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Zika epidemic and social inequalities: Brazil and its fate.

In January 2001, I wrote an editorial on this page with the title “Coffee, Samba, Football, AIDS and Social Inequality in Brazil.” The first paragraph described a contradiction within the Brazilian National Health System: “The most important newspapers and magazines worldwide (The New York Times, Le Monde, The Wall Street Journal, Time Magazine) have been publishing the tremendous results from the Brazilian AIDS program. This is a combination of preventive measures and free distribution of antiretroviral drugs with an impressive fall in hospitalizations and mortality. Now, the Brazilian program has become the paramount public health effort for halting the AIDS epidemic to be followed in other places, especially the sub-Saharan African countries. In contrast, the Health Department of São Paulo State is warning about increasing case-fatality rates of tuberculosis. How can this contradiction be explained for a non-Brazilian?”1 Imagine if I published the same editorial again, just changing the phrase “about increasing case-fatality rates of tuberculosis” by “the recent incidence of Zika virus infection and new cases of microcephaly”. Readers might think that they could detect an instance of self-plagiarism. Unfortunately, this is not a lazy way to write a comment by copying an older one. The fact is that the players can change, but the play is the same on the stage of Brazilian public health. The question transcribed above was answered in that editorial in 2001: “for us, Brazilian physicians and medical researchers, the answer is very easy. AIDS is a disease that has afflicted people with real prestige in Brazilian circles of power. In summary: journalists, popular music stars, soap-opera actors and actresses, physicians, scientists, military officers, priests and other well-born citizens who traveled to the USA during the early 1980s and were infected by sexual intercourse in New York City and San Francisco. After that, they spread the virus and disease among Brazilians who had never dreamed of going up the steps on an airplane. Until the early 1990s, in São Paulo City, the incidence of AIDS cases continued to be greater among affluent people than among poor ones. As the spread of AIDS became a menace to the abovementioned professions, it was easy to pressure the Ministry of Health, State Departments of Health, and other authorities to increase the budget for AIDS control and treatment, including sometimes a shift of resources from other programs”.1 For more than a decade, the Brazilian AIDS program was self-proclaimed as “an example for the world”. In contrast, the control over dengue has deteriorated year by year. Despite the manifest failure of control over the dengue epidemic, which has been conceded by most of the communicable disease epidemiologists in Brazil, in an article in The Lancet, the federal budget for AIDS has been increasing and the budget for controlling vectors like Aedes aegypti is still declining.2