Brazil to U.S.: Keep Your Money

Brazil has rejected $40 million in U.S. funds for fighting AIDS because of demands that it condemn prostitution, a key participant in its flagship AIDS program. The move is seen by some observers as a rejection of Washington's head-in-the-sand linkage of neo-con morality and foreign aid.

''Biblical principles [are] their guide, not science," Pedro Chequer, director of Brazil's AIDS program told media outlets on Wednesday. "This premise is inadequate because it hurts our autonomous national policy."

Acting in accordance with a 2003 federal law, U.S. Congress demanded that Brazil publicly condemn prostitution before accepting the funds from the U.S. Agency for International Development, or USAID. Prostitution is a legal industry in Brazil and a key civic player in fighting the spread of HIV/AIDS.

The Leadership Against AIDS, Tuberculosis and Malaria Act of 2003 refuses government aid to organizations that do not explicitly oppose sex trafficking and prostitution. But bowing to those demands, say experts like Jodi Jacobson of the U.S.-based Center for Health and Gender Equity, would mean contradicting crucial civic cooperation undergirding Brazil's AIDS program, considered a model by international health organizations.

Jacobson said Brazil's sex industry plays a crucial role in the battle against AIDS in part through its role in helping the government review donation assistance. Sex workers are also a key target for the government's AIDS education effort.

"Brazil has taken cutting practical approaches and they were not going to adopt an approach based on ideology," Jacobson said in an interview on Friday.

The U.S. government globally seeds its conservative ideology with tools such as the so-called global gag rule, a measure that blocks U.S. family planning assistance to foreign NGOs that perform abortions in cases other than a threat to the woman's life, rape or incest.

But Jacobson says that unlike the the global gag rule, the demands relating to prostitution appear to be applicable to domestic organizations, such as U.S.-based charities with international operations.

And Washington's response?

A USAID spokesperson referred questions to a statement made by U.S. State Department spokesman Richard Boucher.

"We think it is fully consistent with the purposes that we're working on together, and that's to save people from AIDS and to slow down the spread of AIDS or stop the spread of AIDS among a population that's very vulnerable," said Boucher during a press briefing on Wednesday. "We don't dictate in what manner they have to implement this commitment or this policy. We don't specify how they have to express this in action. We just want to know that they're as committed as we are to fighting AIDS, but also to fighting prostitution and stopping prostitution and sex trafficking, which had been part of the spread of AIDS."

Brazil, which claims a third of Latin America's HIV cases, has reaped international praise for its two-pronged approach of providing free condoms to citizens and free medication cocktails to impoverished AIDS sufferers. The Ministry of Health distributes 20 million free condoms each month, according to the Population Reference Bureau, a Washington-based research group.

Brazil also recognizes a constitutionally based right of each citizen to receive AIDS medication despite their ability to pay. That recognition has driven officials in Brasilia, the capital, to go toe-to-toe with drug firms seeking to charge poor countries brand-name prices for AIDS medications.

Over the years the Brazilian government has effectively negotiated price cuts for some drugs using a negotiation strategy based on tiered or differentiated pricing. It has also funded domestic national laboratories that produce generic versions of other drugs. And in March, government officials threatened to use a World Trade Organization agreement on intellectual property as legal justification to break four antiretroviral drug patents.

Observers say another key to Brazil's success has been its willingness to nurture and include civic groups in the AIDS fight. Non-profit groups, including associations of sex workers, have flourished over the last decade, from 120 registered groups in 1992 to 500 in 1998, according to the World Bank. Moreover, NGOs have been granted high level involvement in government policy, specifically the right to serve on Brazil's National AIDS Council, which oversees the nation's AIDS policies.

That robust civic network has been used to funnel money to the grassroots. Between 1993 and 1997, just over $18 million in World Bank money to combat AIDS flowed through 175 implementing organizations to fund 427 NGO activities, according to the World Bank.

The funds led to the distribution of more than 1 million condoms and educational materials to more than 500,000 people. It also provided "specialized orientation to more than 200,000, and trained 2,000 community health agents," according to the World Bank.

But Brazilian officials have stressed that Brazil's government has borne the majority of costs. From 1997 to 2001, only 10 percent of the total investment in STD and AIDS programs originated from external financial sources such as the World Bank.


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