Uma história global e brasileira da Aids, 1986-2021

Anyone with a general notion of the transnational history of AIDS knows about the Brazilian activists and certain public health officials who played a key role in framing policies about patients’ access to informed medical care, inexpensive lifesaving antiretroviral drugs, and full civil rights. This pioneering work was not inevitable. Ebullient and sensual Carnival festivities have projected an international image of Brazilians as fun-loving, sexually positive revelers living in a supposedly tolerant society where nonnormative sexualities and gender representations are acceptable. However, centuries of traditional Catholic teaching on the immorality of homosexuality, combined with pervasive traditional notions of appropriate gender roles, within the context of an authoritarian military dictatorship (1964–85) and a conservative transition to democracy, could have easily resulted in a very difficult outcome. Although numerous scholars have carefully documented the history of the Brazilian movement's proactive work in favor of people living with HIV/AIDS, few studies have linked those efforts to global campaigns or emphasized the influence of Brazilians on these campaigns.The book under review, by two specialists in the history of science from the internationally acclaimed Oswaldo Cruz Foundation in Rio de Janeiro, seeks to fill this gap by presenting these intertwined stories. The volume begins by outlining the challenges facing people living with HIV/AIDS and the health workers who advocated for them during the 1980s, when the first postdictatorial governments ignored the issue and Brazil seemed doomed to becoming the country in Latin America and the Caribbean with the largest number of people infected with the virus. Widespread misinformation about the disease and notable discrimination against gay men, who were seen as responsible for their own illness and the disease's spread, served as initial barriers. Gay activism in Brazil was less than five years old when news of AIDS began appearing in the country's press. Still, key players both in the movement and within the public health system understood that combating homophobia and related discriminations was essential for developing effective strategies to educate the public and treat those with health problems derived from the virus.The first chapter tells the story of how between 1987 and 1996 an alliance of AIDS activists and sectors of the public health movement (sanitaristas) confronted the indifference of the first postdictatorship governments. They took advantage of the campaign to include the right to universal health care in the 1988 constitution in order to demand a robust official response to the pandemic. Despite ongoing tensions between some activists and the government health bureaucracy, by 1996 international support from the Ford Foundation and the World Health Organization's Special Program on AIDS provided the resources to carry out effective education and prevention campaigns, in which gay men and transgender people were actively involved, as well as HIV testing and training for health-care workers. In that year the Brazilian government also decided to push for universal access to antiretroviral drugs in order to reduce the disease's replication.According to the authors, from 1996 to 2007 Brazil's policies were disseminated worldwide, leading Brazilian activists and health-care specialists to play a crucial role in the international campaigns to address AIDS from a global perspective. Although other countries attempted to follow Brazil's model, these replication attempts were largely unsuccessful because there was not the political will to confront the powerful pharmaceutical companies regarding patent infringements or the conservative religious forces that insisted on the marginalization of homosexuals. Moreover, the economic crisis that unfolded in 2008–9 resulted in a hike in drug prices that diminished the possibilities of worldwide universal drug accessibility.The period from 2007 until the election of extreme-right politician Jair Bolsonaro as president in late 2018 saw a significant retreat in international and national efforts to control the disease and address the health issues of those living with HIV/AIDS. In Brazil, the delayed onset of the international economic crisis, President Dilma Rousseff's impeachment in 2016, and the rise to power of conservative, neoliberal forces committed to reducing the state's role in addressing social issues all helped weaken the attempts to use the pandemic to strengthen the country's public health system.The book also meticulously describes how Brazilian activists—such as former medical student and guerrilla leader Herbert Daniel and public health specialist Dr. Paulo Teixeira, who essentially founded the state-run AIDS program in São Paulo—advocated in Brazil and international venues, bringing the knowledge, skills, and determination of representatives of the global South to meetings, conferences, and agencies that had largely focused on issues of the global North.An epilogue documents the disastrous policies of President Bolsonaro in response to COVID-19, which mirrored his indifference or hostility to those advocating for LGBTQIA+ and gender rights and for AIDS education and prevention campaigns, as evangelical Christians and other ultraconservative forces gained significant influence in the new government.Although the international articulations described in the book were more temporary than permanent interventions in global AIDS bureaucracies, Brazilian contributions to forging a transnational health movement placed patients at the center of advocacy and focused their pressure and criticism on indifferent governments or international agencies. It is an important story to tell

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