Brazil Is Not America

I have been listening in on an email discussion about this New York Times article: Prostitution Puts U.S. and Brazil at Odds on AIDS Policy. The story isn't new, but this is a well-written look at it.

Brazil was beginning to suffer an AIDS epidemic. The United States said, no problem, we'll give you forty million dollars to fight it. But, uh, one thing. You have to issue a statement denouncing prostitution.

Well, in Brazil prostitution is legal. I'm not saying whether that's a good thing or not, but, at the least, they're different from us about that. I'm not saying we're a country of uptight puritans, but ...

In their baseball caps and T-shirts adorned with a rose in the shape of a heart, they are a familiar and welcome presence in the red-light district on the outskirts of downtown here. For years now, they have been distributing condoms to the prostitutes who work the streets, part of the Brazilian government's larger effort to hold AIDS in check.

Until recently, the condom campaign of the group called Fio da Alma had been partly financed through the United States Agency for International Development. But no longer: rather than comply with an American demand that all foreign recipients of AIDS assistance must explicitly condemn prostitution, Brazil has decided to forgo up to $40 million in American support.

"Our feeling was that the manner in which the Usaid funds were consigned would bring harm to our program from the point of view of its scientific credibility, its ethical values and its social commitment," Pedro Chequer, director of the Brazilian government's AIDS program, said in an interview in Brasilía. "We must remain faithful to the established principles of the scientific method and not allow theological beliefs and dogma to interfere."

Experts here and abroad say the disagreement over how to deal with prostitution is symptomatic of a larger conflict between Brazil and the United States over AIDS policy. Brazil, which spends more than $400 million annually on what is regarded as the most successful AIDS program in the developing world, is taking a pragmatic approach in combating the global epidemic, the experts say, while the United States, increasingly, is not.

"It's not as if you're choosing between two neutral policy programs," said Chris Beyrer of the Center for Public Health and Human Rights at the Johns Hopkins Bloomberg School of Public Health. "Brazil has good data to show that their approach works, and to ask them to change that, even if they get the additional money, to one for which there is no evidence, just because of moral squeamishness in the United States, is an extraordinary position to take."

This might remind you of a particular stand-off regarding a certain sex-ed curriculum in a certain suburban-DC county in Maryland. You have one side that wants to deal with an issue directly, and one side that hopes everyone will grit their teeth, exercise their willpower, and make the problem go away. "Moral squeamishness," yes, that rings a bell.

Does Brazil's approach to the AIDS epidemic work?

One gauge of Brazil's success in confronting AIDS is to compare the situation here with that of other developing countries, many of which have sent delegations to study the Brazilian program. In 1990, for example, Brazil and South Africa had roughly the same rate of prevalence of H.I.V. among their adult populations, just over 1 percent.

Today, some studies indicate that 20 percent or more of South African adults of reproductive age are infected with H.I.V. or have AIDS, an estimated total of more than 5 million of the country's 44 million people. In Brazil, in contrast, the rate has dropped nearly by half, and the number of patients being treated has held steady, at about 600,000 out of a total population of 180 million.

"They attempted to take out the stigma and practice safe sex so as to prevent the epidemic from expanding, and in that way they were well ahead of other countries, particularly in the developing world."

So, yes it does seem to work, by comparison. Of course everybody wishes those numbers were zero, but Brazil does seem to have kept the lid on it.

But here's the part that has sparked some discussion.

But the Brazilian approach is anathema to many conservatives in the United States because it makes use of methods seen as morally objectionable. Brazil not only operates a needle and syringe exchange program for drug addicts but also rejects the Bush administration's emphasis on abstinence, being faithful and the controlled use of condoms, the so-called ABC approach, in favor of a pragmatism that recognizes that sexual desire can sometimes overwhelm reason.

"Obviously abstinence is the safest way to avoid AIDS," Dr. Chequer said. "But it's not viable in an operational sense unless you are proposing that mankind be castrated or genetically altered, and then you would end up with something that is not human but something else altogether."

This is weird, isn't it? It's that strange thing we refer to sometimes as ... "reality." Sex, part of being human. Hmmm.

So one lady in this discussion I've been listening in on had this to say.

It's remarkable how so very obvious that comment is, yet how rarely we hear it today. And, to be honest, I think many of us (us, in the general sense) have been intimidated from speaking those very words, because we've been told so often we show so little respect to the fundamentalists.

American thought has been profoundly shaped by a wish to accommodate all types of people, even religious fundamentalists. Not all of us belong to religions that consider sexual feelings and behaviors to be sinful. But we do belong to a society that includes people who belong to such religions. And out of politeness, we respect them by censoring our language and behavior in public. And then they think we all agree with them. Further, the habit of monitoring our own speech and actions in order to accommodate others results in a kind of second-order conscience, where we feel guilty saying or doing things that really don't offend us -- it's just that we would feel bad offending somebody else.

But how far should it go? We can respect that other people have strange, twisted views of the world and human nature, and we can politely not point out the silliness of their beliefs, but at what point have we abandoned our own vision? At some point you have to stand up for common sense, you have to state out loud what seems obvious.

The clue can be seen in CRC lawyer John Garza's recent plea to the school board to come up with a curriculum that doesn't offend anyone. This can only mean that people with intelligent, rational thoughts must keep them to themselves in the presence of weirdos who are offended by anything and everything. I am not thinking that's the way we want to go, especially in the public schools.