.S...
...But they were separated from their loved ones...
...Unfortunately, not all nations in Africa and Latin America are following this policy...
...Paradoxically, the fighting seems to have slowed the spread of HIV in some nations, which has been witnessed in other nations as well, including Angola and Mozambique.11 Panama and Belize, two countries that escaped the fighting, have the highest rates of HIV in Central America...
...What trends might predict the epidemic’s future or suggest how to fight this enemy...
...They often have a low level of schooling, and Spanish may be their second language...
...Shawn Smallman is the author of The AIDS Pandemic in Latin America (University of North Carolina Press, 2007...
...Overall, I was struck by the extent to which a disease spread by the most personal of behaviors is shaped by public policy...
...she also had the benefit of living in a culture in which intravenous drug use is rare...
...Eva likely avoided becoming infected, in part, because of the regular health exams for sex workers mandated by the municipal authorities...
...But there is now a significant market for cocaine and other drugs in Argentina and Brazil, which has shaped the region’s HIV epidemic...
...But the geography of the epidemic does not seem to match this hypothesis...
...Small groups of addicts hid in the long grass and smoked it in pipes made from brokencarantennas...
...report: hiv/aids Mexico, which has a lower HIV prevalence rate than the United States, has enjoyed notable successes in its efforts to addresstheepidemic.Thereareanumberofreasonsforthis, including the fact that intravenous drug use is uncommon, and the sex trade is regulated in most states and municipalities...
...spread in the countryside...
...The policy may ultimately have saved money, because fewer people enter hospitals for expensive end-of-life care and more people now know their HIV status...
...If the United States were to use its influence to further reduce the cost of these medications, and to support the infrastructure to deliver them, it could reshape the future of the roughly 2 million people living with HIV in Latin America and the Caribbean...
...Countries that neither produce nor consume massive quantities of drugs—such as Chile and Venezuela—tend to have a lower prevalence of HIV compared to those with significant drug markets, which tend to have epidemics that affect more communities and have a higher HIV prevalence...
...syndrome in 1981...
...I toured the sanatoriums of Cuba and talked with people living with the virus from Havana to Cienfuegos...
...rock music and rejected the Cuban state...
...How has democratization affected the epidemic in Latin America...
Vol. 41 • July 2008 • No. 4
