There is life with HIV

Care for HIV, COVID-19 and Pocket Asnism: Continuity Threatened

Negationist Bolsonarism, COVID-19 and social discrimination are terribly efficient and frighteningly deadly weapons!

Care against HIV and COVID-19 has been related in a way to an increasing escalation in the difficulty of obtaining access to medication, as well as in the exposure beyond constant and absurd, every holy and damned time that we have to get the medication

A double blow from the pandemic and the unfriendly government to everything that is human threatens to undermine the response to HIV in Brazil. Joe Parkin Daniels reports.

Bolsonaro and Bolsonarists are not ashamed of their evident and well-known fascist and genocidal tendencies

Brazil's response to HIV / AIDS has long received applause. When infections increased in the 1990s, the largest country in South America offered free and universal administration of antiretroviral therapy (ART) and asked pharmaceutical companies to lower drug prices. 

In another movement that proved to be an example of modeling behavior in the face of the crisis, Brazil was among the first 40 countries to offer self-testing. 

The vast country, with a population of 209 million people, was seen as the flagship for developing countries in their fight against HIV / AIDS.

Care against HIV and COVID-19 Bad reputation of BolsoAsnismo

And yet, that reputation is now threatened by two forces often intertwined: 

  • the COVID-19 pandemic, which continues to devastate the country and the entire region;
  • and Jair Bolsonaro, the right-wing populist president who does not hide his skepticism about science and his dislike for vulnerable population groups, including the LGBT + community.

"It is necessary to emphasize that the Brazilian response to HIV / AIDS was one of the greatest achievements in the context of the Unified Health System," said Beto de Jesus, manager of the national program for Brazil of the AIDS Healthcare Foundation. 

“We were already experiencing an accumulated crisis before the COVID-19 pandemic; with the conduct of the current government with cuts and freezes in the area of ​​health, education and social assistance, the situation only gets worse. The pandemic has revealed a dramatic situation! "

Social Differences Always Made Things Hard, but HIV and COVID-19 Care Together, Made it Worse

You add to this the “BolsoAsnismo…

Few countries or regions were prepared to deal with the arrival of COVID-19, although in Brazil - which like most of Latin America has great inequality - the social, economic and public health ramifications have been particularly pronounced. 

In 2018 (last year for which data are available), income inequality in the largest economy in the region reached its highest rate since 2012, when the series of national statistics began. 

This disparity was revealed when Cleonice Gonçalves, a domestic worker in an upscale neighborhood in Rio de Janeiro. He died of COVID-19 in March, probably contracted by his employer, who had recently been abroad. 

Certainly, I think, because of the impossibility of staying at home, without a salary, without support and without income.

In mid-September, Brazil had more than 4 million confirmed cases of COVID-19, with more than 125 thousand deaths. Only the USA and India had more cases.

Poor And Vulnerable In The Relationship Between HIV Care And COVID-19

While COVID-19 devastated poor and vulnerable communities - especially in the country's urban centers - many health experts saw similarities to the ongoing HIV / AIDS epidemic, which also exposed social failures.

About 920.000 people are living with HIV in Brazil, according UNAIDS data, and key populations have higher rates: 30% prevalence among transgender people, 18,3% among gays and other men who have sex with men and 5,3% among sex workers.

"Forty years of responding to the HIV epidemic has taught us that the community and human rights must be at the center of any pandemic or public health response," said Claudia Velasquez (national director of UNAIDS in Brazil). Lancet HIV

Historical HIV-Related Vulnerability

"This historical vulnerability to HIV in Brazil, which already occurred before the COVID-19 pandemic, is also strongly linked to other social determinants of health, such as structural racism, violence against the LGBTI + population and social and economic exclusion."

Prejudice against vulnerable populations, in particular LGBTI + people, has hardly been reduced during Bolsonaro's term as president. 

The populist leader campaigned on a platform of social conservatism, often using blatantly homophobic rhetoric, and has not matured in office.

In July of this year, the respected newspaper Folha da São Paulo reported that Bolsonaro had mocked by presidential officials who wore protective masks like "fairies"; previously, in December 2019, he assaulted a journalist, saying “you have a terribly homosexual face”.

The struggles of members of the LGBTI + community living with HIV were narrated in detail in the last UNAIDS report, Rights in a Pandemic, who quoted a young Brazilian woman describing her experience at her parents' home. 

"Being a lesbian made them so disappointed in me that no matter what I do, it is never enough," said the woman. 

"I feel like I'm watching my life go through someone else's eyes - because I'm not who they want me to be, but I also can't be myself when I'm at home."

Velasquez told the Lancet HIV that the woman’s story is indicative of a broader problem. 

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We are no different, and if you believe we are, you need psychological guidance. Or, perhaps, psychiatric help!

Lesbians and Bisexual Women: Vulnerable and Ignored

 

“Women and lesbians are not part of the key populations for the dynamics of the HIV epidemic in Brazil, but this statement also reflects the levels of vulnerability faced by LGBT + populations, including gays and men who have sex with men and transgender people, who they are part of the key populations in the dynamics and response to HIV. "

Bolsonaro, who sought to minimize the seriousness of COVID-19, also showed little interest in fighting the HIV outbreak. The ongoing turmoil in the health ministry - Brazil went through two health ministers in a month at the start of the outbreak in the country - means that transactional policy often supplants well-thought-out policy.

This follows more subtle attempts to undermine the country's response to HIV / AIDS, such as the decision made in May 2019 to transform the ministry's HIV / AIDS department into a broader and more comprehensive body: 

the Department of Chronic Conditions and Sexually Transmitted Infections. 

When this happened, the team was transferred between departments, leading to further disorganization. Over the past year, non-governmental organizations (NGOs) working in the field have reported that the health ministry has censored or stopped the distribution of HIV prevention and treatment materials published by previous administrators. 

ANAIDS, a collective of leading NGOs working with HIV / AIDS in Brazil, estimates that the country has seen a 30% reduction in services that provide access to pre-exposure prophylaxis. 

HIV testing and CD4 monitoring have also been affected and the supply chains for medicines and supplies continue to be disrupted.

With the COVID-19 pandemic, the dysfunction only increased. In the summer months of May and June, while the COVID-19 cases skyrocketed, Bolsonaro treated the pandemic as a problem that could be solved with harsh rhetoric and a task force of military chiefs. 

The results were artificially low case counts and collapsed health infrastructure in some remote parts of the country, such as the Amazon city of Manaus. 

These measures were aggravated by practical difficulties for health professionals and patients during a pandemic.

"In terms of programmatic continuity, most government AIDS programs (at the federal, state and local levels) are working from home, which has slowed down and complicated everything in terms of the programs' function," said Richard Parker, director of the Association Brazilian Interdisciplinary AIDS (or ABIA), a local NGO working in Brazil since 1987.

“Health services have been overwhelmed with cases of COVID-19, pulling teams from all other areas to help with the care and treatment of COVID -19. "

Copyright © 2020 Barong

The lack of leadership in Brasília, the capital, demanded that civil society take the day off, although this effort is also hampered by the hesitation of the central government. The Ministry of Health announced last year that there would be new helplines and calls for proposals to support NGOs in early 2020, "but once COVID-19 arrived, everything appears to have been canceled," said Parker. "The financing calls that were supposed to happen in the first half of 2020 have not yet been issued, and we are now in the second half of the year."

However, the importance of these NGOs during the pandemic is difficult to underestimate, according to Claudia Velasquez. “In Brazil, we have witnessed an important engagement of civil society involved in the response to HIV, from the engagement and mobilization for online research, to the participation and implementation of virtual training and emergency solidarity projects for the distribution of basic food and hygiene. , as well as community-based distribution of antiretroviral drugs to those who were part of the groups vulnerable to COVID-19. "

Some people living with HIV have organized protests, asking the government to relax its rules on the distribution of ART. Usually, only 1 month of drugs is distributed at a time; because of the pandemic, people are asking for supplies that last 3 months. In some parts of the country, local governments have agreed to provide medicines for up to 2 months. Other patients depend on NGOs.

One of them is Márcia (pseudonym), from a small town in the interior of Minas Gerais.

Usually travels to São Paulo to get antiretrovirals and to do medical exams and consultations, but due to blockages imposed by the prefectures of Minas Gerais and São Paulo, she was unable to do so.

Marcia now depends on a local NGO, Barong, to carry out her therapy. "Of course, the biggest concern is that my treatment could be interrupted by the pandemic, something that Barong helped," said Marcia. Lancet HIV. "In addition, all we can do, everyone in my situation, is to follow the recommendations of the Ministry of Health and the World Health Organization."

published: December 2020

Identificação

DOI: https://doi.org/10.1016/S2352-3018(20)30312-X

Copyright

© 2020 Elsevier Ltd. All rights reserved.

ScienceDirect

Access this article on ScienceDirect

  • Image Copyright © 2020 Barong

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Source of matter: The Lancet

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