Sexually transmitted diseases and AIDS in Brazil in the 21st century: the challenge and the response
Twenty-five years since the identification of a new syndrome that was later characterized as the acquired immunodeficiency syndrome (AIDS), a renewed focus on the various aspects of the HIV/AIDS epidemic in Brazil provides learning opportunities and reawakens interest in the topic. Such learning allows us to produce adequate responses to the various facets of this redoubled international public health challenge; and the interest results from a moment of vigorous public health action, with the AIDS pandemic still far from being controlled in the short or medium term, still capable of raising the visibility of population groups and social networks previously obscured by our prejudices and indifference, in addition to bringing other sexually transmitted diseases (STDs) into the debate when they have often been neglected on the grounds that they are supposedly less relevant.
New issues have arisen for civil society and health professionals, like the need for a careful view by health services (basic and specialized) towards an adequate and timely approach to those who need care, in order to jointly contribute to better health conditions and to reduce the occurrence of avertable illness through early diagnosis and appropriate referrals. Studies on vertical (mother-to-child) transmission of syphilis and HIV provide examples of both neglect and success in reducing human suffering and the costs incurred by public health policies when interventions are not adopted early and comprehensively.
The development of more effective and culturally sensitive strategies for prevention, diagnosis, and treatment, upgrading care, the importance of adherence to antiretroviral medication, and interventions favoring a steady increase in survival and a concomitant reduction in morbidity and mortality are highlighted here, demonstrating the improvement in quality of life for persons living with HIV/AIDS, including comprehensive, continuous care for children born to mothers with HIV.
Great strides have been made, like an important reduction in mother-to-child HIV transmission through the systematic adoption of prophylactic measures, but much remains to be done, given the unacceptable prevalence of syphilis, one of the oldest STDs, with its congenital transmission, despite simple, inexpensive, and well-established diagnosis and treatment. There is a need for more in-depth studies on social inequalities in order for everyone to benefit from the progress achieved, regardless of their social condition.
The articles in this Supplement have resulted from a selection of papers by the Brazilian National STD/AIDS Program through a Call for Articles on STD/AIDS in Brazil in 2005, with additional contributions by renowned researchers from the field.
We hope that reading this Supplement will fuel the debate and foster creative thinking and the development of new strategies and analyses to deal with this redoubled public health challenge at the dawn of the 21st century.
Maria Goretti P. Fonseca
Instituto de Pesquisa Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
Diretoria Regional de Brasília, Fundação Oswaldo Cruz, Brasília, Brasil.
Gerson Fernando Mendes Pereira
Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brasil.