With Brazil's HIV/AIDS response beset by the ongoing COVID-19 pandemic and the antiscience approach from president Jair Bolsonaro, civil society organisations are picking up the slack, even as funds from international donors dwindle. The Barong Cultural Institute, formed in 1996 in São Paulo and working across 50 municipalities nationwide, has long sought to bring a holistic and non-judgmental approach to HIV/AIDS outreach in Brazil, as part of a wider strategy to promote sexual and reproductive health education.
“We work where things happen”, is a common refrain spoken by Barong's team, which can often be found on the streets of Brazil's largest cities—including São Paulo and Rio de Janeiro—working directly with vulnerable communities, including sex workers and nightlife employees. Continuing to work during the pandemic, Barong has distributed food parcels, hygiene products, protective masks and other equipment, and antiretroviral therapies, which are free under Brazil's universal Unified Health System (or SUS), to those unable to travel to distribution centres. Over 1 million people have used Barong's services, while the NGO's human rights team has lobbied for change in Brazil's courts, pursuing over 250 legal actions. With a specially kitted out van, Barong travels to São Paulo's most vulnerable communities, also carrying out prevention and management campaigns. Fittingly, the name is a play on words for “bar” and “NGO” in Portuguese.
“People that live and work on the street, from sex workers to people working in bars and clubs, are those that have been hit hardest by the pandemic”, Marta McBritton, president and cofounder of Barong, told The Lancet HIV. “These are people that work lunch to be able to pay for dinner, and we are seeing more and more people without work living on the street, putting themselves at greater risk… it is these communities that are our focus.”
Barong's unique strategy has won plaudits from other NGOs working in HIV/AIDS. “Barong is a special organisation and one that AIDS Health Foundation (AHF) Brazil continues to work with, on our community-based testing project”, said Beto de Jesus, who heads the Brazil office of AHF. “Every element of Barong's strategy takes key vulnerable populations into account and their pre-formative research locates the most opportune locations and times to reach these populations. They work on days and times that regular health services do not work, so you can find them doing testing on Sunday or even 2 am.”
© 2020 Barong
Those street-smarts have led to collaborations with larger NGOs, including UNAIDS, the AHF, as well as the São Paulo state government's AIDS programme. With support from those institutions, Barong launched the Balaio project, which distributed food parcels, ART, and cooking gas to 800 people in São Paulo in its first 2 months of implementation. They have also sent antiretroviral therapy to people living with HIV in Angola, Paraguay, and Peru.
“Barong have been like angels to me”, said Raquel, who has been living in São Paulo with HIV for 24 years and uses a wheelchair, making travel to a distribution centre impossible during the pandemic. Through Barong, Raquel was put in touch with a psychologist who she continues to see. She also has received food parcels due to her low-income status from Barong as those provided to her by the government were cut off. When the pandemic first struck in March, she was left 1 month without her antiretroviral drugs, until Barong was able to procure them for her. “Without them I would not have received my medication, which is my biggest fear as I don't see the situation in Brazil improving anytime soon”, Raquel said.
McBritton, Barong's president, admitted that funds from donors have been difficult to attract, and that HIV has taken a back seat to COVID-19, both in financial and political terms, in Brazil and further afield. “When I saw what was happening in Italy in March, I began to worry about how it would affect us.” It appears those fears were justified. International donors now believe that Brazil, with the largest economy in Latin America, has both the financial muscle and human resources to tackle the HIV epidemic, McBritton said. And, like other developing countries, the local currency has been destabilised by the pandemic. “With the Brazilian real incredibly weak against the dollar, our operating costs have increased… just sending antiretroviral therapies abroad can cost hundreds of dollars now.”
Yet despite the grim prognosis, McBritton remains optimistic that civil society, and Barong in particular, will weather the storm. “We have prepared as best we can for the pandemic, and all of our volunteers and employees follow biosecurity recommendations”, she said. “And if there's one thing we've learned over the years, it's that there will always be people around who show solidarity.”