Bravo, Brazil, for Refusing US Money, Says Lancet

    Brazil pays for most of its AIDS program itself. The nation’s taxpayers, for instance, ensure that 170,000 Brazilians receive highly active antiretroviral therapy (or ‘HAART’) for free. The country also receives some outside aid to combat the disease.

    But recently, as an editorial in the renowned medical journal “The Lancet” notes, the Brazilian government surprised many by rejecting what is left of a US$ 48 million grant from the US Agency for International Development (USAID).


    The government made this bold decision because the USAID grant contained a clause stipulating that Brazil’s HIV/AIDS program could not mention prostitutes’ rights when it called for research proposals.


    The move is important, the editorial argues, because it sends out the message that grants discriminating against people because of race, religion, sexuality or profession are unhelpful.


    In any case, the USAID clause ignores an important point: that Brazil’s program is succeeding partly because it works closely with prostitutes’ associations.


    The Editorial:


    Brazil leads from the front on AIDS


    Turning down a grant of US$40 million, donated to help battle HIV/AIDS, might be considered unwise, deplorable even. But Brazil’s recent decision to reject what is left of a $48 million grant from the US Agency for International Development (USAID) is both bold and insightful.


    The USAID grant contained a clause stipulating that the Brazilian AIDS programme, a government initiative, could not mention rights of prostitutes in the grant call.


    However, one of the reasons the Brazilian AIDS programme has been so successful is that it works closely with prostitutes’ associations to help reach some of those most at risk of developing AIDS.


    Pedro Chequer, the head of the AIDS programme, quite rightly put the principle of “health for all” ahead of financial incentives to change policy.


    It certainly helps that the Brazilian government pays for the vast majority of the AIDS programme itself. More than 170,000 Brazilians receive HAART, which is available to any citizen for free; this initiative costs the Brazilian taxpayer around $300 million per year.


    375 hospitals are involved in the AIDS programme as well as 381 ambulatory care centers. The $48 million USAID grant, which was to run over 5 years, is tiny by comparison. Unfortunately, however, not all countries that are ravaged by AIDS have governments that are willing or able to invest sums like these.


    In countries in sub-Sarahan Africa, foreign aid programmes constitute a significant proportion of the funds available and it is difficult for them to turn down much-needed cash on the basis of principle.


    It is for exactly this reason that the Brazilian decision is so important: it sends out the message that grants discriminating against people because of their race, religion, sexuality, or even profession, are unhelpful and unwanted.


    In this regard, $1 billion of the President’s $15 billion Emergency Plan for AIDS Relief has been earmarked for HIV prevention through abstinence-until-marriage education. This emphasis, largely due to lobbying from the Christian right, is misguided and dangerous.


    When Brazil first started tackling the AIDS epidemic in 1986, the Church clashed with the Brazilian Ministry of Health and the AIDS programme over how to proceed. Now the Brazilian Church is a major partner in the fight against AIDS and appreciates that abstinence and fidelity, though laudable goals, are not realistic for everyone.
     
    SciDev and Lancet

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