Conta Natura

não entendi o argumento do post, am I stupid?

Nao existe um verdadeiro argumento, estou antes a levantar um problema que merece ser discutido num blogue de ciencia.

Ou seja, quais sao as melhores metodologias para combater a propagacao galopante da Sida? Que tipo te campanhas se devem desenvolver? Deve-se usar o uso do preservativo como meio fundamental no combate 'a sida, ou sera' que tambem e' importante fazer uma campanha de valores que minimize a promiscuidade sexual? E ate' que ponto tal campanha deve ser um cariz moral?
Ou seja, que tipo de campanha se deve fazer? E nos paises africanos, que tipos de metodologias se deviam aplicar tendo em conta a falta de recursos?

Alguns estudos recentes sugerem que a actividade sexual em adolescentes comeca surpreendentemente cedo. Se tal acontece, ate' que ponto se deve abordar estes assuntos com criancas de 11 ou 12 anos?

Muitas questoes, poucasrespostas, mas acima de tudo eu gostava de ouvir opinioes de pessoas realmente bem informadas nesta materia.

Salve Rui,

O Brasil tem a campanha de controlo de transmissao de HIV com maior sucesso do mundo. O numero de infectados hoje e' metade do que foi projetado 10 anos atras. As campanhas Brasileiras, tanto do Governo quanto das ONGs tiveram este exito em grande parte por nao se meterem a moralizar uma epidemia. Recentement o governo Lula recusou dinheiro dos EUA pq o governo Bush queira vincular a ajuda a exclusao das prostitutas das campanhas educacionais, por razoes 'morais' e de 'valores cristaes'. Infelizmente, varios paises em desenvolvimento dependem muito mais da ajuda externa para as suas campanhas. Um caso notavel e' a Uganda, o maior caso de sucesso no continente africano, epicentro da epidemia, que agora se ve ameacado de se juntar aos vizinhos porque os moralistas desta administracao querem 'reformar' as iniciativas de educacao sexual, distribuicao de preservativos e afins.

Thiago,

Podes dar mais detalhes acerca da campanha no Brasil? Quais foram as metodologias usadas? Suponho que existam varias razoes para este sucesso.

SCIENCE & TECHNOLOGY

AIDS in Brazil

Roll out, roll out

Jul 28th 2005 | RIO DE JANEIRO
From The Economist print edition

What can the world learn from Brazil's experience of dealing with AIDS?

IT IS no coincidence that Rio de Janeiro was chosen to host this year's Conference on HIV Pathogenesis and Treatment. Brazil's handling of the epidemic is widely regarded as exemplary. In the early 1990s, the World Bank predicted that, by 2000, HIV would have infected 1.2m Brazilians. Today, five years after that deadline, the total is just half the Bank's prediction—about 600,000. So how did Brazil do it, and can other poor countries learn from what was done?

Perhaps the first lesson is don't be squeamish. Brazil, a predominantly Catholic country, hands out free condoms in abundance. Some 20m are given away every month—a figure that is boosted by 50% in February to accommodate the exuberance of the country's famous carnivals. Drug users, too, are treated sensibly. Those who inject are offered regular supplies of clean needles and, as a result, three-quarters of them claim never to share needles with others. Nor are prostitutes neglected. Both ladies and gentlemen of the night are the targets of campaigns intended to promote condom use.

The second lesson is treat freely. Brazilian law gives all residents the right to the best available drug treatment at no cost. This is important, because having to pay discourages people from complying with the full treatment and thus encourages the emergence of drug-resistant viruses. Providing free treatment is, of course, expensive. This year, the government will spend $395m on anti-HIV drugs, almost two-thirds of it on three expensive patented drugs. This has brought it into conflict with foreign drug companies. Although it has never actually broken a drug-company patent, the government has exploited every available loophole to evade patents and buy or manufacture generic versions of drugs. For those patents that cannot legally be evaded, the government has played chicken with the patent-owners over prices, knowing that manufacturers are desperate to avoid a patent-breaking precedent that others might follow. So far, it has been the companies that have blinked, though the latest staring match, with Abbott Laboratories, an American firm, over a drug combination called Kaletra, has yet to be resolved.

The third lesson is to encourage voluntary action. In 1992, Brazil had 120 charities and voluntary groups devoted to AIDS. By the turn of the century, that had risen to 500. The virtues of voluntarism were recently confirmed when the Global Fund (the main multilateral distributor of anti-AIDS money to poor countries) audited the success of its donations. It found that spending by voluntary groups usually produced the best value for money.

The fourth lesson is to do the sums. One of the arguments that has sustained Brazil's anti-AIDS programme is “if you think action is expensive, try inaction”. The government spent $1.8 billion on anti-retroviral drugs between 1996 and 2002 but estimates that early treatment saved it more than $2.2 billion in hospital costs over the same period. Add that to the GDP loss that Brazil would have suffered if the World Bank had been right, and an aggressive programme of prevention and treatment does not seem so costly after all.

Gráfico: Disease and death.

Gráfico: Sex and sheaths.

No Brasil as campanhas de grande divulgacao promoviam o uso de preservativos sem eufemismos, metaforas, ou fabulas- simplesmente recomedavam as pessoas que os usassem! Isto tambem esta acoplado a uma distribuicao gratuita de preservativos em larga escala e varias pequenas adaptacoes locais, por exemplo os moteis do pais sao obrigados por lei a fornecerem preservativos.
As campanhas da epoca que eu ainda estava no Brasil tambem enfatizavam muito a nocao importante que pessoas saudaveis poderiam transmitir a doenca (o slogan da epoca era "Quem ve cara nao ve AIDS). Ao mesmo tempo buscou-se reduzir o estigma da doenca e a enfatizar a necessidade de se tratar os doentes com dignidade.
E este tambem e' um ponto importante: no Brasil o governo garante o tratamento gratuito aos doentes, e por isto esta sempre em pe de guerra com as grandes farmaceuticas, e todo ano ameaca simplesmente romper as patentes de diversos anti-retrovirais.

E finalmente acho que tambem foi muito importante a decisao de nao excluir nenhum grupo das iniciativas de prevencao.

SCIENCE & TECHNOLOGY

AIDS
Too much morality, too little sense

Jul 28th 2005
From The Economist print edition

Politicians must suspend moral judgments if AIDS is to be defeated

THE world is not winning the war against AIDS. By the end of this year, 3m poor people infected with HIV, the virus that causes AIDS, are supposed to be receiving the treatment they need. So far, though, barely 1m are. At present, about 40m people are living with HIV, some 5m are infected with it each year and over 3m die from it. The human and economic cost is huge. India may well have more infected people than any other country. China's epidemic has the potential to dwarf all others (see article).

In most of the world, AIDS tends to affect fairly discrete groups, usually prostitutes, homosexuals and drug addicts. In most societies these people are frowned upon. Democracies like them no more than autocracies. When it comes to receiving help from taxpayers, they are never at the top of anyone's list, especially in countries so poor that basic health care is not available to most citizens.

But if AIDS is not contained among the groups that harbour it, it spreads into the general population, as it has in Africa. There, it affects every section of the population—slum-dweller and sophisticate, peasant and professional. Everyone who engages in that near universal activity, sex, is at risk. As it is, AIDS is no respecter of morals: it affects babies as they are born, children as they are orphaned, nurses as they are accidentally pricked by a dirty needle, patients of any kind as they receive a transfusion of contaminated blood. Indeed, it affects the entire society in which its victims live and die.

It also affects the faithful wife of the unfaithful husband. That is why the ABC slogan so beloved by the Bush administration—Abstinence, Be faithful and Condoms—is, in practice, a slap in the face to many people. The President's Emergency Plan for AIDS Relief commits at least a third of its promised $15 billion to “abstinence until marriage” as the main way of stopping the spread of AIDS. It also urges that the use of condoms be confined to people who engage in “risky behaviour”—prostitutes or couples with one member who is HIV-positive. Many groups are reported to be ending or reducing their condom-promotion schemes to qualify for American money.

That might not matter if condoms did not matter, but they do. In the absence of a proper vaccine, an absence that is likely to continue for years, condoms are the best prophylactic available to anyone at risk of HIV infection through a sexual encounter, within or outside marriage (see article). Abstinence might, it is true, be better still, but abstinence will not, in the real world, be practised widely enough to bring AIDS under control. Now, in a further demonstration of its moral zeal, the Bush administration is insisting that all groups, American or foreign, that are engaged in the struggle against AIDS must declare their opposition to prostitution if they are to receive American money. The administration is also against all needle-exchange projects for drug addicts, one of the groups most likely to contract, and spread, AIDS in Russia, India and China.

The poor countries that have got on top of nascent AIDS epidemics—Brazil (see article), Thailand, Uganda and Cambodia—have done it by changing behaviour. That is no easy task, involving as it does a variety of actions across a wide front. It has proved possible because limits have been set on the endeavour: people have not been asked to act morally, merely in their own self-interest, which happens to be in the interest of society.

The lesson for rich and poor alike is that to contain AIDS morality must take second place. Politicians may find it easier to yield to sanctimonious lobbyists than to explain why refraining from judging other people makes more sense. But that does not excuse them. Too many lives are at stake.

Gráfico e artigo.

MRS: Obrigado pelo texto...

Muito rapidamente: a escolha da Nigéria não é inocente, a escolha do tema também não. Este é um paper com publicação segura porque reforça o estereótipo dos africanos sedentos de sexo e castigados com sida por causa disso. Gostava de ler o artigo todo, mas o resumo não mostra nenhum dado comparativo das adolescentes na Nigéria com, por exemplo, as de Portugal, ou dos EUA. E acho no mínimo estranho recomendações moralistas num artigo científico. Mas esta não é a minha área...