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Week of November 25, 2003

Program 0347


Africa: AIDS Education Dilemma | Transcript
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Iran: Response and Treatment | Transcript
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China: Rural Patient Care | Transcript
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Russia: Facing an Epidemic | Transcript
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United States: Global AIDS Plan | Transcript
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Brazil: Free Drug Treatment | Transcript
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UNDP’s Mark Malloch Brown | Transcript
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Uganda: Health Worker Profile | Transcript
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This text has been professionally transcribed. However, for timely distribution, it has not been edited or proofread against the tape.

AUSTEN DAVIS: What happens in Africa, you get HIV, you don’t know it. Then you starting to get sick. You’re stigmatized. You lose your job immediately. If you go for a test everyone knows the results of the test. There’s no confidentiality in testing. And there’s nothing to offer.

KEITH PORTER: This week on Common Ground, a special report on the global AIDS crisis.

KRISTIN MCHUGH: AIDS has taken the lives of more than 25 million people around the globe

YOUNG IRANIAN WOMAN ON THE STREET: [via a translator] Everybody knows that AIDS has become a serious problem in Iran. At first officials tried to hide this problem but nowadays they announce it publicly.

MCHUGH: From Africa to the Orient, From Russia to the Persian Gulf, we’ll hear how government officials, medical workers, and AIDS patients are battling the deadly disease.

MIKHAIL MARGELOV: [via a translator] By 2010 up to 8 million Russians could be infected with HIV.

PORTER: Our special World AIDS Day report is coming up next.

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Africa: AIDS Education Dilemma

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MCHUGH: Common Ground is radio’s weekly program on world affairs. I’m Kristin McHugh.

PORTER: And I’m Keith Porter. An estimated 42 million people around the globe are living with HIV/AIDS. In Uganda a woman cares for her two grandchildren because their parents have both died from AIDS. In Iran, a young man struggles with the disease after becoming infected with a dirty syringe. And, in Swaziland, a woman with AIDS can only counsel other patients to eat a balanced diet because there are no drugs available for treatment. December 1st marks World AIDS Day, a day set aside by the international community to call attention to the plight of millions of victims around the globe. In honor of World AIDS Day, Common Ground is devoting our entire program this week to the disease that knows no geographical or age boundaries.

MCHUGH: We begin in Africa where the HIV/AIDS pandemic has been the cause of almost unimaginable misery and death in much of the continent for the last two decades. Tens of millions have died from AIDS-related causes—many millions more have been orphaned. In several southern African countries, at least one in five adults is HIV positive. Yet still persuading people to change their sexual behavior remains an uphill struggle, often not helped by political leaders unprepared to face the seriousness of the threat. Religion and tradition can also pose a significant challenge to AIDS prevention. Rupert Cook reports.

JEAN-CHRISTOPHE: I think about the young boys and the young girls are not clever to use condoms. They don’t like to use it because they, they say that when they use it the pleasure it not enough.

RUPERT COOK: [directly interviewing Mr. Christophe] Do you use condoms yourself?

JEAN-CHRISTOPHE: No, I must use it. Because if I don’t use it I will, I will die soon.

RUPERT COOK: I met Jean-Christophe at a street-side stall in the centre of Kinshasa, the capital of the Democratic Republic of the Congo. Along with the cigarettes and chewing gum, there were also piles of condoms for sale, though many of uncertain vintage, with the packaging faded and cracked from the sun. After six years of civil war, with an estimated 3 million dead, in this nation of 70 million, accurate figures for HIV/AIDS prevalence are hard to come by. In Kinshasa at least, most people to whom I spoke knew of the disease and the deadly consequences of infection. Yet, Jean-Christophe had identified a particularly acute challenge facing anti-AIDS campaigners throughout Africa—that of translating awareness into behavioral change. Mustapha Guei is senior policy advisor with UNDP Special Initiative on HIV and AIDS.

MUSTAPHA GUEI: If we don’t look at the social contract it’s going to be difficult to overcome this epidemic. And here I’m just gonna put an emphasis on the relationship between men and women. It’s no longer okay that you know, men go out, get drunk, have multiple sexual partners, infect many womens, come back home, infect their wives, and then as a community we’re saying this is okay. No. It’s not okay.

COOK: Persuading people to make radical changes in the most intimate aspects of their behavior is hard enough. Often religious faith and deeply-embedded tradition make it yet more difficult. In the Republic of Somaliland, in the north of what was until 1991 a united Somalia, its 3 million people have made impressive progress in building a relatively stable and democratic state. But in this overwhelmingly Muslim and conservative society, there are no condoms publicly for sale. In fact condoms form no part of the government’s official anti-AIDS policy. Yet, public health specialists put Somaliland’s sexually transmitted disease prevalence at around 30 percent. Dr Hassan Ismail Yusuf is Somaliland’s Minister for Health and Labor

DR HASSAN ISMAIL YUSUF: We are a Muslim country. We do not want to publicize the use of condoms. Abstinence is the best form. We do not want to encourage people to have illegal sex by using condoms. No. That, that’s against our religion and against our culture. So that would be inappropriate.

COOK: Relying on abstinence and monogamy, to the exclusion of condom use, may be even more of a challenge in terms of changing people’s behavior. Yet, in Chad, another highly traditional and predominantly Muslim country, where HIV/AIDS prevalence is currently estimated at around seven percent, anti-AIDS campaigners have persuaded both Muslim and Christian religious leaders to promote condom use. Bellou Malem Passerelle is the president of an association for people living with HIV and AIDS, Fraternite Plus, based in N’Djamena, the capital of Chad. He has known that he’s HIV positive for the last five years.

BELLOU MALEM PASSERELLE: [via a translator] Yes, we’ve broken the silence because you see personally I’m Christian, and our group has broken the taboo of talking about AIDS. But it was difficult. We’ve worked with the religious leaders, both Christian and Muslim, but it was hard. Before, the Christians and Muslims didn’t accept condoms; but now we’ve gotten to understand the situation. For the moment that acceptance is showing progress, but there still remains a lot to be done.

COOK: Despite the support of religious and political leaders, the rate of infection in Chad keeps on rising. Increasingly, as the pandemic continues to spread, some health specialists are pointing out that provision of confidential testing and widespread access to anti-retroviral treatment throughout Africa may be almost as crucial in terms of prevention as awareness-raising about the disease. Austen Davis is Director of an international humanitarian NGO, Doctors without Borders.

AUSTEN DAVIS: What happens in Africa, you get HIV, you don’t know it. Then you starting to get sick. You’re stigmatized. You lose your job immediately. If you go for a test everyone knows the results of the test. There’s no confidentiality in testing. And there’s nothing to offer. So you become stigmatized, you stay at home in a dark room, no one wants to see you, your family’s embarrassed, you go through tremendous pain, then you die.

[The sound of traditional African music]

COOK: For Common Ground, I’m Rupert Cook, in N’Djamena, Chad.

[The sound of traditional African music]

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Iran: Response and Treatment

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PORTER: While much of the world’s attention is focused on Africa’s HIV-AIDS pandemic, AIDS continues to spread to regions once considered safe. In recent years, the Islamic Republic of Iran, like many Muslim nations, has gradually woken up to the threat of AIDS. Although Iran’s infection rate is relatively low by international standards, the country is starting to put aside taboos associated with the disease. At the same time, some AIDS-campaigners say more needs to be done to educate Iranians about the issue before it gets worse. Roxana Saberi reports from Tehran.

[The sound of the Moslem call to prayers]

ROXANA SABERI: Despite its strong connection to religious values, the Islamic Republic of Iran has not been immune to the growing threat of AIDS. The country discovered its first case of the Acquired Immune Deficiency Syndrome in 1986.

[The sound of Iranian music]

SABERI: Then, two years ago a young Tehrani named Mehdi learned that he, too, was vulnerable.

MEHDI: [via a translator] It was very difficult for me when I heard I was sick. At that moment, I was with my mom. I had to control myself, and at the same time I had to watch over my mother. They said to my mom, “His HIV is suspicious.” I didn’t know what HIV was. A nurse passed by our room, and I asked her, “Miss, What is HIV?” She said, “AIDS.”

SABERI: Mehdi had been addicted to drugs. He says one day he bought a syringe—less expensive than usual—but the seller said it had never been used.

MEHDI: [via a translator] At the public health clinic, they asked me, “Have you ever used any intravenous drugs? I said “Yes, one time.” Then they told me, “You have to get a blood test.”

SABERI: Mehdi is one of 5,051 Iranians who officials say have been found to have the HIV virus since the mid-1980’s. Dr. Sedigheh Amini is the director of quality control of the Transfusion Organizations of Iran. She says about 96 percent of the HIV positive are men and that most become infected by using intravenous drugs; others through sex, receiving blood, or from their mothers through pregnancy.

DR. SEDIGHEH AMINI: [via a translator] Among 5,051 individuals, 674 people died. These 5,051 individuals were identified among 9,638,000 people who came to testing centers.

SABERI: But some other experts say the actual figure of those infected is much higher.

[The sound of medical training session]

SABERI: Dr. Minoo Mohraz is an infectious disease specialist in Iran who’s been working for years to combat AIDS in the region. Today she’s holding a session on the subject for UN workers in Tehran.

DR. MINOO MOHRAZ: We have a confirmed figure that we say and we have an estimate figure—every, every place have this. Our estimation by the way of reporting of the system of reporting in Iran is about 30,000.

SABERI: Dr. Mohraz says at first, Iranians were in what she calls the “denial stage”—they didn’t want to admit that the Islamic Republic had the problem of AIDS.

DR. MOHRAZ: That’s the denial because they don’t know. The lack of knowledge of even the policymakers, even stakeholders, and general population, and the denial phase that “No, we don’t have the problem.” Why? Because we have Islamic culture. Yes, we don’t have like Southeast Asia or India. But we have. We cannot say that we don’t have this problem. We have the problem.

SABERI: But Dr. Mohraz says in recent years the situation has been improving—drastically. Now many of the country’s leaders have begun to accept that their country, too, is susceptible and are taking steps to prevent the virus from spreading. State-run TV and radio regularly broadcast programs about AIDS and the importance of using condoms as a means of prevention. A help line has been set up to answer callers’ questions. And Dr. Mohraz says schools will soon include the subject in their curriculum.

[Sounds from an AIDS clinic]

SABERI: Iran has also opened a number of AIDS clinics—23 in prisons and 21 elsewhere in the country. This clinic in West Tehran opened three years ago. One of the doctors here, Leila Mirhaghani, says word has quickly spread about the center’s free services for HIV-AIDS patients, such as counseling and group therapy.

LEILA MIRHAGHANI: Here is only place that we take HIV tests anonymously by codes and free of charge, and it is the only place in Iran. Most of the patients coming here are men and most of them are getting HIV through drug use, by intravenous drug use. But the number of women that are coming here is growing, too.

SABERI: The clinic also helped Mehdi quit using drugs and focus on what he loves—playing music.

[The sound of Mehdi playing Iranian music]

MEHDI: [via a translator] When I quit, everything changed, from the ground to the sky. I started to work. Everything got better. Even now, thank God, everything is good. Here at this clinic, I saw how the people who came, how lively and healthy they became.

SABERI: While Iran is making progress in preventing the spread of AIDS, some advocates here say more needs to be done. They’re calling for increased financial and moral support to treat drug users. And they say more education is needed to lessen the gap between those who understand AIDS is a growing problem and those who still believe they are not at risk.

YOUNG IRANIAN WOMAN ON THE STREET #1: [via a translator] Everybody knows that AIDS has become a serious problem in Iran. At first officials tried to hide this problem but nowadays they announce it publicly.

SABERI: One aspect of education that should be improved, says Dr. Ahmad Ghavidel, the director of Iran’s Hemophilia Society, is the need for people to regularly use condoms in their sexual relationships:

DR. AHMAD GHAVIDEL: [via a translator] I think that the Ministry of Health should encourage people to use condoms. The statistics that we have from 100 drug stores in Tehran shows that fewer than 100 condoms were sold. Only in Vanak and Tehran Pars were sales more than 100.

SABERI: Still, many experts say, Iran has come a long way. They say the country is now leading the way in the Islamic world, taking up a realistic and humane approach to an illness that is often swept under the carpet. For Common Ground, I’m Roxana Saberi in Tehran..

[The sound of Mehdi playing Iranian music]

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China: Rural Patient Care

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MCHUGH: China’s search to treat the country’s mounting AIDS epidemic—as Common Ground‘s World AIDS Day special report continues.

[Musical interlude]

MCHUGH: When facing the mounting AIDS epidemic in China, health authorities often feel as if they are caught between a rock and a hard place. Despite an admittedly radical change in the government’s willingness to tackle the problem, a new treatment plan to provide free generic drugs to AIDS patients is plagued with concerns. But as Celia Hatton reports from Beijing, most of the officials involved feel they that are left with little choice but to press on with the program.

CELIA HATTON: It has often been said that when the Chinese government decides to do something, nothing will stand in its way. Now, that kind of drive is being applied to the treatment of HIV and AIDS in China’s poorest rural areas. In the last few months of 2002, top government officials fast-tracked the approval of several AIDS anti-retroviral—or RV—treatment drugs, waived tariffs on imported RVs, and most significantly, licensed two domestic companies to manufacture cheaper, generic copies of four of the most common therapies. Now, with a $98 million infusion of funding from the UN Global Fund, the government is moving ahead full speed with its first major platform for AIDS treatment. The goal is to provide 40,000 AIDS patients with free treatment that would be prohibitively expensive in the West.

[The sound of traffic on a busy Chinese street]

HATTON: This plan may sound foolproof, but anything can go awry in a country of 1.3 billion people, many of them living under the most basic conditions. At first, many activists applauded the Chinese government for electing to provide free treatment to impoverished AIDS patients who could never hope to pay for such high-priced medication themselves. However, now that the plan is in action, critics have reservations that the complex cocktail of drugs that the government is handing out may do more harm than good.

ANDREW THOMPSON: They’re trying to do it very, very quickly. They have essentially leapfrogged all of the learning by doing that has gone on in the United States over the past 20 years.

HATTON: Andrew Thompson is a China analyst at the Center for Strategic and International Studies in Washington.

THOMPSON: They now have to jump right into a maturing epidemic with many late-stage cases that they have to deal with immediately and drug combinations that have by and large been tested but in some cases are a little more complex than perhaps the instructions on the label.

HATTON: RVs require doctors to monitor patients very closely to help them cope with the drugs’ serious side effects. Jean Francois Dechamp is a pharmacist who has worked on an AIDS treatment program in China for Doctors Without Borders. He says that there are many things that can go wrong when dealing with RVs.

JEAN FRANCOIS DECHAMP: You can have problems, okay, because of the quality of the drug, which is quite possible. But you can also have problems because you gave a good quality drug but to a patient who doesn’t have the profile to have this drug. Or you can, a third possibility is that you can also give a quality drug to a patient who has the profile but who is not taking the drugs regularly because there is no one behind. Giving RVs is not like giving M and M’s.

HATTON: Chinese health officials have admitted that they need more trained physicians and have been working on a plan to train volunteers in each village to directly monitor patient treatment. In the mid-1990s approximately 250,000 rural peasants in central China were infected with HIV when they sold their blood. About 50,000 of those people have now developed full-blown AIDS. In September, the government also admitted that HIV cases had jumped 140 percent since last year. So, although the China Cares program is far from perfect, government officials are moving ahead with the plan. When asked about such problems, China Cares Director Zhang Fujie replied, “Domestically made medicine is not the best, but we’re talking about how to help the largest number of people under scarce resources.” Dr. Ray Yip agrees with that sentiment. He’s the director of the China-US Prevention and Care Project, a US-funded project that will provide technical assistance to China Cares. He says that there just isn’t time to fine-tune the project before it gets put into place.

DR. RAY YIP: We have two choice: one is that, let’s work very hard to get all the ducks in a row, so to speak, and then get everybody properly trained to do all the right things, then when that’s set, then we go out and get the program going. But that might take two, three, four years delay. But meanwhile, the people who are hurting cannot wait.

HATTON: On a wider level, it’s extraordinary that the China Cares project has even made it this far. The Chinese government did not acknowledge that there was a massive AIDS epidemic on the mainland until just two years ago. Again, Ray Yip.

DR. YIP: The country is like a person. The changing in their views and attitudes and behavior, it doesn’t happen overnight. And we are basically right now witnessing sort of a period of what I call a very positive shift. And they can only shift so far and so fast.

HATTON: Many would agree that there has never been a better time for such a shift in thinking. If left unchecked, it’s estimated that there will be 10 to 15 million HIV cases in China by the year 2010. For Common Ground, I’m Celia Hatton in Beijing.

[Musical interlude]

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Russia: Facing an Epidemic

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PORTER: In Soviet times, Russia was one of the few countries where HIV, the virus that causes AIDS, did not spread as quickly as it did elsewhere in the world. The disease arrived in Russia only after the collapse of the Soviet Union and for more than a decade the virus incubated silently. But since 1998 the number of registered HIV cases in Russia has increased 20-fold, according to official statistics. But experts say the real number might be even higher. Anya Ardayeva reports from the Russian capital.

[The sound of a crying baby]

ANYA ARDAYEVA: Each month, hundreds of HIV-infected children are born to infected mothers in Russia. Roughly 80 percent of its HIV population is under 30 years of age. Official statistics here says that about a quarter of a million people are infected. But AIDS experts say that in reality, up to 1.2 million people in Russia have HIV. The number of those infected in the country is many times more than in the United States, which has twice the population. Mikhail Margelov is chairman of the committee of foreign affairs of the Russian upper house of parliament. He is also a member of the board of Transatlantic Partners against AIDS—a US-based NGO. Margelov says the government has to take action soon.

MIKHAIL MARGELOV: [via a translator] If the situation gets worse, then by 2010 up to 8 million Russians could be infected with HIV. That’s around 10 percent of the adult population of our country.

ARDAYEVA: AIDS experts in Moscow say the disease is spreading quickly because authorities failed to act fast and because Russians know very little about the disease. Until recently, the overwhelming majority of HIV-positive people were drug addicts and it led many people to believe that there is no way they can ever get infected. But the virus started spreading to the population about two years ago as more and more Russian prostitutes, many of whom are also drug users, got infected. The women passed the disease to their customers and their children. Nearly 1,500 HIV-infected babies were born in Russia in the first six months of this year, according to the figures issued by the Russian Health Ministry. The disease also spreads through the Russian prisons. Mikhail Zadornov, deputy head of the budget and tax committee in the State Duma, says that HIV-infected prisoners are one of the most discriminated parts of the country’s population.

MIKHAIL ZADORNOV: [via a translator] When we talk about discriminating against HIV-infected people, we mean people who are held in the Russian jails and prisons. You understand that the conditions in these places are very far away from the norms accepted in the civilized society. That’s why the spreading of the epidemic in these places has been happening quite fast in recent years.

ARDAYEVA: The Russian government spent only $4 million on AIDS and HIV prevention activities in Russia last year. Observers in Moscow say that the Russian officials don’t seem to take the problem seriously. Because AIDS came to Russia only a decade ago, the actual number of people dying today from the virus is still relatively low. However, the figure is very likely to increase in the coming years. A multi-drug treatment, which can prevent AIDS as long as the drugs are taken regularly, costs up to $10,000 a year—completely unaffordable for most Russians. This year, the government will allocate only a little more than $3 million to help defer the costs of the drugs—enough to support 300 people.

[The sound of a crying baby]

ARDAYEVA: And until Russia gains the upper hand in its battle against AIDS, thousands of infected children will require specialized health care—and thousands more will grow up orphans. For Common Ground, I am Anya Ardayeva in Moscow.

[Musical interlude]

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United States: Global AIDS Plan

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MCHUGH: President George Bush has taken steps to make AIDS funding a major plank in his foreign policy agenda. At the beginning of the year President Bush pledged to spend $15 billion over the next five years to fight the disease in Africa and the Caribbean. But AIDS advocates say the White House’s funding formula just doesn’t add up. Judith Smelser reports.

JUDITH SMELSER: In January, President Bush used his State of the Union address to announce a bold new program to fight AIDS.

PRESIDENT GEORGE W. BUSH: I ask the Congress to commit $15 billion over the next five years, including nearly $10 billion in new money, to turn the tide against AIDS in the most afflicted nations of Africa and the Caribbean. [applause]

SMELSER: But the next week, when the White House released its budget request for fiscal year 2004, it included only $2 billion dollars for the first year of the President’s initiative, instead of the $3 billion that AIDS activists were expecting.

PAUL ZEITZ: When you have a massive crisis with millions of people dying, we wanted to see at least $3 billion spent this year.

SMELSER: Paul Zeitz is the Executive Director of the Global Aids Alliance. He says the extra billion would’ve made big difference.

ZEITZ: According to UNAIDS costing estimates, a billion dollars more in funding would allow public health programs to put another million people on lifesaving AIDS medications and to prevent at least two and a half million infections.

[The sound of street protesters chanting “Bush’s lies don’t save lives—3 billion now!”]

SMELSER: Earlier this year, Dr. Zeitz helped lead a protest in front of the White House against what activists say is President Bush’s broken pledge. But the Bush administration says the countries it wants to help lack the infrastructure to spend $3 billion right now. Dr. Anthony Fauci is the Director of the National Institute of Allergy and Infectious Disease.

DR. ANTHONY FAUCI: ‘Cause if we had thrown a whole bunch of money in right up front, it may not necessarily have been able to have been spent as well. So we planned the program to scale-up so that there’s more than $3 billion per year in the out years, but less in the early part. But at the end of the program, you’ll have $15 billion over five years.

SMELSER: But Paul Zeitz with the Global Aids Alliance rejects that way of thinking.

ZEITZ: That has been the history of the last 20 years of the AIDS epidemic—that mindset that we have to start small and slowly increase our response. And that is what has led to the point where we are now, which, over 20 million people have already died.

[The sound of street protests]

SMELSER: US credibility is on the line, says Zeitz and his fellow activists, and so are millions of lives.

[The sound of street protests]

SMELSER: For Common Ground, I’m Judith Smelser in Washington.

[The sound of street protests]

PORTER: This is Common Ground, radio’s weekly program on world affairs.

[Musical interlude]

KRISTIN MCHUGH: I’m Kristin McHugh.

PORTER: And I’m Keith Porter. Our special report on World AIDS Day continues. Coming up this half hour on Common Ground, Brazil’s successful battle against AIDS.

Dr. Paulo BARROSO: The HIV, it’s a tragedy—in Africa, in Asia, in Latin America. And Brazil has shown that we can make a difference if we try to work together.

PORTER: Plus, the UN’s role in fighting the epidemic. And, Uganda’s grassroots effort to turn the tide on AIDS.

STEVEN S’BANDEKE: Up to today, there are some people who improved on their quality of life. There are still people living I started with in 1990. That is over 10 years ago.

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Brazil: Free Drug Treatment

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MCHUGH: Brazil was on track for a major AIDS epidemic by the year 2000. But it never happened. Brazil’s widespread anti-AIDS education program and free medical care stabilized the infection rate at levels comparable to that of developed countries. Brazilians succeeded with fierce opposition from the international medical establishment and multi-national drug companies. Reese Erlich reports from Rio de Janeiro.

[The sounds of upbeat Brazil music being played in an outdoor setting.]

REESE ERLICH: It’s a warm night along the Copacabana Beach and young people are participating in the mating rituals common to any big city. Eighteen-year-old Allison Almeida and two friends are hanging out on a street corner wearing tight jeans and stylish T-shirts. They carefully eye women dressed in halter tops and even tighter jeans. I asked Allison, if he found a partner tonight would he use a condom?

ALLISON ALMEIDA: [via a translator] AIDS is a very concerning problem, so I, each time I—sometimes I didn’t use, but each time I face the situation of sex, I use it.

ERLICH: How about these guys? [referring to Allison’s friends.] Do they use condoms?

ALLISON ALMEIDA’S FRIENDS: [via a translator] Yeah, we use it. We use it.

ERLICH: Right. Do they, do they have condoms with them now?


ERLICH: Where does he carry it?

ALMEIDA:: [speaks Portuguese, asks his friends the question]

ERLICH: In his wallet?

ALMEIDA: In his wallet.


ERLICH: Three? [laughing] He’s very lucky. He’s very optimistic.

ALLISON ALMEIDA’S FRIENDS: [laughing, speaking Portuguese]

ERLICH: Let’s be honest. A lot of times guys don’t want to wear a condom. Does that, has that happened to them?

ALLISON ALMEIDA’S FRIENDS: [via a translator] He says, first time, “Yeah, yeah! A lot of times. A lot of times. You know, it’s kind of, you’re so hot, you’re so hot at that moment. Yesterday. Yesterday it happened!”

ERLICH: Such conflicting attitudes towards safe sex worry international AIDS experts. In 1995 the World Bank estimated there would be 1.2 million Brazilian AIDS patients within five years. But today less than half that number are HIV positive. In fact, Brazil has reduced AIDS deaths by 50 percent and reduced hospital admissions for AIDS by 80 percent. How did they do it?

[The sound of echoing footsteps as someone walks down a large hallway or a long set of stairs.]

Dr. Paulo BARROSO: This is the, our Infectious Disease ward.

ERLICH: Dr. Paulo Barroso heads the Infectious Disease Department at the Federal University Hospital in Rio.

Dr. BARROSO: We don’t have any more specific beds or wards for HIV patients. They are admitted together with all other patients in the same unit.

ERLICH: Dr. Barroso says international experts would not have believed Brazil was capable of treating AIDS patients so effectively. They used to tell him that the only way to stop an AIDS epidemic in Third World countries was to emphasize prevention. Dr. Bohosso says such advice was effectively a death sentence for people already infected.

Dr. BARROSO: They are talking about prevention, prevention, and prevention. And we had relatives and family dying of HIV and we couldn’t do anything for those, those guys. So I think that now if you look back, we see that it’s possible to, to give therapy in developing countries. Brazil has shown that.

ERLICH: Since the late 1990s, under pressure from nongovernmental organizations and AIDS activists, the Brazilian government has provided free medical care for any AIDS patient, including free blood tests, exams, and drugs.

Dr. BARROSO: Ah, some people say that you should put the money into other things, like education. This is not a high priority.

ERLICH: Brazil provided free treatment through government run hospitals and clinics. But it had to pay $115 million a year for just two anti-AIDS drugs made by US and Swiss pharmaceutical companies. That amounted to 36 percent of the Health Ministry’s entire budget. In order to bring those costs down Brazil embarked on a unique and controversial policy. It started manufacturing its own drugs.

[Sounds from an industrial facility.]

ERLICH: Here at the state-owned Far Manguinhos pharmaceutical factory, a supervisor opens an airtight door leading to the special machinery making anti-retroviral drugs for AIDS patients.

[Sounds from an industrial facility]

PHARMACEUTICAL PLAN REPREENTATIVE: These machines produce about 40,000 capsules per hour.

ERLICH: Forty thousand capsules per hour.

PHARMACEUTICAL PLAN REPREENTATIVE: Yes. Drugs for anti-retrovirals.

ERLICH: Eloa Dos Santos Pinheiro, the factory director, welcomes me into her office. She worked for multinational pharmaceutical companies in the US for 18 years. The Brazilian government asked her to calculate the cost of manufacturing anti-AIDS drugs. For drugs made by Merck and Roche, she compared their retail prices with the cost of manufacture. The difference shocked her.

ELOA DOS SANTOS PINHEIRO: Why the price of the drugs on the patents, why the price so higher? This institute does technology, does research. And then it can buy the raw material from anywhere. And I calculate the costs. And I saw that Merck, Roche, could drop their price also.

ERLICH: She estimates that companies such as Merck and Roche charge 80 to 90 percent over the cost of production for AIDS drugs. For other pharmaceuticals the difference is even higher.

PINHEIRO: There is some products here for hypertension. One difference between my price and the price in pharmacies—2,000 percent. Two thousand! They are so greedy, it’s incredible.

ERLICH: Pharmaceutical companies argue they spend a massive amount of money to research and develop drugs. So their high prices are justified because they must recoup those initial expenses. Pinero says she can research and develop a drug for 10 percent of the cost claimed by the multinationals.

PINHEIRO: They calculate about $500 million to develop new entity. I think this is outrage because the research and ten times more than our calculation. I know that there is a difference of salary. That is one thing that I know they have that we haven’t. They pay for lobbies. They pay for marketing. They pay for a lot of things.

ERLICH: Brazilian officials said they wouldn’t let the multinationals get away with charging outrageously high prices. They threatened to break the patents and start making those drugs generically in Brazil. That threat brought the companies to the negotiating table. They reduced their prices by up to 70 percent and the government continues to make generics with those drugs no longer under patent.

[The sound of a busy public place.]

ERLICH: If I lived in a small town or a village in rural Brazil, would I still be able to get these drugs in a medical treatment?

Dr. BARROSO: Yeah. Exactly. Yes. But as in any country, if you go to the middle of Texas probably it’s going to be harder to have access to medicines and therapy than if you are in New York City or Miami. So, but still, we have AIDS programs working in most of the states and most of the cities, the big cities.

ERLICH: But some Brazilians say it doesn’t always work out that way. The complain of long lines and drug shortages in some regions.

[The sound of a busy restaurant.]

ERLICH: Here at a Copacabana restaurant in Rio, prostitutes grab a quick bite to eat before resuming their work along the nearby beach front. Some of them are very critical of how government hospitals handle AIDS patients.

BRAZILIAN PROSTITUTE: [via a translator] A daughter of my roommate, she contracted HIV and she went to the hospital to get the free medicine. And she stayed on the line to get the free medicine. And she stayed so, so much time that when she got the right to get the free medicine she was already in a terminal phase. So she died.

ERLICH: But she and the other sex workers say that on the whole the government anti-AIDS program works well. AIDS education helps.

BRAZILIAN PROSTITUTE: [via a translator] They do a campaign on that. It motivates us to use the condom and talk about the aspects of the disease. In the summer they come here, they go through the beach. They distribute condoms and folders explaining about the disease. They are volunteers mostly, and I think this is very interesting. I don’t think this is a pressure from the government. It’s a good thing. And it’s trying to make people more aware…

ERLICH: Make people more aware…

BRAZILIAN PROSTITUTE: [via a translator] More aware, yeah.

ERLICH: Everyone interviewed here in Copacabana knows about Brazil’s successful fight against AIDS. This prostitute says she now has something else to be proud of in addition to the country’s winning soccer teams.

BRAZILIAN PROSTITUTE: [via a translator] I think all the countries should modelize themselves to, to copy Brazil on that issue. Because Brazil is an example of that attitude.

ERLICH: Dr. Barroso says Brazil has some unique advantages because of its government-run pharmaceuticals industry. But he says in recent years South Africa and other Third World countries have also successfully pressured drug companies to lower their prices.

Dr. BARROSO: Everybody in the world who works with HIV needs to recognize that there’s this disparity of having tens of millions of people dying with HIV, without having access to drugs that are available in developed world, in the developed world. This is big difference between rich and poor countries is not acceptable anymore. This is a tragedy. HIV, it’s a tragedy—in Africa, in Asia, in Latin America. And Brazil has shown that we can make a difference if we try to work together.

ERLICH: For Common Ground, I’m Reese Erlich in Rio de Janeiro.

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UNDP’s Mark Malloch Brown

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PORTER: The reversal of the HIV/AIDS global pandemic appears to be a long ways off. In fact, it continues to get worse. The United Nations estimates the number of people infected by the disease is likely to double in less than ten years. Common Ground‘s Cliff Brockman talked to United Nations Development Program head Mark Malloch Brown earlier this year about the UN’s goals to reverse the AIDS pandemic.

BROCKMAN: What is UNDP’s role in the fight against AIDS?

MALLOCH BROWN: UNDP is not a health agency. There are others—the World Health Organization, the Global Fund for HIV/AIDS, Malaria, and TB—and other vehicles which can tackle the public health items. What we are, though, is the development and the governance organization. And both are under threat because of AIDS. We are seeing economies undermined because the workforce is gone. We are seeing governments undermined because the civil servants are gone. We see service delivery by government—healthcare, education—undermined because the teachers and healthcare workers are gone. So we have a huge role here of capacity replacement. How do we train new rows of doctors, health workers, teachers, civil servants? How do we create new methods of, of economic production which are less dependent on the availability of labor than has been the case in the past? You know, we see societies that we’ve been partnering with for 40, 50 years, you know, now being threatened by this and undermined. And so as a development organization we’re taking on those non public health aspects.

BROCKMAN: There has been a gender shift hasn’t there? Women are more affected now by AIDS, and HIV/AIDS?

MALLOCH BROWN: Yes. In Southern Africa, you know, a majority of the victims are actually women. It has become a disease of heterosexuality. Where, you know, many of the social practices, both traditional social practices of male dominance, but new social practices where so many men have to migrate such a long way to mines or long distance truck drivers or do other things which keep them away from home and their families for a long time, has, when you combine it with the demands of men on women for sexual favors, you’ve got this potent cocktail of modern economic factors such as migration, combining with a traditionally male dominant society, to make women enormously vulnerable to a heterosexually transmitted disease, where even their body, their physical vulnerability is greater than those of their male partners. So, you know, women are disproportionately the victims. And within that, young women who are least able to say “No,” for reasons of custom, in the sort of 16-to-25 age group, are the single biggest group of victims.

BROCKMAN: How do you see it playing out? How will this victory finally be won against global AIDS?

MALLOCH BROWN: It will be won country by country and individual by individual, in that we have seen in countries as geographically far apart as Brazil, Uganda, and Thailand, that where there is a committed political and perhaps more important, social leadership which absolutely convinces a population who will listen to it of the dangers of this disease and for a need for a change in behavior, then you can dramatically bring down the incidence rates, particularly if you can support that campaign of prevention with affordable treatment options, as happens particularly in Brazil of those three countries. Then you’ve got a kind of winning strategy.

BROCKMAN: Mark Malloch Brown is the administrator of the United Nations Development Program. For Common Ground, I’m Cliff Brockman.

BROCKMAN: Mark Malloch Brown is the administrator of the United Nations Development Program. For Common Ground, I’m Cliff Brockman.

[Musical interlude]

MCHUGH: Coming up next, our World Aids Day special report continues with one Ugandan health care worker’s personal story. You’re listening to Common Ground, radio’s weekly program on world affairs.

[Musical interlude]

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Uganda: Health Worker Profile

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MCHUGH: There isn’t much good news about AIDS in Africa these days. The continent is home to just 10 percent of the world’s population, but 70 percent of all HIV infections on the planet. But the East African nation of Uganda stands out as a beacon of hope. It’s now estimated that less than 10 percent of Ugandans carry the virus that causes AIDS, an impressive number for a country that was once ranked as one of the most heavily infected countries in the world.

PORTER: Health officials credit the Ugandan government for attacking the problem head-on, but also point to the local people, who formed a grassroots group, “The AIDS Support Organization,” or TAH-so, that educates with an eye toward preventing the disease, and supports the millions of Ugandans affected by AIDS. Two years ago correspondent Eric Whitney spoke with one TAH-so veteran about how people can cope with HIV successfully in an impoverished country.

ERIC WHITNEY: There is perhaps no better example of the difference between life in the industrialized and developing worlds than in the fate of people infected with HIV. In the United States and Europe, even people with limited means can get sophisticated anti-retroviral drugs. It may be hard for the poor to get the intensive medical follow-up that’s necessary to maintain people on these effective but highly toxic drugs, but it’s still generally available. In Africa, treatment for people with HIV often consists of being advised to eat a healthy diet. Lucky patients may get some counseling. For Africans, it can be hard to get even common drugs to fend off the opportunistic infections that start HIV-positive people on a downward spiral. Only a handful of the wealthiest have access to the medicines that fight the virus itself.

The best treatment offered in many African countries is counseling. Steven S’bandeke provided that kind of support to the HIV positive in Uganda for a decade. Taking a break from his work at a primitive rural hospital, he says that even people in the poorest, most remote areas have heard about the new generation of AIDS fighting drugs.

STEVEN S’BANDEKE: Yes, they are, people here are aware, especially the HIV-affected people. They are aware it is available, but they are also aware that it is very costly, they cannot afford.

WHITNEY: Under pressure from activists and governments in developing countries around the world, some drug manufacturers are donating AIDS drugs to poor nations, or are making them available at a lower cost. Lack of medical infrastructure, and its cost, is why the ground troops in the war on AIDS, like S’bandeke, spend a lot of their time counseling their HIV-positive clients about good nutrition and maintaining a balanced diet. It may not sound like much help, but he says he’s seen it make a difference.

S’BANDEKE: Up to today, there are some people who improved on their quality of life. There are still people living I started with in 1990. That is over 10 years ago.

WHITNEY: For years, Africans have referred to AIDS as “slim disease,” because it’s common for them to see their friends and neighbors mysteriously begin to lose weight, and then rapidly sicken and die. S’bandeke says that doesn’t have to be the case. He’s helped his clients deal with the persistently strong stigma against the HIV positive, encouraging them not to isolate themselves and dwell on their misfortune.

S’BANDEKE: If you are busy working it is—you can hardly find time to think about death, about the future of your children, about the future of your wife. You know, when you are busy you know, you—there is something occupying you at that particular time. So you have no worries. But if you sit down and what you think about is HIV, how it has disrupted your plans, how you are going to die and leave your children, how you are going to die and leave this plan unfulfilled, you know that is the major causes of worries. So when we are talking to people we tell them, “Please, even if you are not feeling very strong, do something light.”

[The sound of motorcycles idling and revving their engines.]

WHITNEY: After 10 years, S’bandeke had to give up his job as a counselor because of hypertension. But he’s still in the health field. He spends his days riding a small motorcycle, visiting poor subsistence farmers scattered across the Ugandan countryside.

[The sound of S’bandeke talking with patients in the field.]

WHITNEY: Many of the people he visits are HIV positive. He says he doesn’t sense anger among them that they can’t access the sophisticated anti-AIDS drugs available in the first world, but that doesn’t mean they don’t want and need help.

S’BANDEKE: The issue I think is not being frustrated. I think the people who are affected that way—I mean infected and those affected—they feel that maybe the scientists should do more to find easier ways of dealing with the virus, other than looking at these expensive treatment which people may not easily access. There is that anxiety, that something should be done, and done quickly.

WHITNEY: For Common Ground, I’m Eric Whitney in Tororro, Uganda.

Our theme music was created by B.J. Leiderman. Common Ground was produced and funded by the Stanley Foundation.

Copyright © Stanley Center for Peace and Security

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