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
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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.
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."