From human blood to politics: the impact of AIDS in Brazil

Luiz A. de Castro Santos Cláudia Moraes Vera Schattan P. Coelho About the authors

This paper focuses on the extraordinary impact of Aids on blood-related policiesinBrazil during the late ! 9 80's. The thrcatof acquiringthe HTVthrough blood transfusions, combined with the widespread social fearof contraeting the global disease, triggered an unpreeedented array of social movements and non-government agencies demanding improved, safer, and more ethieal blood banking and produetion of plasma fraetions. In fact, there were pressing dcmandsof popular opinion and the press since the late 1970'sandearly I980's against the transmission of infeetious di se ases by blood transfusion, sueh as doença de Chagas and hepatitis. Such pressures brought about some tightening of federal inspection and the launching of a National Blood Program, known as Pró-Sangue, in 1980. But these measures had little impact on the quality of services, comparcd later developments during the decade. The spread of Aids through transfusion attracted national attention to institutional and political problems of the blood and plasma produetion sectors. The population at large joined the groups and movements created on the wave of that debate. The political parties fõllowed suit. The federal government yielded to pressures by developing new policies for the sector in 1988, more comprehensive and a bit more effective than the older programs. However, real progress in the creation of regional and state-funded blood centers, in the quality-control of blood, and in the adoptionof strict standards for the plasma market was only achieved when state governments (such as the states of São Paulo and Rio de Janeiro) took the lead and worked together with the Ministry of Health authorities. But much remains to be done from the point of view of medicai inspection and legal contrai, especially in some Brazilian states where action is heavily dependent on the federal government. From a broader point of view, a complete overhauling of the system of blood donation and produetion of plasma fractions is expected. The Aids dehate highlighted several institutional problems of that system tliat cut across very old, unsettled political issues in Brazil, such as state control vis-à-vis private control, federai centralization vis-à-vis regional decentralization, the (im)fairness of public subsidies to profit-making flrms and acti vities, etc. These are proper concerns and should be pursued. However, the discussion of these issues has heen soaked in too much ideology and petty politics, particularly during the debates of lhe National Constitution Assembly of 1988. What we argue is that the legislation approved by the Constitution - which still nwiespecific defínition of rules and regulations - lacked proper consideration of technical and institutíonal problems affecting the blood donation sysícm and the plasma market. We also argue Üiat the workshops, conferences and puhlic debates preceding the Assembly meetings did not benefit from, or took advan-tage of, the lessons contained in the vast literature regarding the international experience, in ali its a future issue ofPhysis, we expect to make an effort in considcring the international experience. We will review the international literatureon relevant technical and institutíonal dimensions of blood-related policies and programs, and discuss those speeifie topics that bear upon Brazil's particular case.

IMS-UERJ PHYSIS - Revista de Saúde Coletiva, Instituto de Medicina Social Hesio Cordeiro - UERJ, Rua São Francisco Xavier, 524 - sala 6013-E- Maracanã, 20550-013 - Rio de Janeiro - RJ, Tel.: (21) 2334-0504 - ramal 268 - Rio de Janeiro - RJ - Brazil