Health Report

Brazil's Unconventional AIDSFight: An AIDS-Infected Transsexual Is Among Unlikely Leaders of the Hailed Program

by Miriam Jordan, Wall Street Journal, U.S.A.

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Sao Paulo, Brazil - Jacqueline Rocha turns heads.

But she isn't the latest Brazilian fashion model to conquer the catwalks. Ms. Rocha, nee Jacques Rocha Cortes, is a transsexual who is infected with H.I.V., the virus that causes AIDS.

Petite with shoulder-length streaked brown hair, Ms. Rocha has emerged as a leader in one of the developing world's most widely heralded anti-AIDS programs. The former English teacher is frequently consulted by Brazil's government and has been invited to speak on the epidemic in countries from the U.S. to South Africa.

Few nations would embrace a transsexual for any cause, let alone an issue like AIDS, which has to struggle to gain the attention of mainstream society. But there was Ms. Rocha last November, sitting beside Brazilian Health Minister Jose Serra at an international AIDS conference in Rio de Janeiro. "It is absolutely natural for us to see her share the stage with our health minister," says Paulo Teixeira, chief of Brazil's AIDS program. "Jacqueline is a superb activist."

Brazil's acclaimed AIDS program involves more than just the free distribution of local knockoffs of patented drugs for people with AIDS. Latin America's biggest country also serves up an unconventional but potent mix of activists, including the 41-year-old Ms. Rocha, Roman Catholic priests and government officials.

Even a military-police officer has joined the campaign, volunteering to run Brazil's first halfway house for people afflicted with AIDS after the program's transvestite founder died. "I felt a desire to contribute in some way," says Lt. Clecio Tadeu. "The sexual habits of the needy are beside the point."

This broad coalition impresses international health officials, who are used to antagonism between governments and advocacy organisations in developing countries.

"Brazil has the ability to involve diverse groups in the fight against AIDS," says Fernando Zacarias, the AIDS coordinator at the Pan-American Health Organisation in Washington, D.C. "It reflects an openness about the realities of life that most countries lack."

Ms. Rocha serves on the National AIDS Commission, a body that discusses prevention, care and control of the disease.

Also on the commission, along with Brazilian bureaucrats and scientists, are prostitutes and drug users. "Not a single ad campaign airs without consulting all members," says Health Ministry spokesman Flavio Guilherme de Souza.

"It makes absolutely no difference that Ms. Rocha is a transsexual," notes Pedro Chequer, a former head of Brazil's AIDS program who is now the regional chief for AIDS, a United Nations program. He came to know Ms. Rocha through her e-mail messages - hundreds of them.

"She was always critiquing, demanding, bringing facts to our attention about the epidemic," he says. "She is extremely committed and serious about care and prevention."

Among other things, Ms. Rocha has taken Brasilia to task over a shortage of medicine for AIDS-related infections. She has pressed the government for assurances that locally produced AIDS drugs will meet the same standards as those made in more developed countries.

She has alerted officials to rights violations, such as discrimination against AIDS-positive Brazilians in the workplace.

"Our goal is to attain a better quality of life for those with AIDS," says Ms. Rocha.

"The way to achieve that is by talking to the government at all levels - local, state and federal."

Ms. Rocha was one of three sons in a family in Niteroi, across the bay from Rio de Janeiro. More like her two sisters than her brawny and hirsute brothers, Ms. Rocha was feminine, though endowed with a pronounced square jaw. She is now receiving hormone treatment and is hoping to undergo surgery to complete her sex-change later this year. Ms. Rocha contracted AIDS in 1994 from a male partner.

At the time, Brazil wasn't yet passing out a cocktail of anti-AIDS drugs. Ms. Rocha participated in a pilot program of drug distribution in 1995, and has been on medication ever since.

"Without the cocktail, I wouldn't be on the planet Earth today," she says, though her first combination of drugs raised her cholesterol and contributed to a heart attack in 1999. Her doctor changed one drug, and now, "I am free to exercise, swim and dance," she says.

As the drugs helped thousands of afflicted Brazilians regain their strength, Ms. Rocha and others felt the need for AIDS-positive people to "reinsert ourselves in society," she says. "We were tired of being victimised."

In 1996, she joined the recently formed Brazilian National Network of People Living With AIDS/AIDS, where she quickly stood out for her oratory and leadership skills. Today she is co-leader of the network in Brazil.

Last year, Ms. Rocha was a key organiser of Forum 2000, the AIDS conference where she appeared with Brazil's health minister. Ms. Rocha recently received government funds for her proposed program to train AIDS-positive Brazilians to create community-support networks in smaller cities, where the epidemic is spreading fastest.

"We need to develop a young leadership to fight misinformation, prejudice and isolation," says Ms. Rocha. Her project has also received funding from such U.S. groups as the Red Hot Organisation and the National Minority AIDS Council, evidence that Ms. Rocha's efforts are gaining international recognition.

During her first jaunts abroad, she recalls, "People stared at me." She knew they were not used to seeing a transsexual as a public figure. But eventually, she says, they realised that "intellectually, I'm not different from anyone else."

One recent morning, dressed in a sheer silk blouse and snug jeans and sporting pink lipstick and violet eye shadow, she showed off photographs from her trip to Atlanta last October.

She was one of eight foreigners invited to the biggest annual American AIDS conference.

"I was audacious and daring," she says. In a speech, she called on U.S. pharmaceutical makers to cut the cost of drugs to "improve our chances of living."

Ms. Rocha was also lucky to be there. The U.S. had turned down two previous visa applications. But this time she had high-powered recommendations: The Global Health Council, a Washington, D.C. advocacy group, stated that Ms. Rocha's participation was "crucial," and the deputy coordinator of Brazil's AIDS program attested to Ms. Rocha's status as a "transsexual activist" whose "legal documents carry the name Jacques Rocha Cortes." Ms. Rocha got a 10-year multiple-entry visa.

Brazil, the country with the world's largest Roman Catholic population, is also the only place where the Catholic Church has its own AIDS commission.

Despite the Pope's denunciation of condoms, many Catholic groups are working to contain the disease endorse their use.

"Condoms are not about religion; they are about public health," says Rubens Oliveira Duda, a theology student and AIDS activist in Sao Paulo.

Sometimes that partnership triggers controversy. One priest, Valeriano Paitoni, a longtime AIDS activist, caused a stir last year when he produced an AIDS informational videotape for clergy members that said it wasn't a sin to encourage the use of condoms.

Subsequently, the archbishop of Sao Paulo, Claudio Humes, published a statement in a leading Sao Paulo newspaper condemning the use of condoms and reprimanding Father Paitoni. The Health Ministry, which helps fund Father Paitoni's programs, repudiated the archbishop's statement. Going one step further, the ministry has released religion-laden condom ads ahead of this week's annual pre-Lenten Carnival celebration. The ads show an angel and a devil, and read: "No matter which side you are on, wear a condom."

Ms. Rocha, too, is stepping up her campaigning. Last year, she was elected co-leader of the Latin American Network of People Living With AIDS/AIDS, which represents 16 countries. She has left teaching to do advocacy work full-time.

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