Prostitution puts U.S. and Brazil at odds on AIDS policy

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."

"If we increasingly focus the prevention of AIDS along these lines, we are generating carnage, a slaughter," he said. "It's not a realistic vision, and the epidemic is going to grow larger and larger."

Brazil , of course, is not the only country to have been affected by the American policy. Senegal has one of the lowest H.I.V. prevalence rates in Africa , but has been cut off from the Bush administration initiative, public health experts said, because prostitution has been legal there since 1969. And in Central American countries like Guatemala , religious groups supported by American financing have distributed fliers to prostitutes urging them to adopt the ABC approach.

Fio da Alma, which means Thread of the Soul in Portuguese, is one of about 30 AIDS groups across Brazil that works with prostitutes in cooperation with an organization called Da Vida, or For Life. As many as one million condoms a month are distributed through that program, one of several that were initially financed in part through the American aid agency and were expected to continue as part of a grant that would last through 2008.

The United States wanted to remain involved because the White House in 2003 announced a five-year $15 billion program known as the President's Emergency Plan for AIDS Relief. Congress has authorized financing, but also required that all groups getting American money make an explicit statement of policy opposing prostitution and sex trafficking.

Brazilian AIDS groups that work with prostitutes argue that they are not endorsing the sex trade. Because many of those involved in the Brazilian program are prostitutes themselves, they know the risks involved.

"With what we do, we are definitely not encouraging the sexual exploitation of women and girls," said Ivanilda Lima, 64, the director of Fio da Alma, who said she had been a prostitute herself since age 13. "We just want women who are already on the streets to be able to protect their health."

Brazil and the Bush administration have differed on other AIDS-related issues in the past, including what Dr. Chequer described as a recent effort to get Brazil to endorse the ABC approach. But in each case, he said, the two sides managed to find a middle ground without violating their own principles.

Over the prostitution issue, however, a compromise does not appear possible. Even if the Bush administration were willing to offend the conservative religious groups that are one of its main constituencies, its hands would be tied by the Congressional legislation.

"We follow the law," Dr. Dybul said. "The law says that groups must oppose prostitution, and we will enforce that. We believe that prostitution is a bad thing, both for H.I.V. infection and for the individual. But we are opposed to the activity, not to the person."

Brazilian AIDS workers, on the other hand, argue that even if the Ministry of Health here were willing to accept the American demand, it could not do so legally. Under Brazilian law, two people having sex in exchange for money is neither a felony nor a misdemeanor, but an infraction much like a traffic violation (although procurement is a crime).

"Prostitution in Brazil isn't legalized, but it's not illegal either," Dr. Chequer explained.

In addition, Brazilian labor law recognizes "sex worker" as a profession. That entitles prostitutes, call girls and street hustlers to contribute to the official government pension fund and to receive benefits when they retire.

"We view prostitutes as partners in this effort, partners who are efficient and competent" in getting Brazilians to give up dangerous sexual behavior, Dr. Chequer said. "Prostitution exists everywhere in the world, including the United States, and we have a commitment to work with this group and respect them."

Online at: http://www.nytimes.com/2005/07/24/international/americas/24brazil.html

Source: New York Times