The public health system in Brazil as a promoter of sexual and reproductive health and rights: how does it help in the fight against HIV/AIDS?

This article was exclusively written for The European Sting by Ms. Gabrielle B. V de Souza and Ricardo Costa, two medical students at Tiradentes University (Sergipe, Brazil). They are affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writers and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

The public health system in Brazil has revolutionized access to health care: since 1990, it offers free health care to all 209 million Brazilians [1]. Guided by the principles of equity, integrality, and universality; the unified health system (Sistema Único de Saúde [SUS]) contemplates the promotion of sexual and reproductive health and rights (SRHR) in all its three levels of care – divided according to the category of services [2].

At the primary level, Brazilians have access to sex education programs, reproductive planning, prenatal care, screening for Sexually Transmitted Infections (STIs), immunization against Hepatitis B and HPV, lubricants, and male and female condoms. Regarding the Education, Culture, and Social Assistance spheres, SUS also operates in other issues that impact the HIV epidemic. These topics are conflicts of power and violence in relations between genders, intolerance between generations and their cultural values, and marginalization of sexual minorities (such as sex workers and LGBTI+ people) [4]. At the secondary level, we have free and immediate access to confirmatory tests, treatment of HIV infection and other STIs, and Pre-prophylaxis (prioritizing sex workers and the LGBTI+ community), and Post-Exposure to HIV (official protocol addressing victims of sexual violence). Finally, at the tertiary level, the adoption of the protocol for the prevention of vertical transmission in childbirth care and the provision of milk for children of mothers living with HIV represent considerable achievements in the field of SRHR.

It is necessary to recognize that sexual and reproductive health care is one of SUS’s priority areas of action [3]. Even if there is no cure for HIV, it is possible to fight it through a well-structured healthcare system, which does not neglect the importance of SRHR [4]. The measures adopted in Brazil – proven to be effective in reducing the transmission of the virus – represent a way to combat this problem [4]. Statistics only confirm: our 2019 national epidemiological bulletin demonstrates that there is a relationship between the adoption by SUS of the SRHR actions and the decrease in the rate of detection and mortality from AIDS [5]. Thus, it is possible to affirm that the promotion and support to a universal and free health system that includes the guarantee of SRHR is a fundamental step in combating the HIV epidemic.

Given this, it is notable that the Brazilian public health system, a reference to the world, is essential for combating the HIV/AIDS epidemic – Brazil is one of the few countries that offers free care to people living with HIV [1]. Furthermore, it is impracticable to ignore the intimate relationship between politics and sexual and reproductive health care universal access. In this context, the fight against the HIV epidemic must also be done in the political sphere: choosing delegates and politicians who prioritize the guarantee of sexual and reproductive rights. Therefore, Sexual and Reproductive Health and Rights should be a priority in public health policies – to efficiently decelerate transmission, sequelae, and deaths caused by the HIV epidemic.

References

[1] DUARTE, E; EBLE, LJ; GARCIA, LP. 30 anos do Sistema Único de Saúde. Epidemiol. Serv. Saúde,  Brasília, v. 27, n. 1, e00100018, mar. 2018. Disponível em <http://scielo.iec.gov.br/scielo.php?script=sci_arttext&pid=S1679-49742018000100001&lng=pt&nrm=iso>. acessos em 24 nov. 2020. Epub 09-Mar-2018.  http://dx.doi.org/10.5123/s1679-49742018000100018.

[2] CASTRO, M. C. et al. Brazil’s unified health system: the first 30 years and prospects for the future. The Lancet, v. 394, n. 10195, p. 345-356, 2019. ISSN 0140-6736, https://doi.org/10.1016/S0140-6736(19)31243-7. (http://www.sciencedirect.com/science/article/pii/S0140673619312437)

[3] BRASIL, Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Saúde Sexual e Saúde Reprodutiva. CADERNOS DE ATENÇÃO BÁSICA Nº 26. Brasília: Ed. Ministério da Saúde, 2013. 302p. 1 ed.

[4] BRASIL, Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. HIV/AIDS, hepatites e outras DST. CADERNOS DE ATENÇÃO BÁSICA Nº 18. Brasília: Ed. Ministério da Saúde, 2006. 197p. 1 ed.

[5] BRASIL, Ministério da Saúde. Secretaria da Vigilância em Saúde. Boletim Epidemiológico de HIV/ AIDS. Brasília: Ed. Ministério da Saúde, 2019. Edição especial

About the authors

Gabrielle B. V de Souza and Ricardo Costa are medical students at Tiradentes University (Sergipe, Brazil). They’re both Local Officers on Sexual and Reproductive Health including HIV/AIDS at International Federation Of Medical Students’ Association Brazil UNIT (2020). Gabrielle is a member of LINFECTO (Infectology League) at Tiradentes University. Ricardo is also director at his university’s Obstetrics & Gynecology Academic League (2019-2020). Faithful SDSR advocates, they also believe and defend the existence of SUS, a public health system that offers free health care to 209 million Brazilians.