A reflection on politics, sex education, and humanizing those living with the virus this World AIDS Day.

This World AIDS Day, we look to Brazil’s Sistema Único de Saúde and how their decades-long policies have shaped better access to care, better sexual health education and better treatment for those living with the virus.

What Can The World Learn From Brazil's Treatment Of HIV? By Pimenta Cítrica

What Can The World Learn From Brazil's Treatment Of HIV?

In the World Cup of 2014, Thie was celebrating with a group of friends around a FIFA Fanfest in downtown Recife, Brazil, when he stumbled upon a trailer offering free HIV testing for anyone passing by. He decided to go for it and get tested – and in that trailer he was confronted with a positive diagnosis.

 “It was really unexpected. I still had this mindset that being HIV-positive means death.” He believes the initial shock of it could have been much worse if it wasn’t for the support he received.

” – which translates to something like “sheltering” – is a full concept designed to soften the initial blow of the diagnosis. While talking to the doctor about the news, Thie was given all the information about how to live with HIV, how the medication works and how it would be accessible to him. He was also offered physiological treatment as well as group meetings with fellow HIV+ folks.

they bring the test to people instead of waiting for them to look for it. 

That makes a lot of difference.” Thie has since then gotten in an open, 

 with Davis. Besides making hot videos for Lustery, they create content and host events spreading awareness about HIV. Davis is also a 

Brazil’s public policy around HIV is conducted by SUS (Sistema Único de Saúde), Brazil’s universal healthcare. Inspired by the UK’s NHS, it’s actually even more comprehensive. Anybody can have access to free care, even foreigners. You don’t need to be Brazilian to be checked into a hospital.

SUS offers treatment that goes from trauma care to free medication for psychiatric disorders to prenatal assistance. And while it had been the target of systematic dismantling for the past three decades, it is, in fact, a constitutional right – a permanent clause granted by the constituent Assembly formed after the fall of the Military Dictatorship in 1988.

For some this might sound surprisingly progressive, especially while the country has been in the media for the past years for its populist, extreme right-wing president Jair Bolsonaro.

For me, it was the norm. During my early twenties in Brazil, getting tested for STIs was something I always took for granted. So, it was very much surprising how after moving to Germany in 2016, I realized testing is not nearly as accessible.

“It’s really important how they bring the test to people instead of waiting for them to look for it. That makes a lot of difference.” 

Living in Berlin, I was told by a gynaecologist I should pay around 30 Euros per possible disease if I wanted to get tested, which would amount to up to 400 euros for a full panel – and this is while being insured.

Back then, I didn’t have that kind of money, so she reluctantly admitted that I could “try my luck” at sexual health center in Berlin but she advised against it, as they “weren’t doctors, so they could disclose [my] medical information and being tested for STIs could harm my professional life”. (Sidenote: it’s illegal to disclose any medical information without consent in Germany.)

The center the doctor referred me to is the Centrum für Sexualwissenschaft in Schöneberg, a wellness center that offers free HIV testing for low-income folks and charges €10 for those who can afford it. 

While the center is a life-saving initiative for sex workers and queer Berliners, it’s relatively unknown to the wider public. In Berlin, STI testing seems to be reserved only for those in “

Meanwhile in Brazil, cities are equipped with CTAs – testing facilities open for everyone. “You can tell the whole team working there is very prepared,” Davis adds. “From the receptionist to the doctors, they are very welcoming and non-judgmental. Regardless of results being positive or negative, you have a full conversation with the doctor about how to mitigate future risks. There are male and female condoms you can take for free. In some cities, you can take an HIV self-test to do at home.” (I brought three of those in my suitcase on my last visit to Brazil, after I told the CTA doctor about the difficulties of getting tested in Germany.)

Thie and Davis are very vocal about the importance of sexual education in living with HIV. 

“I know a lot of people who are scared of getting tested, and a lot of people who are scared of doing the treatment,” Thie tells me. “Sometimes, peopleare so scared they fall into denial.

 This is why it’s so important to talk about these things. So people can understand that regardless of being HIV-positive or negative, the most important thing is being proactive in taking care of oneself.”

Thie explains that his HIV medication is distributed for free, and he has to get a refill every three months. “They call you if you haven’t picked up the meds to ask what happened. They constantly check in on patients.”

However, not everything is perfect. In the last four years, with Bolsonaro in power, SUS has seen a great shortage in resources. There was talk of the HIV medication supply running out. Thie was faced with the terrifying prospect of not having access to his meds. “It was scary. There was a time when we didn’t know if I would get the next refill, and I didn’t know what I was going to do.”

Not only that, but there were fewer and fewer public campaigns educating on the importance of getting tested. “It was something we saw frequently before Bolsonaro. In the last few years, they have disappeared,” Davis recalls.

Fortunately, four years were not enough to dismantle a structure that has been in place for over two decades. One proof of this is the gratuitous distribution of PrEP by SUS. PrEP, or ​​

, is a cutting-edge treatment in the prevention of HIV. It consists of daily medication that pre-emptively avoids becoming infected in 99 percent of cases.

Davis has been on PrEP, also supported by SUS, and he believes it’s a great aid not only in his relationship with Thie, but also in his daily work.

 Here in Berlin, PrEP has been criticized in queer circles for giving people the false sensation of complete security since it only prevents HIV and no other STIs. This way, it’s said, the medication could potentially encourage risky behavior.

When I asked Davis what he thought about this, he said the way SUS distributes it eliminates this risk. “They only give you enough for three months. Every time you go get a refill, you have to get tested for all STIs to get the medication.”

In Berlin, PrEP is accessible for those with health insurance but the request must be approved by doctors before the medication is given.

Testing is a crucial step in dealing with HIV for two reasons. First, the earlier one catches the infection, the more successful the treatment will be. Second, folks who are HIV-positive but don’t know it have a higher viral count, which means they are more prone to transmitting the virus to others.

Even the World Health Organization (WHO) recommends testing as an effective measure to combat HIV/AIDS. However, in order for it to really work, testing not only should be readily available but people should be educated on how it is for 

HIV is silently spreading among married heterosexual women

: 870,000 contract the virus around the world annually – and 80 percent of them are infected by their husbands or boyfriends.When I tell this to Davis, he seems unfazed.

“This doesn’t surprise me at all. Among my clients, gay men usually are the ones who take care of themselves, are regularly tested, and always use condoms. 

I have many clients who consider themselves straight that don’t want to use condoms. They believe that because they are not ‘fully gay’ they can’t get AIDS,”

For Thie, the stigmatization is by far the most painful part of living with HIV.

 “I’ve also had high-blood pressure all my life and I take 

. It’s no different than treating the HIV. The problem is how other people view you, how you are treated, how a lot of them still think queers are bad and that they are out to make other people sick.”

But the stigmatization is not only dangerous to those living with HIV, queer people, and sex workers. It’s dangerous to straight folks, too. It gives them the idea they don’t need to get tested, don’t need to wear condoms and that they’re not at risk.

HIV can affect anyone. The stigma helps the virus spread in silence.

When I asked both Davis and Thie how they think we can turn this around, they were both categorical: 

Sex education is the basis for creating a safer environment for everyone.

 “We must continue to demystify HIV,” Thie says. “And we have to give HIV-positive people a voice to advocate for themselves.”

I would add that the world can learn from Brazil in shifting the conversations around STIs from a marginalized group’s problem and making them everybody’s problem. 

Awareness is a first step, but this World AIDS Day it’s fundamental to realize offering comprehensive sexual healthcare takes resources and effort

. And de-stigmatization is not going to happen on its own – it takes active political will.

https://exame.com/brasil/modelo-no-mundo-departamento-de-combate-ao-hiv-do-brasil-perde-status/

https://fenafar.org.br/2022/05/20/entidades-repudiam-declaracao-de-bolsonaro-afirmando-que-as-pessoas-com-hiv-aids-sao-uma-despesa-a-sociedade/

https://www.bemparana.com.br/saude/mais-de-80-das-mulheres-infectadas-por-hiv-sao-contaminadas-em-relacoes-sexuais-com-parceiros-homens/

https://portal.unit.br/blog/noticias/mulheres-casadas-correm-cada-vez-mais-riscos-de-contrair-hiv/