The New York Times - December 14, 1986
Alan Riding

Brazil ranks third after the United States and France among countries with the largest number of AIDS victims. Health Ministry records show 921 people diagnosed with the disease - 54 percent of them already dead - as of Nov. 20.

But state officials believe that, allowing for unreported cases, the real figure is 20 to 30 percent higher and will probably reach 2,000 by the end of 1987. More than half the AIDS victims are residents of Sao Paulo, Brazil's largest city, while a quarter come from Rio de Janeiro.

"Brazil has the potential to have an African-style epidemic of AIDS," Jonathan Mann, director of WHO's program on AIDS, said this month in a reference to the large number of victims identified in Central Africa. "In Brazil, as in the rest of Latin America, the Government still wrongly believes that AIDS is not a major problem." Panic Set Off

Dr. Alvaro Matida, an epidemiologist who runs the local AIDS program in Rio de Janeiro, recalled that "press sensationalism created a panic" about AIDS last year, but there was little follow-up. "We need to focus on the deficiencies of the public services," he said. "In Brazil, the average survival after diagnosis is one to two years while in the United States it is four to six years."

Nudged by the criticism and by new press attention to the problem here, the Health Minister, Roberto Santos, announced this month that several initiatives would shortly begin, including a prevention-orientated education and publicity program and, to protect hemophiliacs, obligatory screening of the supplies of all blood banks for anti-bodies of the AIDS virus.

"I know there has been criticism," Dr. Miriam Franchini, who works in the ministry's special AIDS program, said, "but it took time to form teams. This office was only set up in April. How can you care for AIDS cases without forming the proper teams to deal with all aspects of the problem - medical, therapeutic, psychological, judicial and so on?"

Another reason for the ministry's slow response is that several other infectious diseases, among them malaria, yellow fever, tuberculosis and Chagas' disease, affect a much larger segment of the Brazilian population than does AIDS. Carlos Sant'Anna, who served as Health Minister until last February, said that in this context it was difficqlt to consider AIDS a priority. 'A Very Wearing Business'

As a result, until now most of the burden of handling victims of AIDS, or acquired immune deficiency syndrome, has been carried by local health authorities. "It's a very wearing business," said Dr. Teresa Klieman, who works on the state program in Sao Paulo. "You're dealing with patients who are going to die and a problem that keeps growing."

Over the past two years, Sao Paulo has developed a 100-member team that is now training health workers from elsewhere in Brazil as well as running an outpatients' clinic. But even in Sao Paulo, the shortage of beds for victims who need hospitalization is acute. "First, there is the fear of the medical personnel," Dr. Franchini said. "Then there is the extraordinary cost of caring for these patients."

In Sao Paulo, Dr. Klieman estimates some 400 AIDS victims are still alive and only 150 beds are available, although this figure is challenged by Paulo Cesar Bomfin of the Group to Support the Prevention of AIDS, who contends there are only 60 beds. In Rio de Janeiro, the situation is more serious, with only 16 beds for more than 100 surviving AIDS patients.

"At a state level we're still doing far less than we should," Dr. Matida noted, "but isolated measures are not going to have any impact. This is a national problem that must be faced nationally." 'Whole Population at Risk'

Mr. Bomfin, whose group is made up mainly of homosexuals, concurred. "You can't just talk of high risk groups because the whole population is now at risk," he said, noting the growing number - over 20 percent of the total - of bisexual victims of AIDS here.

Nonetheless, health authorities have so far given little importance to providing information about prevention of AIDS to the population at large. "It's still a taboo subject," Mr. Bomfin said. "Ninety percent of patients face rejection by their family and friends. Our group hasn't even been able to rent space because of discrimination. And meanwhile the saunas are still full of homosexuals who seem to have forgotten that AIDS exists."

Mr. Bomfin said there was an urgent need for a nationwide education program. "People have to ta p precauonons," he said. "You dot t ban driving becausearars can kill. You tell people to wear seat belts and drive slowly. It's the same here. You don't have to stop sex just because AIDS kills. We're saying you should wear condoms and have less partners." </txt> _{ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS); EPIDEMICS; HOMOSEXUALITY} <org> WORLD HEALTH ORGANIZATION (WHO) </org> <per> RIDING, ALAN </per> <geo> ;BRAZIL </geo> <nexsqn> 064696861215 </nexsqn> <edt> Late City Final Edition </edt> <sec> A </sec> <pg> 11 </pg> <sortpg> 0011 </sortpg> <cl> 1 </cl> <dsk> Foreign Desk </dsk> <nexpd> 19861215080000 </nexpd> <pdate> 19861215 </pdate> <day> Monday </day> <pdm> 12 </pdm> <pdd> 15 </pdd> <pdy> 1986 </pdy> <sqn> 469686 </sqn>
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