Responding to AIDS from the Altar: Religion, Politics and AIDS in BrazilRichard Parker, Ph.D.

Miguel Munoz Laboy, Dr.PH.

Jonathan Garcia, M.Phil.

Laura Murray, M.H.S

May 7, 2009HIV Center Rounds

Space distribution of districts with at least one case of AIDS. Brazil,

1980 - 2002.

1980-1987

1988-1994

1995-2002

Stabilization of the epidemicTendency of AIDS epidemic: 1996-2007

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

19961997

19981999

20002001

20022003

20042005

20062007

AIDS cases, by year of diagnosis, 1996-2007

Source: National AIDS Program, Brazilian Ministry of Health, Boletim Epidemiológico AIDS. ANO V No. 01. 2008

Stabilization of the epidemicTendency of AIDS incidence rate 1983-2007

30

0

5

10

15

20

25

30

1983

1984

1985

1986

1987

1988

1989

199019

91

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

MaleFemaleBrazil

Source: National AIDS Program, Brazilian Ministry of Health, Boletim Epidemiológico AIDS. ANO V No. 01. 2008

Research Problem

Little recognition of the fact that organized religion, religious beliefs and religious institutions and organizations have played a key role in shaping the Brazilian response to AIDS.

The impact of religion has arguably been as important as the impact of government programs and policies in shaping the ways in which Brazilians have confronted the epidemic and the challenges it has posed.

Historical Conceptual Framework Political economy of the religious movements in Brazil Social movements theory Community mobilization theory Political economy of AIDS in Brazil

Research Context: Religious Plurality in

Brazil

Roman Catholic Church (1500 – Present)

Historical dominance of the Catholic church in the country for centuries

Liberation theology movement (1960s)

“Christian Base” Communities (CEBs)

Evangelical Church (doubled in the 1990s) Multiple denominations:

Assemblies of God Universal Church of the Kingdom of God The Pentecostal Church of Jesus Christ

Brazilian Candomblé (1549 – Present)Candomblé in Candomblé in

BahiaBahia Xangô in Xangô in PernambucoPernambuco

Candomblé Candomblé Jejé-NagôJejé-Nagô in in

Rio de JaneiroRio de Janeiro

Batuque in Rio Batuque in Rio Grade SulGrade Sul

Umbanda in Brazil (1900s – Present)

Patterns of movement through religious tradition in Brazil Terreiro Pentecostal Temple

Patterns of Religious Migration in Brazil

Roman Roman CatholicsCatholics

Source: De Almeida & Montero (2001).

Roman Roman CatholicsCatholics

Not ReligiousNot Religious

SpiritistsSpiritists

Source: De Almeida & Montero (2001).

Roman Roman CatholicsCatholics

Not ReligiousNot Religious

SpiritistsSpiritists

HistoricalHistoricalProtestantsProtestants

Source: De Almeida & Montero (2001).

PentecostalsPentecostals

Roman Roman CatholicsCatholics

Afro-BrazilianAfro-BrazilianReligionsReligions

Not ReligiousNot Religious

SpiritistsSpiritists

HistoricalHistoricalProtestantsProtestants

Source: De Almeida & Montero (2001).

PentecostalsPentecostals

Roman Roman CatholicsCatholics

Afro-BrazilianAfro-BrazilianReligionsReligions

Not ReligiousNot Religious

SpiritistsSpiritists

HistoricalHistoricalProtestantsProtestants

Source: De Almeida & Montero (2001).

PentecostalsPentecostals

Religious responses to AIDS emerged from long

traditions of institutional involvement in the health and illness of religious

followers.

Religious Responses to AIDS in Brazil

U.S. National Institute for Child Health and Human Development (Grant number: 1 R01

HD050118)

Project Specific Aims

1. To develop a comparative analysis of the multiple ways in which Catholic, Evangelical, Protestant, and Afro-Brazilian religions have responded to HIV and AIDS.

2. To empirically document the importance that each of these three major traditions have given to HIV and AIDS, and the reasons that have led them to do so.

Project Specific Aims

3. To assess the ways in which the responses of each of these religious traditions have interacted with local communities, the wider social universe of civil society, and the nation-state, in impacting upon the broader social response to the epidemic.

4. Through comparative analysis, to more fully understand the organizational and institutional structures that each religious tradition exhibits, and the ways in which each interacts with and articulates itself with communities, civil society, and the state, in order to shape the social and political response to AIDS.

Research Site 5: Porto AlegrePopulation: 3,950,000Accumulated AIDS cases until 12/2003: 11,190 (3.6%)

Research Site 4: São PaoloPopulation: 20,200,000Accumulated AIDS cases until 12/2003: 59,773 (19.3%*)

Research Site 1: RecifePopulation: 3,750,000Accumulated AIDS cases until 12/2003: 3,297 (1.1%*)

Research Site 2: BrasíliaPopulation: 3,500,000Accumulated AIDS cases until 12/2003: 3,672 (1.2%*)

Research Site 3: Rio de JaneiroPopulation: 12,150,000Accumulated AIDS cases until 12/2003: 29,352 (9.5%*)

* % of national accumulated AIDS cases until December 2003

Source: National AIDS Program, Brazilian Ministry of Health, Boletim Epidemiológico AIDS. ANO XVII No. 01. 2004

Religious Responses to HIV and AIDS in Brazil:Study Field Sites(Locations, Populations, AIDS Burden)

Research Team Structure Richard G. Parker, PhD (Principal Investigator)

Veriano Terto, Jr., PhD (PI– Brazil) Miguel Muñoz-Laboy,DrPH (Co-PI)

Rio de JaneiroCristina Pimenta, PhD

(Local PI)Ivia Maksud

Juan Carlos RaxachAline Lopes

SSao Paulo

Vera Paiva, PhD (Local PI)

Dani Carli Licciardi Andrea Paula Ferrara Alessandro O. Santos

Cristiane Silva

RecifeFelipe Rios, PhD (Local PI)

Cinthia OliveiraFrancisca Luciana de Aquino

Claudia CruzDavid Handerson Coelho

Porto Alegre Fernando Seffner, PhD

(Local PI)Luana Rosado Emil

Marcello MúscariCarolina Peres Terra

Columbia UniversityVagner de Almeida (Project Director)

Jonathan GarciaCarmen Yon

Laura Murray

METHODOLOGY:

INSTITUTIONAL ETHNOGRAPHY

Institutional Ethnography

Archival research

Ethnographic case studies including:

Oral Histories

Life histories

In-depth interviews

Participant Observation

Ethnographic Case Studies Themes explored with each institution:

Religious belief systems as they relate to HIV and AIDS Organizational structure and the internal organization of

ecclesiastical power Relations with the external world The construction of risk, illness, care and treatment

Location Catholics EvangelicalsAfro-

BrazilianActivists/Gov

Officials

Sao Paulo 24 18 17 6

Recife 25 23 33 14

Porto Alegre 17 16 19 6

Rio de Janeiro 17 29 18 23

FINDINGS:

FOCUSING ON ONE CASE STUDY

“Strange Bedfellows”: The Brazilian National AIDS Program and the Catholic Church Strained relationship between Catholic

Church and government HIV programs in other

Brazil unique in terms of the nature of relationship between the National AIDS Program and the Catholic Church

Formula for a Positive Pelationship Shared Values

Similar Backgrounds

Right Place, Right Time

Shared Values

We don’t discriminate at the time of funding a project. We have a historical principle to respect human rights, diversity, and this is how we establish partnerships, be they with the church, forming institutions, civil society, or the university. (National AIDS Program official)

So the Church finds itself faced with AIDS. [With] the reality of the person that needs treatment, of the person that needs affection, of the person that needs to be included and not excluded...The Church places itself before an infected person that needs to be seen with mercy, with the same care that God wants us to have for any person. (Catholic Priest)

Similar Backgrounds: Political Context

In Brazil, we can never separate the organization and the community work of the Church. I am convinced of this…when people ask me how is it that in Brazil…the government and civil society are able to work [together], I always respond the same way: it is because Brazil has a history where the Church, was progressive and worked a lot at the community level.” (former National AIDS Program official)

Organizational Structure of National AIDS Program and CNBB

Right Place, Right Time: Social Networks

For us, it’s strategic, the churches arrive at places that it would take us too long to arrive. They are able to bring together an very large group of volunteers to be able to work, this is another characteristic of the dedication related to the cause; I would say that it is a war of positions, bringing together the possible movements with the ones allied with the church, to be able to expand the strategy. There is no doubt, it is a political strategy. (National AIDS Program official)

Political Alliances

Relationship between Catholic Church and National AIDS Program concretized through formation of the Pastoral da AIDS

Partnership seen as mutually beneficial: “It was hunger coupled with the desire to eat together.” (National AIDS Program official)

Lovers’ Quarrels

Condoms and Compromises They [the Church] have to understand that the families do what

they call sins, and they have to include the question of condoms, and other methods…there is a negotiation. The National [AIDS] Program does not want to say that “they have to use condoms,” but it is has to be put out there that there are relations outside of marriage, and that for these relations to be safe, they have to be protected. So the negotiation is in this sense, of being attentive a little to the language without taking away the content of the information. (National AIDS Program official)

Making Up

AIDS and Religion Seminar 2006

AIDS Ribbon at Christ Statue in Rio 1988 and 2007

Examples of Broader FindingsPolitics and policyGender and sexualityCare and treatment

Examples of Broader Findings, Cont. Stigmatization and sex Interaction and intersection between

HIV, youth, sexuality, and religion Gender, power, violence, and conflict

in intimate relationships

FUTURE DIRECTIONS: ‘TIL DEATH DO US PART?

Final Year of Study: Next Steps Finalize case study write-ups

Finalize data analysis

Organize national seminar to

disseminate results

Next Steps Cont.

Dr. Patrick Wilson’s supplement on the role of religious institutions in responding to HIV and AIDS among Black MSM in NYC (Grant number: 5 R01 HD050118)

Jonathan Garcia’s dissertation: Responses of Afro Brazilian religions to HIV and AIDS in Brazil (Grant number F31HD055153)

New research and interventions?

Publications and Presentations Conference

presentations in Brazilian and international settings

Publications for Brazilian and international readership

Academic and lay publications

PublicationsPublished Articles

Author Title Journal

Rios, L.F., de Aquino, F.L., Muñoz-Laboy, M., Oliveira, C., and Parker

Catholics, Fidelity, and AIDS: Between the Cross of the Moral Doctrine and the Swords of the Sexual Life of Everyday Followers

Debates do NER, 9(14):135-156, 2008.

Seffner, F., Silva, C.G.M., Maksud, I., Garcia, J., Rios, L.F., Natividade, M., Borges, P., Parker, R., and Terto Jr., V

Religious responses to AIDS in Brazil: impressions from research about the STD/AIDS Pastoral of the Catholic Church

Ciencias Sociales yReligión/Ciências Sociais e Religião, 10(10):159-180, 2008.

Seffner, F., Silva, C.G.M., Maksud, I., Garcia, J., Rios, L.F., Natividade, M., Borges, P., Terto Jr., V. and Parker, R.

Religious Responses to AIDS in Brazil Urbanitas. V: 10. 2008

Rios, L.F., Paiva, V., Maksud, I., Oliveira, C., Silva, C.G., Terto Jr., V., and Parker, R.

Young people’s socialization to be careful with the “flesh” Psicologia em Estudo. 13: 673-682. 2008.

Publications Accepted and Not Yet Published

Garcia, J., Muñoz-Laboy, M., de Almeida, V., and Parker, R

Local impacts of religious discourses on rights to express same-sex sexual desires in periurban Rio de Janeiro

Sexuality Research and Social Policy

PublicationsPublications Accepted and Not Yet Published Cont.

Silva, C.G., Garcia, J., Seffner, F., Rios, L.F., and Parker, R.

Afro-Brazilian religions face HIV/AIDS in Brazil in Rio de Janeiro, Porto Alegre, Recife, and Sao Paulo: preliminary research notes.

In: Afro-Brazilian Readings: territories, religions and health. Editora UFS

Silva, C.G., Santos, A.O., Carli, D., and Paiva, V.

Religion, adolescence and sexuality: between autonomy and rigidity

Psicologia em Estudo

Paiva, V., Garcia, J., Rios, L.F., Santos, A.O., Muñoz-Laboy, M., and Parker, R.

Working with religious communities on sexuality and human rights

Global Public Health Special Edition

Publications Under Review

Rios, L.F., de Aquino, F.L., Murray, L., Muñoz-Laboy, M., Oliveira, C., and Parker, R.

The catholic church, moral doctrine, and HIV prevention in Recife, Brazil: Negotiating the contradictions between religious belief and the realities of everyday life

Medical Anthropology

Paiva, V., Silva, C.G.M., Seffner, F., Maksud, I., Rios, L.F., Muñoz-Laboy, M., and Parker, R.

Acolhimento: religious communities facing youth sexuality and AIDS

Culture, Health, and Sexuality

Wilson, P., Muñoz-Laboy, M., Valera, P., and Parker, R.

Contributions of qualitative research in Informing HIV/AIDS interventions targeting black MSM in the U.S.: A Review of the Literature

AIDS

FINALLY:IRRECONCILABLE DIFFERENCES?

Times of London, March 2009

New York Times, March 17, 2009

The Pope’s form of prevention?

Thank you!

Richard G. Parker: rgp11@columbia.edu Miguel Munoz Laboy: mam172@columbia.edu Jonathan Garcia: jg2320@columbia.edu Laura Murray: lrm2137@columbia.edu