[procaare] Re:'Scaling-Up: Lessons from Brazil'

[Zelda Jeffers <procaare@usa.healthnet.org>]

Re:'Scaling-Up: Lessons from Brazil'
-Zelda Jeffers, Brazil
***************************

[Moderators note: Here follows a response to the posting: 'Scaling-Up: Lessons from
Brazil' from the AIDS2002 coverage.]

Dear Colleagues,

It is not always easy working here where I am in Brazilian Amazonas, and it is encouraging
to hear about what is going on in the rest of the world. One of the largest problems here
is the non-functioning of the Brazilian health service and especially the health programs,
such as the endemics, TB, and STD/Aids.

I am working alongside indigenous health agents and see their struggles to try and ensure
that their patients receive treatment. Now once again I read about Brazilians blowing
their own trumpets in the international forum. Sadly the picture given by Dr Teixeira is
far from complete.

In this area of the upper Solimoes the population is extremely vulnerable and the HIV/AIDS
program is not functioning in any real manner. Testing in the towns is non-existent or
difficult, counselling does not happen and pregnant women, even the minority who manage to
get prenatal care, do not get offered HIV testing.

People, indigenous and non-indigenous in communities outside the towns have even greater
difficulties obtaining health care when they are ill let alone preventive measures or HIV
testing or education.

In this situation it is impossible to say what the HIV status of the population is, but I
am afraid that given the conditions here, if it is not bad yet, it soon will be. We know
people are dying of TB, although the statistics there are not complete, if after so many
years the TB program does not function how much more difficult that the STD/AIDS program.

Condoms are difficult for the people in distant communities to buy due to price and
non-availability as well as there being some lack of knowledge of their importance. Those
available free from the health service are rationed and run out.

How can the doctor talk about a reduction in the rate of incidence when statistics are
incomplete, not testing leads to not knowing not to no cases!  We know that ignorance
kills, the ignorance of the population must be overcome with adequate education, the
ignorance of health professionals at every level needs to be confronted at all levels, the
beginning of knowledge is knowing that you don't know.

The Dr can't know the state of HIV in Brazil because at least one area is outside any
program. I am here and know that this is the sad situation I can't comment on other parts
of Brazil but suspect that all is not so well in other areas.

Yours sincerely
Zelda Jeffers
Email: zeidyj@hotmail.com

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