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World Day to Combat AIDS - Have you done your part?

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Foto: Marcos Santos/ USP Imagens
Vera Paiva, a professor at the University of São Paulo and coordinator of NEPAIDS (Center for Studies on Prevention of AIDS).
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Vera Paiva, a professor at the University of São Paulo and coordinator of NEPAIDS (Center for Studies on Prevention of AIDS).

In prolonged fights, as the effort to control the AIDS epidemic that entered its 32nd year, honor the people we lost on the way to the critical reflection on what we're doing. They thought, like us, the future of the next generations.

A year ago, as now, the balance that always makes the World Day to Combat AIDS researchers and activists began to publicly express their concern deepened as understanding signs, worrying that gathered in living experiences in prevention, reading media, people in care in specialized care or not, management policies and programs. The interpretation of signs sparked the debate, especially among those working with young people (school, girls and gays) or monitoring actions within the Unified Health System (SUS). A good response to the epidemic has always depended on its principles, or as they say informally in AIDS SUS works.

In December 2011, the debate 30 years of the AIDS epidemic in Brazil: the 4th decade will be the last? , Pointed to the unnecessary and high level of new cases each year, and discussed how to interpret the growth rate of AIDS mortality. Two questions emerge: how to innovate with new prevention speeches about growing epidemic in some regions of the country and among historically targeted segments of stigmatization and disregard of rights, how to react to the growing international validation of the use of medication as prevention? ABIA and NEPAIDS, two of the oldest organizations in this fight, sought to innovate speech inaugurating a permanent exhibition on Facebook (go here), which spread images of social response to the epidemic, noting that one can not relax on an individual, programmatic and social - because the virus continues to circulate at levels unacceptable epidemic, studies that theme driven by these concerns finally revealed with force in 2012. We did our part!

Many who lived through the tragic early years of the epidemic remained, however, insomniacs. Control of the epidemic and the possibility of living well with AIDS, in times of universal access guaranteed by our national response messages were yesterday. Today, reinforced the relaxation of people with prevention, neglect of managers who left practice without which we would not have stopped the growth of the epidemic - as the support of powerful social control made by NGOs and the ongoing effort devoted to prevention (HIV infection and illness), effort based on scientific evidence and respect for autonomy and rights, especially among youth and every generation. Among opinion leaders and word of mouth that reaped popular in various work fronts, we watched a misinterpretation of speeches about the epidemic: the epidemic control was perceived as dominated and that's all we got to the end of the emergency, the need to eliminate death-civil so often denounced early in the epidemic and the message, correct, that it was very possible to live worthily and with AIDS, was re-signified as medicine has no need to worry or warn me and prevention is no longer a priority.

The debate among researchers increased soon after the International AIDS Conference, World, held in July this year in Washington, in the United States on the eve of the IX Brazilian Congress of Prevention: (a) press coverage Brazilian confused everyone with news that focused the promises of healing, when in fact what was being discussed in Washington was a horizon that would envision a generation without AIDS, since accumulated science (basic, clinical, epidemiological, social and prevention); But the center of the discussion was the path full of social and political barriers to get there! (B) It was disappointing to watch the loss of Brazilian leadership in this new context. (C) Worse, municipal elections brought new confusion between religion and political pressure for political and electoral alliances, threatened the secular state and the creative relationship that we have learned over the years of living with the religious people and the religious leaders. (D) The marketing overcame the enormous social research accumulated in response to the AIDS epidemic in the context of human rights that we were so proud and defended in international forums and publications. We were no longer honoring in our policy and programmatic action internationally validated the notion that stigma and discrimination of rights has been a major driver of the epidemic through homophobia, racism, sexism and machismo - and that exposes the hypocrisy explicit sexuality on television, but denies sexuality education in schools.

To broaden the discussions made in offices and academic spaces, to resume a frank and open discussion more independent, produced a manifesto supported by more than 300 researchers and activists and a permanent space for public debate, in a blog . We have done our part.

As we synthesize our concerns? In five priority issues presented for discussion at a meeting convened by Health Minister Alexandre Padilha, who acknowledged the difficulties in frank discussion of ideas that has always characterized our social response. Throughout the year, and before the debate proposed by the manifest, non-governmental organizations threatened to close denounced the lack of support for the sustainability of social control, the scrapping of specialized care location (state and municipal) and the precariousness of actions and local programs that without sufficient staff and political support, could not perform the required and planned. The enlarged meeting, proposed around the five points by the Department of STD, AIDS and Viral Hepatitis, advanced dialogue to which we contribute anticipating and detailing the issues at each point - believing that good forwards always asking questions relevant answers and solutions. In summary:

1.Nos past five years there has been a reversal in the trend of the AIDS epidemic in Brazil and, to a level of relative stability, there is a new growth in the prevalence of infection, with important regional diversity. The southern region has had AIDS incidence rates 1.6 times higher than the South East and the growth of the epidemic in the North occurs at a speed that may become, briefly, that the region with the highest incidence in the country is growing prevalence of infection in some segments which is accompanied by a reduction of safe sex practices in the Brazilian population. The epidemic controlled expression should be replaced by concentrated epidemic. In specific social segments: the prevalence ranges from 4% to 15% in sex workers, homosexuals and homeless. There are more than 350 annual cases of AIDS transmission, virtually eradicated situation in high-income countries and many middle-income and low.

2nd. The AIDS policy must be based on human rights. The secular state has been one of the most important protections of the Brazilian people, and the separation of politics and religion, a guarantee of effective prevention policies focused on evidence-based information and universal access to health, ensuring the rights of populations at higher vulnerable to HIV, such as MSM, gays, transvestites, transsexuals, sex workers, prison inmates and drug users. Campaigns widely disseminated to these populations include not only their rights, but indicate that recognizes their citizenship demonstrating to the nation and other segments that are subject worthy of special attention, rights holders as all Brazilians.

In confronting the AIDS epidemic among women, the Stork Network can not be celebrated as a synonym of good strategy: because they are not mothers, the vulnerability of girls, women in menopause, the sex workers, the homosexuals, among other segments is out of focus. Especially in the government of President Dilma, it was expected that marketing does not overcome the evidence of social research, women do not have to leave the body, or be subject to rights. Choose flagship, the stork is a sign outside the Brazilian culture and reinforces programmatically exclusively a woman's role as mother, while erasing the female body, your body erotic and reproductive already invisible in efforts and prevention messages that focus on condom, insist is not used by the woman. The woman depends on being valued as a subject in discussion with partners about condom. The clear choice for the woman's body, and leave to prioritize combating the epidemic of homophobia and gay more clearly, does not overcome the urgent need for sexuality to be addressed by public policies for prevention and care. There is no lack validated models in Brazil and many other countries and inspired by the teachings of decades of studies on sexual, reproductive and AIDS.

3rd. It is urgent discussion and formulation of consensus regarding the incorporation of new prevention technologies. The renewal of prevention has the potential to set a response within the SUS, coping with this epidemic concentrated and focused prevention efforts among people groups where the virus has greater circulation. The multiplicity of strategies and technologies offer every individual, concrete possibilities of greater protection, as the international literature has discussed.

4th. We need to understand the maintenance of high mortality rates, when the scientific evidence consolidate the assumption that death by AIDS should be, increasingly, a rare event, since antiretroviral treatment is initiated in a timely and appropriate drugs accompanied by comprehensive care quality. States and Municipalities neglect outpatient beds and close without replacement professionals in a context of increasing number of patients with HIV and AIDS in monitoring. Theme complex and difficult to solve, his face should be intersectoral and depends on a strong mobilization of all, while considering and understanding the local context.

5th. Critical thinking and independent, as well as the existence NGOs strong, has always been the greatest protection of people who are more vulnerable to HIV infection or living with AIDS. Access to public funds in a correct and transparent investment effort to contribute to the sustainability of non-governmental organizations and community networks is crucial.

The public debate of 2012 did reflect all managers, activists, media persons and afetadas.Fizemos our part.

Did you do yours? Critical reflection is an essential part of DAY OF THE FIGHT AGAINST AIDS.

   Palavras-chave:   World Day to Combat AIDS    AIDS    HIV    SUS    Vera Paiva   
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