The Status of Women with HIV/AIDS in Post-Authoritarian Brazil:
The “Battle” Continues… 

José de Arimatéia da Cruz
Armstrong Atlantic State University

Laura K. Stephens
University of Kentucky

I.         Introduction
     This article discusses the HIV/AIDS pandemic in Brazil, the most populous country in Latin America and the epicenter of the pandemic accounting for 57 percent of all HIV/AIDS cases in the area. It examines how the disease impacts women and what measures are being taken by the Brazilian government to minimize the overwhelming havoc wreckage caused by this deadly pandemic of the twenty-first century. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) in its December 2007 “AIDS Epidemic Update” the estimated number of people living with HIV totals 33.2 million (30.6-36.1 million).
     In Latin America, according to the UNAIDS 2007 AIDS Epidemic Update, the estimated number of new HIV infections was 100 000 [47,000—220,000], bringing to 1.6 million [1.4 million –1.9 million] the total number of people living with HIV in the region.  Also, an estimated 58,000 [49,000—91,000] people died of AIDS in the past year.  Furthermore, according to the 2007 “AIDS Epidemic Update,” globally, more adult women (15 years or older) than ever before are now living with HIV. The estimated 15.4 million [13.9--16.6 million] women living with HIV in 2007 numbered 1.6 million more than the 13.8 million [12.7--15.2 million] in 2001. In Latin America, the proportion of women living with HIV continues to grow and there seem no signs of abatement.   Between the realms of Latin America and the Caribbean, Brazil holds one third of all persons living with the virus in Latin America (UNAIDS, 2007). The devastating impact of the scourge of HIV/AIDS is forcing Brazil’s government officials, political institutions, and civil society organizations to recognize the gravity of the problem since HIV/AIDS is now among the world’s top five leading causes of death. 
II.         Statement of the Problem
     Brazil registered its first case of HIV/AIDS in 1983. A decade later in 1992 the World Bank had estimated that by the turn of the century Brazil would have some 1.2 million people infected with HIV.  At the beginning of the twenty-first century, the Brazilian government reports that there are 620,000 people infected with HIV¹ --- much lower than the World Bank’s forecast (See Table 1). 
     Given this situation, Brazil must act quickly to curtail the spread of this deadly pandemic in order to prevent an economic, political, and social catastrophe². To effectively respond to this pandemic, Brazil must treat HIV/AIDS as both an emergency anda long-term developmental issue; governments must resist the lure to acknowledge the predictability of HIV/AIDS as just another of the world’s many problems. Due to the resolve and the easy transmission of the HIV/AIDS virus, it requires a response that is flexible, creative, energetic, and vigilant.³  HIV/AIDS is one of the greatest health catastrophes the world faces today and according to former U.S. Secretary of State Colin Powell, AIDS is the “greatest weapon of mass destruction on the earth.”⁴ Despite the characterization of HIV/AIDS as a dreadful disease, for the last 20 years only few academics and policy makers have debated the social, political, and economic impacts of HIV/AIDS.  Most have preferred to ignore and/or deny the problem completely.⁵
     Registering its first case of HIV/AIDS in 1983, Brazil became aware of this deadly pandemic that was havoc wracking societies across the globe from media accounts of the disease in Western nations, particularly the United States.  According to James A. Inciardi, Hilary L. Surratt, and Paulo R. Telles, in their book Sex, Drugs, and HIV/AIDS in Brazil, “based on those reports and the dominance of Western sexual preference designations of heterosexual and homosexual, AIDS was believed to be a disease that targeted wealthy, promiscuous, gay men.”⁶  This appalling attitude that to have HIV/AIDS was “cool” and “a sign of status” among Brazilians has led anthropologist Cristiana Bastos, in her book Global Responses to AIDS: Science in Emergency, to argue that in Brazil:

AIDS became newsworthy for the simple reason that this came from the United States, and even more so because this mysterious disease seemed to affect mostly famous people and gays, who were considered exotic… If Brazil were to have AIDS, it would mean that on some level Brazil was a developed country; after all, AIDS was a First World disease.⁷

Although the majority of those in Latin America who are infected are men, the infection gap among men and women is rapidly diminishing, leading many to assert that the disease is indeed becoming feminized. The greater rise in the number of women with HIV/AIDS compared to their male counterparts is a global concern, as indicated by UNAIDS, which found that in sub-Saharan Africa HIV positive women outnumber HIV positive men. In addition, UNAIDS found that not only are 67 percent of newly infected individuals in the developing world young people between the ages of 15 and 24 years, but 64 percent of those in this 15-24 year age group are women and girls.⁸  Brazil is also experiencing a rapid “feminization of the epidemic,” especially among young females in the largest urban centers such as São Paulo and Rio de Janeiro, where the epidemic is most severe (Table 2).
     The UNAIDS Strategy Note also points out that AIDS intensifies the “feminization of poverty,” particularly in hard-hit countries, where women are disempowered and have fewer options vis-à-vis the labor market.  Thus, when the husbands/partners die, many women descend into poverty, seeing that they alone cannot make ends meet. Knowing what we know today regarding this deadly pandemic---that those most vulnerable are typically the marginalized and poor---countries can no longer afford to view poverty (and how this impacts women in qualitatively different ways) as an issue separate from strategies to deal adequately with this disease.  Entire families are also affected when women’s time caring for the sick takes away from other productive tasks within the household.⁹
     The acknowledgment that the HIV/AIDS pandemic had finally arrived in Brazil  in the 1980s by government officials and policy makers also coincided with another event in Brazil’s history: the return of the military regime to the barracks and the “slow decompression” of democracy after twenty-one years of military rule.  Brazil’s bureaucratic authoritarian regime, which came to power in 1964 after ousting President João Goulart, was finally swept away by the “third wave”¹⁰ of democratization of the late 1980s and early 1990s.  After twenty-one years in power, the Brazilian military returned to the barracks and allowed for the democratic election by an electoral college of its first civilian president since João Goulart.  Tancredo Neves was elected by an electoral college, but prior to assuming office, was hospitalized with a severe intestinal infection from which he would not recover and consequently died. Assuming the presidency was José Sarney, a former Senator and Governor of the State of Alagoas and a strong supporter of Brazil’s military.
     It was during this transition from bureaucratic authoritarianism to democracy that HIV/AIDS arrived in Brazil and the first efforts to “combat” and “attack” this pandemic began to be implemented.  The use of the militaristic metaphorical words “combat” and “attack” to describe the actions taken by the Brazilian government to address the HIV/AIDS pandemic is not unintentional.  As Susan Sontag, in her extraordinary book Illness as Metaphor and AIDS and Its Metaphors, has pointed out, “where once it was the physician who waged bellum contra morbum, the war against disease, now it’s the whole society.  Indeed, the transformation of war making into an occasion for mass ideological mobilization has made the notion of war useful as a metaphor for all sorts of ameliorative campaigns whose goals are cast as the defeat of an enemy.”¹¹
     This mass ideological mobilization to “combat” and “attack” HIV/AIDS began with the adoption of the Constitution of 1988.  In Article 196 of the federal Constitution, universal heath care was declared a right to everyone and a responsibility of the state.¹²  Decree Law 9.313/1996 also made mandatory the free distribution of medicine to anyone infected by HIV/AIDS.  According to Susan Okie, in her article “Fighting HIV—Lessons from Brazil,” published in the New England Journal of Medicine, “health-advocacy organizations, including groups working on HIV prevention among homosexuals, commercial sex workers, and injection-drug users, regularly receive government funding for their activities.”¹³  The State of São Paulo, one of the states with the highest concentration of HIV/AIDS cases in Brazil, launched the first statewide HIV/AIDS program in the nation in 1983.
III.         HIV/AIDS and Women in Brazil: Contributing Factors to the Spread of the HIV/AIDS Pandemic
     In this section we discuss the contributing factors leading to the feminization of HIV/AIDS in Brazil.  The contributing factors can be divided into the following categories: biological, social, and cultural factors.  They are not mutually exclusive, but rather work in conjunction with each other and sometimes reinforce each other to perpetuate the relationship of power and risk of HIV infection among women in Brazil.  Those contributing factors are also reinforced by Brazil’s colonial legacy of patriarchy inherited from the Portuguese colonizers, in which there are culturally defined social roles for male and female within Brazilian society.  As Inciardi, Surratt, and Telles have pointed out, “men and women are defined in terms of their opposition—men are superior, strong, virile, violent, while women are inferior, weak, desirable, and subject to absolute domination by the patriarch.¹⁴”  This patriarchal legacy has also led to the widespread practice of gender-based violence (GBV) in Brazil, a topic later discussed in this essay.
     The United Nations estimates that 7,000 people are infected with HIV every day and that 50 percent of them are women who are young, poor, married, and infected primarily through heterosexual relations. Furthermore, socially and economically disadvantaged women show the fastest growing rates of HIV infections.¹⁵  One of the contributing factors for the closing gap between infected men and women with HIV/AIDS is the fact that women are biologically more susceptible than men to becoming infected through intercourse, according to recent studies by the United Nations Development Fund for Women (UNIFEM).¹⁶ 
     Alexandra Arriaga points out that, “microlesions can occur during intercourse more easily among women and may serve as entry point for the virus.”  Arriaga goes on to argue that, “very young women and girls, and victims of coerced sex or other forms of violence are even more vulnerable.”¹⁷  Women who are sexually and physically abused are also more likely to develop high-risk pregnancies, obstetric risk factors, adverse pregnancy outcomes, maternal deaths, and other gynecological problems including but not limited to irregular vaginal bleeding, vaginal discharge, painful menstruation, pelvic inflammatory disease, and sexual dysfunctions such as difficulty in orgasms, lack of desire, and conflicts over frequency of sex.¹⁸  In Brazil, the ratio between men and women has decreased from 26.5 infected men for each woman in 1985 to 1.5 in 2007, according to the Brazilian National STD/AIDS Program. 
     In addition to the biological factors impacting women exclusively, there are also social factors that impact women far more than their male counterparts.  In fact, in all societies there are cultural practices, institutions, and beliefs that undermine a woman’s autonomy and therefore contribute to the feminization of the HIV/AIDS pandemic, especially in patriarchal societies such as Brazil.  According to the Center for Global Development, an independent research institute for practical ideas for global prosperity, HIV/AIDS disproportionately affects women. In 2007, of young women aged 15-24 years old, 6%-11% were living with HIV, compared with 3%-6% of young men in that same age group.  The vulnerability of females to the scourge of HIV/AIDS is enhanced by several societal factors, including but not limited to, age, globalization, migration, sex industry, and drugs, alcohol and violence.  As in many parts of the developing world, a young woman’s first sexual encounter in Brazil usually occurs at a very yearly age.  According to a recent survey in the São Paulo and surrounding areas involving 7,500 youths between the ages 13-16 years old, 75 percent claimed to have used a condom during sex.¹⁹  This first sexual experience also tends to be with an older male counterpart who is usually not only more experienced but also may have had several sexual partners and is more likely to be infected. Another contributing factor for the spread of HIV/AIDS among young women is the fact that many women have little or no say in a relationship with her partner.  Thus, negotiating condom use by the husband or boyfriend is an inappropriate request, often leading the male to suspect that their partner is cheating. Even in cases where a female is aware of her husband’s or boyfriend’s unfaithfulness, her request for the husband or boyfriend to wear a condom could result in a beating or loss of financial support, since the male will automatically assume that the wife or girlfriend is the one being unfaithful. 
     Unequal employment opportunities as well as unequal access to wealth thus leading to what Jeffrey D. Sachs refers to as the “poverty trap”²⁰ is also a contributing factor in the feminization of HIV/AIDS worldwide, but especially in Brazil, which scores low on the Gini index.²¹   For instance, the top 10 percent of the wealthiest members of society receive about 47.2 percent of the total income whereas the bottom 20 percent of the population receive 2.6 percent of the total wealth of the country.²²  According to the United Nations, more than two-thirds of women worldwide are illiterate and 70 percent live in poverty, making it especially difficult to escape from dependency on their husbands or male providers.²³  The inability to escape this condition of poverty and dependency on their husband, male provider, or lover is creating a condition among females worldwide commonly referred to as “inter-generational sex” or “sugar daddy syndrome” in which older men are prepared to give money, goods or trade favors in return for sex with much younger females.²⁴ 
     Another social factor contributing to the vulnerability primarily of females to HIV/AIDS is globalization.  Simply defined as “the interconnectedness of capital, production, ideas and cultures at an increasing pace,” globalization influences every aspect of economic, social, and cultural life.²⁵  Socio-political changes in the post-Cold War international system have led to an increase in the rapid spread of HIV/AIDS thus making HIV/AIDS a global pandemic.²⁶  Disease has always been a “transnational phenomenon, which pays no heed to territorial state boundaries,” and globalization has further influenced its global spread.²⁷  While multinational firms move capital and factories around the world, people move with the availability of employment.  As the world becomes more globalized and national boarders become less important, nation-states become less capable of containing ideas, people, and money. 
     Globalization impacts sexuality in economic, cultural, and political ways.²⁸ Economic changes have caused sex to become a commodity dispersed through advertisement and the sex industry.  Cultural changes have led to a wide homogenization of ideas about sexual behavior, which may conflict with traditionally ingrained beliefs. The global movement of populations has also facilitated the spread of HIV/AIDS, especially the need for migration and urbanization in order to gain economic independence for young women. In fact, HIV/AIDS has followed population movements in the last twenty years linking the industrialized world to the Third World or developing nations.
     Populations have moved for many reasons, but in an increasingly knowledge based global market economy, relocation due to new economic opportunities and mobility has become a paramount reason.  Globalization moved markets from industrialized nations to countries with a lower level of development and thus lower wages.  Between 1980 and 1991, Brazil experienced a “rural exodus” which decimated the rural population by 15.8 million and impacted all states.²⁹  An economic recession paired with increased globalization of capital led the rural population to seek work in urban areas in search for economic prosperity and opportunity. The movement of migrant labor paired with rapid urbanization led to fundamental changes and disruption of social structures while providing “fertile conditions” for HIV to spread.³⁰  This rapidly developing knowledge based economy oftentimes leaves women behind. According to the United Nations, more than two-thirds of women worldwide are illiterate and 70% live in poverty.  These circumstances give women very little chances to leave the dependency on their husbands and make it on their own. Additionally, women that are socially and economically disadvantaged also experience the fastest growing rates of HIV infection.³¹  Poverty, lack of sexual education, and availability of healthcare reinforce already existing discrimination and social gender norms as well as violence against women.
     Furthermore, the World Bank and International Monetary Fund’s (IMF) neo-liberal policies imposed on Brazil to jumpstart its economy and promote economic development have led not to prosperity and growth, but to severe cuts in funding for social services and education.  The structural adjustment programs (SAPs), sometimes also referred to as the new tool of “neo-colonialism” in the twenty-first century, imposed on Brazil were intended to liberalize the economy by privatizing state-owned enterprises, ending import restrictions, and devaluing the national currency in exchange for IMF and World Bank loans.  However, SAPs led to a reduction in spending on primarily the social sector.  A marginalization of the already poorer classes of society was the result, as well as a further decline of their health and living standards.³²  The irony of the situation lies in the fact that while neo-liberal policies resulted in an increase in the spread of HIV/AIDS and less availability of health resources, the World Bank has in recent years given Brazil a major loan, making it possible to increase the medical services for those with HIV.³³
     While international trade and patent laws prohibited the production of drugs in a cheaper manner for a long time, recent developments in Brazil have led to progress in this area. Today, any infected person is entitled to treatment with antiretroviral drugs in Brazil.  In 2007, Brazil imposed “compulsory licensing” for the drug “Efavirenz,” which will enable the import of “unbranded copies” of the drug.   Brazil can now import the drug at a quarter of its price in exchange for paying the producer Merck a large compensation.³⁴   Neo-liberalism also causes a dilemma for the state itself if it intends to deal with HIV as a solely national problem.  Globalization paired with neo-liberal policies leads to a reduction in the importance of the state.  We are witnessing in the twenty-first century not the “end of history,” but the “end of geography” as traditional geographical boundaries become more porous and irrelevant. 
     While multinational corporations’ international capital, international agencies as well as local nongovernmental organizations (NGOs) gain influence and importance in this new globalized international system, state capacity and autonomy are being increasingly undermined and hollowed out.  At the local level, where disease control and prevention takes place, state functions are oftentimes being transferred to NGOs and international agencies, which are steered by international efforts, such as UNAIDS programs.³⁵  This leads to a parallelism of the governmental and non-governmental sectors, in which primarily the governmental sector has the financial capability and means for actively controlling the disease, installing equality in treatment and preventing discrimination.   Therefore, states need to recognize and treat the HIV pandemic as an international problem and become actively involved in transnational efforts and alliances to combat it. According to Doug Porter, this “new global cultural economy” is a “complex, overlapping, disjunctive order,” which no longer adheres to standards “of centre-periphery, inner-outer, state-border models of the past.”³⁶
     Another social factor exacerbating the spread of HIV and its impact on women in Brazil is the sex industry.  With globalization causing an increased flow of trade in sex and drugs, it also leads to the spread of HIV.  While the disease is both caused and reinforced by globalization and spread further through prostitution, the fear of the disease also alters the character of the international sex-industry and sex-trade, now often calling for even younger girls that have presumably been less exposed to STDs and HIV.³⁷ Closely intertwined with the movement of people and capital, the sex industry often blossoms in proximity of migrant labor and spreads into the most productive realms of society. The decline of state control also further facilitates the illicit sex trafficking in Brazil and in other Third World nations.  Migrant labor workers enhance the need for a supply of young girls and create a flourishing sex industry. In recent years, reports have indicated that “white slavery” and an enhanced traffic in women and girls is appearing more frequently.³⁸  Recruited from villages in the south of Pará and Maranhão States, young women are forced to work as prostitutes near mining camps and civil construction projects. They are promised high wages in the local service industry, but upon arrival they are forced into prostitution to pay off their transport fees and other debts.  The money for sexual services is usually paid directly to the brothel owners who manage the women’s “debts.” With no money and not knowing how much they own, those young women and girls are at the mercy of the brothel owners.  Mistreatment, beatings, and coerced sex are daily encounters, even with the direct involvement of local police officers.  Father Bruno Sechi, Coordinator of the Amazonian “Street Boys and Girls Movement,” states that, there is “evidence to suggest that it occurs throughout Amazonia and is deeply linked to other systems of exploitation and family disintegration in the region.”³⁹  These circumstances, paired with lack of sexual education and access to health care causes an increase in the spread of HIV, especially among commercial sex-workers and prostitutes.⁴⁰
     The research, however, is partly based on this account. While the globalization of the sex industry does contribute to an increase of the rate of infection among women, other Brazilian women are also at a high risk of infection.  Today, infection through drug-using sexual partners is an augmenting threat for heterosexual Brazilian women.⁴¹  A study conducted concerning HIV positive women in São Paulo interviewed 145 women and found that 77% of women were infected by their steady partners (current or past). More than half of the HIV/AIDS positive women could trace their partner’s status of infection back to his injection drug use.  Injection drug use (IDUs), next to homosexuality, is the highest risk factor for the contraction of HIV/AIDS.  Studies also indicate that the disease in Latin America originated in these two populations and then spread via the bisexual community increasingly into the heterosexual community.⁴²
     There is also evidence that the growing internationalization of sex and drugs combined have facilitated the spread of HIV/AIDS significantly. Habitual illicit drug consumption is becoming homogenized through globalization and can be linked to a spread of HIV/AIDS in several affected regions.  In South America, the U.S. initiated “war on drugs” has caused injection drugs to spread and replace traditional drugs consumed by smoking, such as cannabis and opium.  These drugs take up more room and are easier to detect than injection drugs, while needles are easier to hide than pipes.⁴³ Rapid urbanization, increased demand and the scarcity of clean needles have caused an increase in drug use and its side effects to become an issue of public health in Brazil, while fueling the illicit global drug market.⁴⁴
     Similar to drugs, alcohol and interpersonal violence in relationships also help further the spread of HIV.  Women, due to their physical inferiority to men and “unequal power relations,” are at a great risk of contracting HIV/AIDS through some form of sexual abuse or sexual violence.⁴⁵  Alcohol can enhance male sexual aggression and the impulse to inflict violence and transmit HIV/AIDS to the partners either male or female.  Girls and women are often unable to refuse unsafe sex and have little control over condom use negotiation, even when one partner knows of the infection and very few practice dual protection (a combination of two forms of contraception).⁴⁶ 
     Cultural institutions, beliefs, and practices undermine women’s autonomy and independence and therefore contribute to gender-based violence and the feminization of HIV/AIDS among young women in Brazil’s patriarchic society.  For the purpose of this essay, we define culture in its most “purely subjective terms as the values, attitudes, beliefs, orientations, and underlying assumptions prevalent among people in a society.”⁴⁷  Within the realm of Latin America, important cultural traditions directly impacting the feminization of HIV/AIDS are the notions of machismo and marianismo. Machismo, or maleness, is an integral part of the Latin American cultural landscape and clearly defines traditional male-female relations. Based on this concept of “machismo,” Latin American males are supposed to be assertive and their aggressiveness is tolerated, if not encouraged, while females are most often taught to not cause a commotion, not challenge authority frontally, and at least appear to be submissive. Marianismo, on the other hand, is the glorification of the traditional female role. A woman is expected to be the bastion of family honor, the submissive woman, and long-suffering family anchor.⁴⁸  According to this cultural belief system, “the family is held together spiritually and emotionally through the mother’s steadfast devotion. Women’s dedication to their families is expected to extend beyond their selfless commitment to child bearing, domestic tasks, caring for the sick and elderly, and other reproductive roles; women must also maintain their purity by remaining within the safe haven of the household.”⁴⁹ 
     The “macho culture” and traditional male behaviors of superiority are exemplified among Brazil’s truck drivers.  In a study conducted with short distance truck drivers stationed in Santos, São Paulo, Villarinho et al. found that of all 279 truck drivers interviewed, 93 percent had a stable female partner, 40 percent engaged in casual sex with females, and 19 percent said to have sex with other regular partners.  Men’s multiple sexual partners as well as the tacit approval of men’s infidelity coupled with inconsistent condom use, means in turn that females are more likely to become infected.  These gendered ideas regarding sexuality, together with men’s long periods away from home, seem to be factors in both the spread of HIV/AIDS and women’s greater vulnerability to HIV/AIDS.⁵⁰  Commercial short distance truck drivers have not only transported the HIV/AIDS virus but also transplanted it to other parts of Brazil. 
     Latin America’s culture of “machismo” and its cultural norms and values that enhance masculinity and grant unlimited power to men and authority over women also enhance gender-based violence (GBV) in Brazil.  In spite of the fact that worldwide at least one woman in every three has been beaten, coerced into sex, and gender-based violence is recognized as a major public health concern, violence against women is the least recognized form of human rights abuse in the world.⁵¹  Recognizing “the urgent need for the universal application to women of the rights and principles with regard to equality, security, liberty, integrity, and dignity of all human beings,” the United Nations General Assembly on December 20, 1993 put forward the first official definition of violence against women.  According to Article 1 of the Declaration, violence against women means:

Any act of gender-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion, or arbitrary deprivation of liberty, whether occurring in public or private life.⁵²

Gender-based violence became such an important issue of concern in the international arena in the 1990s that several key declarations, resolutions, and conferences⁵³ were held addressing the issue not only as violence against women but also within the context of a gender framework, since regardless of where and how a woman is victimized or brutalized by her male counterpart it “usually stems in part from women’s and girls’ subordinate status in society.”⁵⁴ 
     As far as Brazil is concerned regarding gender-based violence, Cecília MacDowell Santos has succinctly pointed out in her seminal book Women’s Police Stations: Gender, Violence, and Justice in São Paulo, Brazil (2005), since colonial times, the Brazilian law and justice system has legitimized, and even praised, violence against women as “normal” and deserved by the female victims who “provoke it.”⁵⁵  Violence against women impacts all women in Brazil, but the poor “favelada” or shantytown women are the most vulnerable and powerless when it comes to gender-based violence. The Brazilian “favelada” women live in a constant state of fear in the Brazilian “favelas” where the rule of the land is “I have not seen, heard, or know anything.”  Violence and crime are common events in Brazil’s “favela.” Indeed, violence in Brazil has reached its pinnacle that even the police are afraid to enter Rio’s “favelas” where criminals are better armed than the police themselves.  The Brazilian “favelados” are usually considered by the Brazilian elite to belong to a class of undesirables therefore any form of violence against this group usually blamed for the waves of violence and crimes in Brazil is not only allowed, but also encouraged by the Brazilian population.    
     The “favelas” environment of anarchy and the “unrule of law” not only perpetuates violence against women but also justifies violence as a means to control ordinary crime in poor neighborhoods, and the victims come from the most vulnerable groups in society—the poor, the homeless, women, and those of African descent.  Furthermore, such acts of violence and even killings receive broad support not only from the elites but also from the poor.  According to James A. Inciardi et al., it is well known in Brazil that some police officers routinely raid the “favelas” to humiliate its residents, and sexually brutalize the “favela” women who they see as “putas” (whores) who are there to serve them.⁵⁶  In this culture of fear and violence in which masculine superiority is paramount and the “unrule of law” prevails, the state of São Paulo, under the governorship of Franco Montoro, established the Conselho Estadual da Condição Feminina in 1983 (State Council on the Feminine Condition or CECF) to design gender-based public policies and in 1985 established the world’s first delegacia da mulher (women’s precinct).  According to Santos, “the creation of this unprecedented police station was a direct response to the feminist critique that policemen in regular police stations were sexist and did not take women’s complaints of violence against them seriously.”⁵⁷  The issue of gender-based violence (GBV) must be dealt with not only as a matter of human rights but also as an issue of public health and development since harmful gender-based cultural norms and practices, perpetuate women’s and men’s vulnerability to HIV/AIDS.⁵⁸
     In addition to this cultural tradition of “machismo,” another major problem in Latin America serving to justify and legitimize violence against women and the perpetuation of the feminization of poverty and HIV/AIDS is cultural attitudes toward female’s chastity and male honor.⁵⁹  According to Population Reports, in many parts of Latin America as well as the Middle East, a man’s honor is often linked to the sexual “purity” of the women in his family, therefore, if a woman is “defied” sexually—either through rape or by engaging voluntarily in sex outside of marriage—she disgraces the family honor.⁶⁰  The ultimate penalty for such hasty behavior and soiling of the family’s name and honor is nothing short of death. Another important cultural element preventing women as well as men from seeking to find out his or her serotype status is the stigma and discrimination usually attached with one being known to have a seropositive status. In most Latin American countries men who have been infected with HIV/AIDS through sexual contact will rarely admit it. They are more likely to attribute their infection to transmission from female prostitutes rather than sexual contact with other men.⁶¹  In fact, many men who have sex with men (MSM) will make a clear distinction between the male that is “penetrated” and the man that is the “penetrator,” since to be the “penetrator” means that you are in control therefore you are not gay or homosexual. “Penetrators” are on the giving side rather than the taking end, simply enjoying sex. In doing so, they wish to avoid the stigma and guilt associated with the term de risco (of risk; at risk) which often leads to ostracism from family, friends, community, and even loss of job.⁶²
  IV.         Brazil’s HIV/AIDS Response: Moving Closer to Curbing HIV/AIDS
     In 1992, the World Bank estimated that by the turn of the century approximately 1.2 million Brazilians would be infected with HIV/AIDS. Confronting the possibility of having 1.2 million Brazilians infected with HIV/AIDS and an apocalyptic future, the Brazilian government, together with civic and international organizations, has set the standard for governmental health policies in the early twenty-first century. The Brazilian federal government has declared universal health care a right for everyone and a responsibility of the state, under the Constitution’s Article 196. Furthermore, Decree Law 9.313/1996 has also made mandatory the free distribution of medicine to anyone infected with HIV/AIDS.⁶³ 
     The Brazilian national media has also played an important role in the fight against HIV/AIDS. The media cannot be ignored, especially where one finds near-universal access to television, thus making it a major force in shaping the attitudes and aspirations of the population.  The Sistema Rede Globo de Televisão (TV Globo), under the leadership of the late Sr. Roberto Marinho, reaches nearly eighty percent of Brazil’s populace.  Its signal is picked up by 95.5 percent of Brazil’s 5,507 municipalities scattered across a territory comprising twenty-seven states covering over 8.5 million square kilometers. Throughout the day, during its regularly scheduled programming, TV Globo constantly tells the Brazilian public, “A Ciência esta fazendo sua parte. Faça você tambêm a sua. Use camisinha.  Todos contra a AIDS” (“Science is doing its part, now do yours. Wear a condom! Everyone against the HIV/AIDS virus”).⁶⁴  On November 27 2007, the Brazilian government launched its newer media campaign against HIV/AIDS. The campaign includes two movies running thirty-seconds each, a forty-five second radio spot, and one hundred and two thousand billboards spread across the country with the slogan, “Sua atitude tem muita força na luta contra a Aids,” (Your attitude is a strong force against AIDS).⁶⁵   This is a significant improvement over Brazil’s media campaign against HIV/AIDS in the early 1980s which can best be characterized as stigmatizing, threatening, and ineffective.⁶⁶ 
     The media has also played an important role in the fight against HIV/AIDS due to its ability to recruit Brazil’s rich and famous (pop-singers, soccer players, soap-opera stars, etc.) to become HIV/AIDS campaign spokespersons. For example, in 2003 the Ministry of Health (MoH) in its effort to promote condom use among Brazil’s most vulnerable segment of the population to HIV/AIDS, females aged 13-19 years, during the Carnival celebration contracted Kelly Key, a popular Brazilian singer, to become the spokesperson for the “Carnival Campaign.”⁶⁷  Kelly Key’s message, according to Susan Okie, to her high-school aged fans was startlingly forthright and to the point, “Show how you’ve grown up. This Carnaval, use condoms.”⁶⁸ 
     The Brazilian government has also expanded its efforts to fight this deadly pandemic by collaborating with commercial sex-workers (CSWs) who freely walk Brazil’s famous Copacabana beach sidewalk offering their services to foreigners and Brazilians alike, to eradicate the stigmatization, violence, and shame associated with HIV/AIDS.  The government has assumed a more proactive role in preventing the spread of HIV/AIDS among both female and male CSWs working the streets, clubs, and casa de sauna (commercial bathhouses).  Personal information campaigns have provided direct and accessible information to high-risk groups.  During the Carnival celebration this year (2007), the Ministry of Health (MoH) not only distributed condoms in Rio de Janeiro’s Vila Mimosa, a red-light district, but also distributed pamphlets at local bus stops advertising a fictional character known as “Maria Without Shame,” a cartoon prostitute who reminds commercial sex workers to take pride in their jobs and tells people that condoms should be used without guilt.⁶⁹ 
     The Brazilian government has also effectively been fighting the international patent monopolies of pharmaceutical companies.  When the World Trade Organization was established in 1995, it was created on three pillars: the agreement on Trade-Related Intellectual Property Rights (TRIPS), the new General Agreement of Trades in Services (GATS), and the new General Agreement on Tariffs and Trade for goods (GATT).⁷⁰  The TRIPS agreement is a comprehensive international consensus on the protection of intellectual property rights and encompasses seven major areas of intellectual property.  Pharmaceuticals are protected under patents, which are “legal titles granting the owner the exclusive rights to make commercial use of the invention.”⁷¹  
     However, the TRIPS agreement has allowed powerful pharmaceutical monopolies by protecting the production rights of very urgently needed drugs and at the same time discouraging much needed competition. Pharmaceutical companies have tried to maintain equal drug prices in developed and developing nations, disregarding the extreme gap in per-capita income levels between the two separate and unequal worlds.  Pharmaceutical companies fear the demand for cheaper drugs by consumers in developed countries, if those same drugs were offered at lower prices in developing nations.  This leads to the comparably high prices of essential drugs that developing nations cannot afford to pay.⁷² 
     Because the prices for, as well as the standards of protection under the TRIPS agreement are set at industrial nations’ standards, it has become increasingly difficult and expensive for developing nations, such as Brazil, to implement the agreement through national laws. Especially the field of patent law is a novelty for many developing nations and they have helped themselves on this field, by using legal mechanisms like compulsory licensing to encourage new innovations and limit the amount of patents on the pharmaceutical field.⁷³ Compulsory licensing allows the production and use of generic drugs without the permission of the patent holder. Article 31 of the TRIPS agreement lets countries issue such licenses for a few reasons, one of which is “national emergencies.”⁷⁴ In cases of non-commercial public use, these nations do not need to negotiate the circumstances with patent holders prior to the issue of drugs. However, some form of compensation needs to be paid to the drug producer and patent holder.⁷⁵
     According to the UK-based HIV and AIDS charity AVERT, Brazil first started making antiretroviral drugs universally available in small quantities in 1991.  In 1996, a new revolutionary drug named HAART was made accessible to all who needed it.  By 2005, around 180,000 or 85% of all infected Brazilians were receiving pharmaceuticals to alleviate their symptoms.⁷⁶  This high percentage is comparable to the coverage that developed nations usually achieve. 
     The key to Brazil’s success lies in its domestic production of the necessary drugs.⁷⁷ An industrial property law passed in 1996 allows the copying of a patented drug under issued compulsory licenses if the patent “is not worked in the territory of Brazil.” In other words, to receive full protection under Brazilian patent laws, the patent holder must work the patent in Brazil. ⁷⁸  On one hand, some of the produced antiretroviral drugs were patented before the TRIPS agreement in 1996 and can be legally copied and generically produced in Brazil.  Other drugs, however, have to be acquired on the international market.  The Brazilian government has placed pressure on some pharmaceutical companies to reduce prices, by threatening to issue compulsory licenses if the companies do not comply.  Even though it could lead to substantial damage in the trade relations between Brazil and the international pharmaceutical companies, Brazilian President Luis Inacio “Lula” da Silva declared in 2007, that compulsory licenses would be issued to create a lower cost version of the antiretroviral drug Efavirenz, until then produced by the company Merck, because a low enough price could not be negotiated in trade talks.⁷⁹
     Brazil has long been led by the positive side-effect of saving money in its battle against HIV/AIDS.  In 2002, the Ministry of Health estimated to having saved more than US$ 1.1 billion in HIV/AIDS related hospitalizations, due to the widespread availability of antiretroviral drugs.  It is also estimated that the president’s current plan to issue compulsory licenses will save the government US$240 million by the year 2012.⁸⁰ This current plan, however, has provoked positive as well as negative responses from the public and pharmaceutical companies. On one hand, human rights and AIDS activists approve and praise the government’s decision, while the pharmaceutical companies criticize the move as being counter-productive for the AIDS drug research by discouraging investment in that area out of fear of not receiving a rightful compensation for pharmaceutical developments.
     Brazil’s patent laws have triggered a heated dispute with the United States.  The United States criticized Brazil’s pharmaceutical policies and saw itself as speaking on behalf of developed nations.  This is not surprising since international statistics show a predominance of intellectual property ownership in the hands of developed nations, which play a substantial role in the international global economy.⁸¹  In 2000, the United States filed a complaint against Brazil before the World Trade Organization (WTO) claiming Brazil was in violation of its obligations under the TRIPS agreement and undermined the intellectual property rights of pharmaceutical companies.⁸²  Brazil’s response was that western drug companies could easily afford to lower their prices and the profits they achieved in developed countries alone would be incentive enough to continue drug research and production.  The United States eventually dropped its complaint also due to pressure by the United Nations. ⁸³
V.         Conclusion
     The purpose of this paper has been to examine Brazil’s attempts to battle the spread and devastating impact of HIV/AIDS.  Brazil has come a long way since the World Bank’s 1992 prediction that by the turn of the century its rate of infection would be approximately 1.2 million people. The Brazilian government has taken positive steps in the fight against HIV/AIDS with declaring universal health care a right for everyone under its Constitution Article 196 and passage of Decree Law 9.313/1996, which has made mandatory the free distribution of medicine to anyone infected with HIV/AIDS.  Several social programs and media campaigns despite the deeply ingrained culture of masculine superiority and machismo have also targeted the feminization of HIV/AIDS.  Brazil has worked closely with commercial sex workers (CSWs) and men who have sex with men (MSMs) rather than criminalized or stigmatized those segments of the population most vulnerable to the disease.  An effective media campaign has also been launched by the government in its efforts to fight this deadly disease and to raise collective consciousness and awareness within the Brazilian population.  Despite the impressive efforts, the disease continues to have a devastating impact on Brazil’s population, primarily its youth, aged 15-24. Therefore, it is incumbent upon the government to double its accomplishments in order to eradicate this deadly disease of the twenty-first century.

1. There is some conflicting data available regarding the exact number of people who are HIV/AIDS in Brazil due to underreporting cases and fear of stigmatization and discrimination by those who admit to be carrier of this deadly virus.
2. For an excellent discussion of the growing impact of HIV/AIDS on a nation’s economic, social, and political areas see the articles written by Stefan Elbe in the International Security, Vol. 27, No. 2 (Fall 2002)entitled HIV/AIDS and the Changing Landscape of War in Africa and Andrew Price-Smith, Steven Tauber and Anand Bhat in the Seton Hall Journal of Diplomacy and International Relations Vol. V, No. 2 (Summer/Fall 2004) entitled State Capacity and HIV Incidence Reduction in the Developing World: Preliminary Empirical Evidence.
3. UNAIDS, 2004 Report on the Global AIDS epidemic. 4th Global Report, 13.
4. Powell Presses AIDS Fight, Fox News Channel, available at http://www.foxnews.com.  Accessed on 8/24/2004.
5. Barnett, Tony, and Alan Whiteside, AIDS in the Twenty-First Century: Disease and Globalization (New York: Palgrave Mcmillan, 2002), 5.
6. Inciardi, James. A., Hilary L. Surratt, and Paulo R. Telles, Sex, Drugs, and HIV/AIDS in Brazil(Colorado: Westview Press, 2000), 39.
7. Bastos, Cristiana. Global Responses to AIDS: Science in Emergency. (Bloomington: Indiana University Press, 1999), 70.
8. UNAIDS, 2004 Report on the Global AIDS epidemic. 4th Global Report, 4.
9. Ibid., 4.
10. According to Samuel P. Huntington, in his book The Third Wave: Democratization in the Late Twentieth Century (1991), a wave of democratization is a group of transitions from non-democratic to democratic regimes that occur within a specified period of time and that significantly outnumber transitions in the opposite direction during that period of time.  A wave also usually involves liberalization or partial democratization in political systems that do not become fully democratic.  Three waves of democratization have occurred in the modern world: the first wave had its roots in the American and French revolutions; the second wave started in the aftermath of World War II; and the third wave begins with the fall of the Portuguese dictatorship in 1974.
11. Susan Sontag. Illness as Metaphor and AIDS and Its Metaphors. (New York: Picador USA, 2001), 98-99.
12. Constituicao da Repulica Federativa do Brasil, Article 196 Available at http://www.planalto.gov.br/ccivil_03/Constituicao/Constitui%C3%A7ao.htm. Accessed October 12, 2007
13. Susan Okie. Fighting HIV—Lessons from Brazil, The New England Journal of Medicine May 11, 2006,  Vol. 354, Iss. 19, pg. 1977-1982.
14. Inciardi, James. A., Hilary L. Surratt, and Paulo R. Telles, Sex, Drugs, and HIV/AIDS in Brazil(Colorado: Westview Press, 2000), 31.
15. Alexandra Arriaga. HIV/AIDS and Violence Against Women, Human Rights (Summer 2002): 18
16. Ibid., 18
17. Ibid., 18
18. Impact on Women’s Reproductive Health, Population Report December 1999, Vol. 27, Issue 4, p. 113.
19. Aumenta casos de AIDS entre as meninas [Increases the number of AIDS among females] Available at http://fantastico.globo.com/Jornalismo/Fantastico/0,,AA1663011-4005,00.html. Accessed on November 27, 2007.
20. Jeffrey D. Sachs The End of Poverty: Economic Possibilities for Our Time. New York: New York, 2005: 56, 248.
21. According to the United Nations Development Report 2006, the Gini index measures the extent to which the distribution of income (or consumption) among individuals or households within a country deviates from a perfectly equal distribution.  A value of zero (0) represents perfect equality, a value of one hundred (100) perfect inequality.  Brazil’s Gini index stands at 58.
22. David de Ferranti, Guillermo E. Perry, Francisco H.G. Ferreira, and Michael Walton. Inequality in Latin America: Breaking with History? (Washington, D.C.: The World Bank, 2004): 2.  The quotient is the Gini coefficient, a measure of inequality in a socieity. For a perfectly distribution the Gini coefficient is zero whereas for an imperfect Gini coefficient would be one. 
23. Alexandra Arriaga. HIV/AIDS and Violence Against Women, Human Rights (Summer 2002): 18
24. Nthabiseng Phaladze and Sheila Tlou, Gender and HIV/AIDS in Botswana: a focus on inequalities and discrimination, Gender & Development Vol. 14, No. 1 (March 2006): 2335; Mohga Kamal Smith, Gender, Poverty, and Intergenerational vulnerability to HIV/AIDS, Gender& Development, Vol. 10, No. 3 (November 2002): 63-70
25. Kennedy, Paul, Forecast: Global Gales Ahead, New Statesman & Society (31 May 1996): 28.
26. Altman, Dennis. Globalization, political economy, and HIV/AIDS, Theory and Society August 1999, Vol.28, Iss. 4, pg. 560.
27. Thomas, Caroline, On the Health of International Relations and the International Relations of Health, Review International Studies 15 (1989):273.
28. Altman, Dennis. Globalization, political economy, and HIV/AIDS, Theory and Society August 1999, Vol.28, Iss. 4, pg. 563.
29. Perz, Stephen G. The Rural Exodus in the Context of Economic Crisis, Globalization and Reform in Brazil. International Migration Review, Vol.34, No. 3 (Autumn 2000), pg. 872.
30. Lee, Kelley and Anthony B. Zwi. A global political economy approach to AIDS: Ideology, Interests and Implications, New Political Economy Nov 1996, Vol.1, Iss.3, pg.359.
31. Arriaga, Alexandra. HIV/AIDS and Violence Against Women, Human Rights (Summer 2002): 18.
32. Lee, Kelley and Anthony B. Zwi. A Global Political Economy Approach to AIDS: Ideology, Interests and Implications, New Political Economy Nov 1996, Vol.1, Iss.3, pg.359.
33. Altman, Dennis. Globalization, political economy, and HIV/AIDS, Theory and Society August 1999, Vol.28, Iss. 4, pg. 574.
34. A Conflict of Goals; Brazil’s AIDS Programme. The Economist, May 12 2007, U.S. Edition.
35. Altman, Dennis. Globalization, Political Economy, and HIV/AIDS, Theory and Society August 1999, Vol.28, Iss. 4, pg. 579.
36. Porter, Doug, A Plague on the Borders, In L. Manderson and M. Jolley, Sites of Desire/Economies of Pleasure (Chicago: University of Chicago Press, 1997).
37. Altman, Dennis. Globalization, Political Economy, and HIV/AIDS, Theory and Society August 1999, Vol.28, Iss. 4, pg. 564.
38. Forced Prostitution of Women and Girls in Brazil. Anti-Slavery International, Focus on Gender, Vol.1, No.2, (Violence; Military and Civilian Strife). (June 1993), pg.40.
39. Forced Prostitution of Women and Girls in Brazil. Anti-Slavery International, Focus on Gender, Vol.1, No.2, (Violence; Military and Civilian Strife). (June 1993), pg.41.
40. Sabatier, Renee. HIDS in the Developing World. International Family Planning Perspectives, Vol.13, No. 3. (Sep. 1987), pg.98.
41. Santos, Ventura-Filipe and Paiva. HIV Positive Women, Reproduction and Sexuality in Sao Paolo, Brazil. Reproductive Health Matters, Vol.6, No. 12, Sexuality. (Nov., 1998), pg. 33.
42. MacQueen, Kathleen M. The Epidemiology of HIV Transmission: Tends, Structure and Dynamics. Annual Review of Anthropology, Vol.23 (1994), pg. 512.
43. Wodak, Alex. Health, HIV Infection, Human Rights, and Injection Drug Use. Health and Human Rights. Vol.2, No.4 (HIV/AIDS and Human Rights. Part I: The Roots of Vulnerability). (1998), pg. 29 ;  Altman, Dennis. Globalization, Political Economy, and HIV/AIDS, Theory and Society August 1999, Vol.28, Iss. 4, pg. 564.
44. Naim, Moises. Illicit. How Smugglers, Traffickers and Copycats are Hijacking the Global Economy.  New York: Anchor, 2005. pg 72.
45. Smith, Mogha Kamal. Gender, Poverty, and Intergenerational Vulnerability to HIV/AIDS. Gender and Development Vol.10, No.3, Poverty. (Nov. 2002), pg.64.
46. Santos, Ventura-Filipe and Paiva. HIV Positive Women, Reproduction and Sexuality in Sao Paolo, Brazil. Reproductive Health Matters, Vol.6, No. 12, Sexuality. (Nov., 1998), pg. 35.
47. Lawrence E. Harrison and Samuel P. Huntington (eds.) Culture Matters: How Values Shape Human Progress.  New York: New York, 2000: xv.
48.   Harry E. Vanden and Gary Prevost, Politics in Latin America: The Power Game 2nd ed. New York: Oxford University Press, 2006, p. 116.
49. Mary Vaughn, Women, Class, and Education in Mexico, 1880-1928, in Women in Latin America, William Bollinger et al. Riverside, California: Latin American Perspectives, 1979: 63-80.
50. Villarinho, Luciana, Ivanilda Bezerra, Regina Lacerda, Maria do Rosario Dias de Oliveira Latorre, Vera Paiva, Ron Stall, and Norman Hearst, Caminheiros de rota curta e sua vulnerabilidade ao HIV, Santos, SP, Rev. Saude Publica 2002; 36(4 Supl.): 61-7.
51. The World Takes Notice, Population Report, Vol. 27, Issue 4 (December 1999):1; Ending Violence Against Women, Population Reports Vo. 27, Issue 4, (December 1999): 1.
52. United Nations General Assembly, A/RES/48/104 85th Plenary meeting, 20 December 1993, Declaration on the Elimination of Violence against Women, Available at http://www.un.org/documents/ga/res/48/a48r104.htm. Accessed on November 28, 2007.
53. In addition to the 1993 UN General Assembly Declaration on the Elimination of Violence Against Women, other important meetings addressing violence against women are: 1994 International Conference on Population and Development (ICPD) in Cairo; 1995 Fourth World Conference on Women in Beijing; 1994 the Inter-American Convention to Prevent, Punish and Eradicate Violence Against Women; 1996 49th World Health Assembly just to name a few.
54. Population Report Vol. 27, Issue 4 (December 1999): 2
55. Cecilia MacDowell Santos Women’s Police Stations: Gender, Violence, and Justice in Sao Paulo, Brazil.  New York: Palgrave MacMillan, 2005: 3.
56. Inciardi, James. A., Hilary L. Surratt, and Paulo R. Telles, Sex, Drugs, and HIV/AIDS in Brazil(Colorado: Westview Press, 2000): 87
57. Cecilia MacDowell Santos Women’s Police Stations: Gender, Violence, and Justice in Sao Paulo, Brazil.  New York: Palgrave MacMillan, 2005: 1-2.
58. President’s Emergency Plan for AIDS Relief : Report on Gender-Based Violence and HIV/AIDS, November 2006, Report to Congress Mandated by House Report 109-152, Accompanying H.R. 3057, Submitted by the Office of the U.S. Global AIDS Coordinator, U.S. Department of State.  Available at http://www.state.gov/documents/organization/76447.pdf.   Accessed on November 25, 2007.
59. Population Report Vol. 27, Issue 4 (December 1999): 6
60. Ibid., 6.
61. Bastos, Cristiana. Global Responses to AIDS: Science in Emergency. (Bloomington: Indiana University Press, 1999), 25.
62. Ibid., 25.
63. Brazil’s Rede de Direitos Humanos (RDH—Human Rights Network); Programa de Alternativas Assistenciais (PAA—Supporting Alternatives Program); Servico de Assistencia Especializado (SAE -- Specialized Assistance Service); Assistencia Domicilar Terapeautica (ADT—Therapeutic Home Assistance); Saude na Escola (Health at School); Dial Health/Ask About HIV/AIDS program.
64. Jose de Arimateia da Cruz, Becky K. da Cruz, and Corie Hammers, HIV/AIDS: The Pandemic Hits the Sleeping Giant, International Social Science Review, Vol. 82, Numbers 1 & 2, 2007: 63
65. Familia participa de campanha de prevencao da aids, Em Questao, Editado pela Secretaria de Comunicacao Social da Presidencia da Republica, No. 574, Brasilia, 28 de novembro de 2007.
66. Karen Giffin and Leticia Legay Vermelho, Brazil, in HIV and AIDS: A Global Viewed. Karen McElrath (Westport, CT: Greenwood Press, 2002): 18.
67. Susan Okie. Highting HIV--Lessons from Brazil,_ The New England Journal of Medicine May 11, 2006,  Vol. 354, Iss. 19, pg. 1977-1982; Mauro Pereira Porto, Lutando contra a AIDS entre meninas adolescents: os efeitos da Campanha Carnval de 2003 do Ministerio da Saude do Brasil [The fight against AIDS among adolescents girls: the impact of the 2003 Carnival campaign by the Brazilian Ministry of Health] Caderno de Suade Publica Vol. 21, Issue 4 (July-August 2005): 1234-1243.
68. Susan Okie. Highting HIV--Lessons from Brazil, The New England Journal of Medicine May 11, 2006, Vol. 354, Iss. 19, pg. 1977-1982.
69. Monte Reel, Where Prostitutes Also Fight AIDS, Available at http://www.washingtonpost.com/wpdyn/content/article/2006/03/01/AR2006030102316.html.  Accessed on November 29, 2007.
70. Lanoszka, Anna. The Global Politics of International Property Rights and Pharmaceutical Drug Policies in Developing Countries, International Political Science Review Vol. 24, No.2, The Politics of Health Politics. (Apr. 2003), pg. 183.
71. Lanoszka, Anna. The Global Politics of International Property Rights and Pharmaceutical Drug Policies in Developing Countries, International Political Science Review Vol. 24, No.2, The Politics of Health Politics. (Apr. 2003), pg. 184.
72. Ibid., pg. 182.
73. Ibid., pg. 184.
74. Thomas, Caroline. Trade Policy and the Politics of Access to Drugs. Third World Quarterly, Vol.23, No.2, Global Health and Governance: HIV/AIDS (Apr. 2002), pg.254. Kremer, Michael. Pharmaceuticals and the Developing World,  The Journal of Economic Perspectives, Vol.16, No.4 (Autumn 2002), pg.74.
75. Thomas, Caroline. Trade Policy and the Politics of Access to Drugs. Third World Quarterly, Vol.23, No.2, Global Health and Governance: HIV/AIDS (Apr. 2002), pg.255.
76. Pembrey, Graham. HIV/AIDS in Brazil. Available at  http://www.avert.org/aids-brazil.htm Accessed on Nov 27, 2007;  Thomas, Caroline. Trade Policy and the Politics of Access to Drugs. Third World Quarterly, Vol.23, No.2, Global Health and Governance: HIV/AIDS (Apr. 2002), pg.257.
77. Pembrey, Graham. HIV/AIDS in Brazil. Available at  http://www.avert.org/aids-brazil.htm Accessed on Nov 27, 2007
78. Lanoszka, Anna. The Global Politics of International Property Rights and Pharmaceutical Drug Policies in Developing Countries, International Political Science Review Vol. 24, No.2, The Politics of Health Politics. (Apr. 2003), pg. 189.
79. A Conflict of Goals; Brazil’s AIDS Programme. The Economist, May 12 2007, U.S. Edition
80. Pembrey, Graham. HIV/AIDS in Brazil. Available at  http://www.avert.org/aids-brazil.htm Accessed on Nov 27, 2007
81. Lanoszka, Anna. The Global Politics of International Property Rights and Pharmaceutical Drug Policies in Developing Countries, International Political Science Review Vol. 24, No.2, The Politics of Health Politics. (Apr. 2003), pg.182.
82. Lanoszka, Anna. The Global Politics of International Property Rights and Pharmaceutical Drug Policies in Developing Countries, International Political Science Review Vol. 24, No.2, The Politics of Health Politics. (Apr. 2003), pg. 186. Pembrey, Graham. HIV/AIDS in Brazil, Available at  http://www.avert.org/aids-brazil.htm Accessed on Nov 27, 2007
83. Pembrey, Graham. HIV/AIDS in Brazil, Available at  http://www.avert.org/aids-brazil.htm Accessed on Nov 27, 2007.

Table 2:
Number of Cases among Females per Year and by Age Distribution, 1983-2003