STD/AIDSSTD/AIDS OF SAO PAULO CITY HEALTH DEPARTMENT FEBRUARY 2002,

Quem teve a idéia de cortar o “tempo em fatias, ao que se The priorities in deu o nome de ano, foi 2001 um indivíduo genial. Industrializou a esperança, follow in fazendo-a funcionar no limite da exaustão. Doze meses dão para qualquer ser humano se cansar e entregar os pontos. Aí 2002 entra o milagre da renovação e tudo começa outra vez, com Integration into the Universal Health outro número e outra vontade Care System (SUS) de acreditar que daqui para diante vai ser diferente”. Humanization of services Carlos Drummond de Andrade ” Emphasis on Prevention

STD/AIDS OF SAO PAULO CITY HEALTH DEPARTMENT Celso Pacheco Photos: Minute Thought Considerations

uring the first year of Marta Su- Such program is undermined by a po- Such view regards the answer to AIDS plicy’s mandate, the work litical proposal that considers the HIV epidemic to rely on an effective public done by the STD/AIDS of Sao and AIDS epidemic one of the main health care system, so as SUS. It is, thus, DPaulo City Health Department problems of public health. Also, it a political proposal that bears in mind concerned the physical remodeling and views people’s dedication and collec- partnership and autonomy, decentrali- the reorganization of health services, tive work force as crucial impetus for zation and partnership as the main an- through new perspectives and attitude. the fight against STDs and HIV/AIDS. swers to life. 1

institucional_eng1.p65 1 28/6/2002, 01:41 AIDS in the City of Sao Paulo It has been rising in the suburbs among heterosexuals, women and injected drug users. ao Paulo scored 46.889 HIV infected infected man and women. Since 1997, this persons, a number accumulated since rate had kept steady in a 2 to 1 status; how- Surveillance 1980, 45.456 of which are adults and ever, in 2001 it became less than that 2 to 1 S 1.433 children. The growth in AIDS basis. Since HIV treatment resources avail- Work rate in the City of Sao Paulo was of able have improved, thank to the anti-AIDS 40.48 notified infections in 100 thousand in- cocktail, a stabilization trend among adults Improving the Epidemic habitants (number of notifications of the in- has been noticed: about four thousand in- Surveillance System is crucial fection in 1998 for the resident population). fections notified per year, consistently con- to a straight prevention plot and According to a ranking of the 96 ad- trolled in 1996, 97, 98 and 99. On the other ministrative districts in Sao Paulo, some in the fight against HIV/AIDS hand, there has been a fall by 30% in the and other STDs deserve special attention among the 10 first number of notifications among children, in districts in numbers of notified infection. spite of the notification of 70 new cases of In 2001 Health Surveillance Centers República, Santa Cecília and (in Mother to Child HIV transmission per year. were organized and technicians were the downtown area), Jabaquara and Sapo- Concerning exposition, the last five trained according to the Health Ministry pemba (in the Southeast area), Brasilândia, years have shown a predominance of policies. HIV and STD surveillance has Cachoeirinha, Santana and Freguesia do Ó heterosexuals (34.6%), men who have been reinforced through the standardiza- (in the northern area), (in the West- sexual intercourse with other men tion of procedures and because of detailed ern area) and Campo Limpo (in the South- (23.6%), and injected drug users (14%). data scheming on STD/AIDS services. ern area). Such ranking reveals a change in There has been an “aging” in the aver- Among the health care staff, a sur- the profile of HIV infection in the city, age age of new AIDS patients in the last veillance of accidents during work which has been moving towards the sub- 5 years. Among men, the average 25-29 hours when handling biological mate- urbs because of epidemic trends among year old group shifted to a 30-39 age rial was accomplished last year. More- injected drug users and heterosexuals. group. Among women, this shift was over, the control of mother to child HIV from a 25-29 age group up to a 25-34 transmission has been improved, which What really changes age group. Finally, after a dramatic fall agrees that a child aged less than 18 by 52% at the introduction of the cock- months born to an HIV-infected moth- Among adults, there has been a signifi- tail, the rate of AIDS was estabilized at er will be categorized for surveillance cant decrease concerning the rate of HIV 1.400 deads per year in the last 3 years. purposes as not infected with HIV. The surveillance group is preparing an epi- demiological bulletin for April 2002. Highlighted practice The work in STD/AIDS in the city should consider service based researches

ork in STD/AIDS means to tion of a Committee Human Research. produce scientifically, to turn The participation of the profession- public the result of this produc- als of STD/AIDS of the city of Sao Pau- W tion and to act according to this lo in congresses and seminars were also produced scientific knowledge. It is what an accomplished objective. For example, technicians of the several municipal units in the IV Brazilian Congress of Preven- are trying to do everyday. Last year, a first tion of STD/AIDS, accomplished in Sep- team participated in a course of Basic tember of 2001 in Cuiabá, it was present- Research skills on AIDS in the School of ed 15 papers, which published their stud- Public Health of USP, systematizing its ies and a latter on summary of the de- practice in projects. At the same time, all bates to the whole team of STD/AIDS, of the studies that are being developed in in the seminar “Heats of Cuiabá”. STD/ the municipal services were gathered in a AIDS City of Sao Paulo was also present publication, the Inventory of Researches in several national and international sem- and Studies in STD and AIDS. STD/AIDS inars on Harm Reduction. To the XIV In- of Sao Paulo City Health Department also ternational Conference on AIDS, AIDS contributes with the Cogest (Coordination 2002, that will take place in Barcelona, The projects developed in the Course of of Decentralized Administration of the Methodology of Research are also part of the about 40 papers of the several areas were General Health Office), in the constitu- Inventory of Researches and Studies in DST/AIDS submitted. 2

institucional_eng1.p65 2 28/6/2002, 01:41 Perus STD/AIDS

Anhanguera Tremembé Jaraguá Brasilândia of Sao Paulo City Health Department Cacho- eirinha Jaçanã

Mandaqui Pirituba Freguesia Ermelino The STD/AIDS section has do Ó Matarazzo São São Casa Cangaíba Miguel Limão Santana Vila Domingos Verde Vila Vila Jacuí Curuça Vila Amália been remodeled in order to Guilherme Lapa Barra Penha Vila Bom Funda Pan Leopoldina Retiro Santa follow the integration of the Tatuapé Itaquera Lajeado Cecília Belém Vila Matilde Artur Perdizes Repú- Alvim Jaguaré Alto de blica Carrão Consolação Guaianazes city health care services Moóca Bela Cam- Cidade Líder Vista José Jardim Liber- buci Água Vila Bonifácio Butantã Pinheiros Paulista dade Rasa Formosa Aricanduva Rio Pequeno Parque do into the Universal Health Carmo Cidade Vila São Tiradentes Raposo Mariana Ipiranga Vila Lucas Care System (Sistema Tavares Morumbi Prudente Vila Sônia Itaim Moema Sapopemba São Mateus Bibi Iguatemi Saúde Único de Saúde – SUS) Vila Campo Sacomã Andrade Belo Campo he improvement in HIV-infected and Limpo Santo Amaro Jabaquara STD patients’ life standards and the

Capão Jardim prevention from HIV transmission Redondo São Luiz Campo Grande Cidade Ademar have been the main goals in the remod- Socorro Teling of health care services. This specialized

Pedreira network of services provides full health assis- Jardim Ângela tance, and aims at the upgrading of city labo- ratories for diagnosis and at a complete super- vision of HIV/AIDS and other SDT infections. In 2001, an emergency call for medical staff enlarged the number of nurses and infec- Grajaú tious desease doctors, who have been official- Prevention and Aid Center on STD/AIDS ly hired in 2002. Moreover, an agreement be-

Parelheiros tween the City of Sao Paulo STD/AIDS has CTA – Testing and Counseling Center on STD/AIDS granted supervision and monitoring services by members of the staff of the University of Medical Specialities Outpatient service Campinas (UNICAMP) in order to assist the SAE – Specialized Assistance Service on STD/AIDShealth service reorganization process. Nowadays, the 19 public services special- CR – Reference Center on STD/AIDS ized in STDs are distributed into four CTAs - Testing and Counseling Centers (Centros de Testagem e Aconselhamento), nine SAEs – Specialized Assistance Service (Serviços de Assistência Especializada), three CRs – Ref- erence Centers (Centros de Referência), one CPA – Prevention and Aid Center, and two AEs – Medical Specialities Outpatient Service (Ambulatórios de Especialidades).

Service Structure

CTA – Testing and CR – Reference Center AE – Medical Specialities Counseling Center Center of prevention and aid supporting Outpatient Service Guidance, counseling, and HIV-testing STD/AIDS services. It carries out diagnosis, It assists various patients with different and will be furnished with a bigger and more center, specialized in the prevention and diseases, including STD and HIV- infected detection of sexually transmitted infections. complex lab, which will allow emergency patients. and HIV testing. SAE – Specialized CPA – Prevention and Aid Center All the STD/AIDS public Assistance Service It carries out prevention, testing and services distribute male and female condoms This center carries out prevention and counseling procedures. It receives patients syringes and needles for injecting drug diagnosis procedures, besides various STD with different STDs. It also has a small lab users, besides different STD/AIDS therapies. It also has a small lab and an and an assorted staff. prevention devices. assorted staff.

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institucional_eng1.p65 3 28/6/2002, 01:41 The fight for Challenges of a human rights, the respect for diversity and the pursuit for citizenship are steps towards a major impact upon MEGACITY STD/AIDS epidemic

hat are the implications of into the population. This is a means of over- public health assistance, and the living so- working in the STD HIV pre- coming conservative perspectives ruled by cial apparatus. Such an attitude enables the vention services together with a prescriptive approach and by a medicine identification of agents who would pro- more than ten million people, specialized method, which focus on indi- mote prevention procedures and also Win a city of multifold layers of viduality and risky behavior. grants its maintenance. living conditions? The road traced by STD/ In the city of Sao Paulo, specialized Besides prevention, some services AIDS of Sao Paulo has been the introduc- prevention teams have adopted an active acts directly into definite groups, such tion of a model that addresses not only the attitude concerning the development of in- as men who have sex with other men, disease, but also the historical, social and tervention plots. They also go more often and transgender. Furthermore, last year political background relationships in- to work in the field in order to learn better saw the elaboration of some scientific volved. Such an approach enables health the reality of more vulnerable groups, es- projects designed for Sex Professionals care systems intervention into social com- tablishing partnerships with them. Their es- (including seven different services munity organization, trying to understand sential purpose is to articulate projects in around the city) and for youth (includ- how good health and illnesses are produced different regions, with the commitment of ing eigth services).

HEALTH EDUCATION Paulo Freire’s a The Health Education in Prevention and Sexualit It is the school community’s responsibility to und

rugs, sexuality, STDs, AIDS, and adolescents – 35% of the municipal sexual diversity are more than just school community – have been partici- subjects in Sao Paulo’s public pating. D schools’ syllabus are. Community Professors and the school staff have problems, world questionings and daily performed its first activities. In the work- news are not approached through a medical shops, everybody could face the difficul- perspective, neither in a recipe’s format. It ties and their own limitations in refer- is far from that teacher student hierarchy, in ring to such problems as drugs and sex- “Santo de Casa” is a Servicers’ Health which the teacher has the role to teach and uality. Firstly, a research and sensibili- Promotion Program of the City of Sao the students to absorb information. zation period was made necessary. Af- Paulo Government and the Health De- This program’s lead is that everybody ter, groups of adolescents and pre-ado- partment. It was released in October involved is a “wise”: from its director, lescents were created in each school, 2001, on the celebration for the Public the students and parents, and the school aiming at prevention and sexuality is- Servicers’ Day. It concerns the ideal ap- staff, up to the teachers. It was officially sues. Adolescent members of NGOs, proach towards accidents during work launched in the second semester of 2001 who had already dealt with such subjects, hours, while handling biological materi- in the city of Sao Paulo Legislative Pow- have instructed those adolescents. Final- al, besides prevention from Hepatitis “B” er Hall, by a partnership between the head ly and further is the formation of multi- through vaccination. Similarly, it assists of the City of Sao Paulo Education De- pliers in the community, which will re- alcohol and drug users, and puts condoms partment, Fernando José de Almeida and quire students’ parents’ participation. available for SDTs and AIDS prevention. also the head of the Health Department, The “Santo de Casa” Project binds the- Eduardo Jorge. All the 13 Active Edu- The right to learn matic areas, such as Workers’ Health, cation Centers of the city of Sao Paulo Alcohol and Drugs and STD/AIDS. (Núcleos de Ação Educativa da Prefeit- The distribution of preventive devic- ura – NAEs) will take part on this pro- es is also part of the Health Education in gram. Up to now, 1.560 adults and 450 Prevention and Sexuality Program. Stu- 4

institucional_eng1.p65 4 28/6/2002, 01:41 HARM REDUCTION Injected drug users are citizens he poetry in the song Pa- public servicers from the health radeiro, by Arnaldo An- area have been trainned for work- tunes, Marisa Monte and ing in the 19 STD/AIDS centers. Carlinhos Brown reflects Nowadays, each service provides T the ideas, dreams and the the population with harm reduc- work of PRD-Sampa – of the City tion kits. of Sao Paulo Harm Reduction The Harm Reduction Project is Project. Here, injected drug users part of a municipal government’s are citizens whose rights to health priority to introduce a public pol- and prevention devices such as sy- icy regarding the use of drugs. It ringes, needles, destiled water and is a humanitarian proposal that of- others are guaranteed. This is the fers ex-centered citizens, who are only means to avoid AIDS, hepati- deprived of their essencial rights, tis “C”, besides other diseases, an opportunity for life in society. “haverá paradeiro uns vão de pára-quedas since users are not willing to, or are Having citizens as health agents para o nosso desejo outros juntam moedas not able to quit injected drugs. acting for harm reduction among dentro ou fora de um vício? antes do prejuízo The PRD Sampa was launched their own comunity is PRD Sam- uns preferem dinheiro num momento propício in September 2001, and represents pa’s next step. It concerns them the outros querem um passeio haverá paradeiro para isso? a strategy for a public health care answer to the questions in the perto do precipício haverá paradeiro para system and for HIV prevention. opening song. The public health haverá paraíso o nosso desejo This was how the media, the com- care service aims at respecting sem perder o juízo e dentro ou fora de nós?” sem morrer? munity and health professionals their flights, offering parachutes “Paradeiro” received the program, which has for their falls, and believing that haverá pára-raio Arnaldo Antunes, para o nosso desmaio Marisa Monte e Carlinhos Brown been successfull worldwide and in there is something other than a no momento preciso? Brazil. More than seven hundred cliff ahead. reire’s approach on and Sexuality Program has a collective purpose. nsibility to understand the health problems at stake.

dents from 11 up to 14 years old are giv- Prevention became less a teacher’s prob- en an interactive agenda, in where there lem than a collective concern integrated are explicative topics and plenty of room into the Pedagogical Project of the schools. The number for note taking on their bodies’change, “Such proposal is a daily practice of a dem- and potential questions they would ask ocratic education”, said Terezinha Reis of condoms at a doctor’s appointment. They also re- Pinto, pedagogue of the STD/AIDS of Sao ceive a filing folder for recipes, a mirror Paulo City Health Department staff and co- distributed by for self-examination, condoms, pads for ordinator of the Technical Orientation Sec- the girls’ first period, and a shaving tion of the City of Sao Paulo Education the STD/AIDS cream for the boys. Department. According to her, “We are not doing something extraordinary. Instead, the public services Some schools have been distributing difference is that everybody is now able to condoms to the night shift students, teach- understand the content of what our purpose has tripled up ers, staff, and parents during counseling is about”. meetings. Furthermore, there has been to THREE great publicity and research concerning the In reality, the Health Education in female condom. Prevention and Sexuality Program is a liberalizing prevention model, to recall MILLION Paulo Freire’s pedagogy. This implies an Pedagogical Project extra homework: “to look through the in 2001. school, at the community and its region;

The reality in schools has been really to offer assistance in educational tasks 3. . changing due to this new practice: parents and health issues”. Such lesson has be- and teachers exchange condoms, and those ing done by the Program participants, are not made into “globes” by students. who reveal their secret: “To give a dif- ferent look at things”. 5

institucional_eng1.p65 5 28/6/2002, 01:41 Specific knowledge Administration and health policies and aplication Professional upgrading in STD/AIDS contributes to of resources the quality of services and promotes the integration of the area into the health system In order to guarantee the development of STD/AIDS projects, a group has been raining in handling with sexual professionals from different sections of the working on management and monitoring of transmitted diseases in service, city government, and harm reduction pro- the Anual Operation Plan and of Coopera- and also the introduction of the fessionals and members from civil organi- tion agreements in STD/AIDS, with nation- T Harm Reduction Program as a zations could atend the courses. al and international organizations, such as health policy, including the discussion of Seminars, congresses, courses and BIRD, UNESCO and the Ministry Health. concepts and strategies that embrace all workshops on Therapeutic Home Assin- In 2001, the city has received 2 mil- the STD/AIDS area, those have been the tance, Oral Health in STD/AIDS, Medical lion reais from national and international main accomplishments towards the im- Knowledge updating, prevention, pharma- agreements, and also 8 hundred thousands provement of the STD/AIDS profession- ceutical and laboratorial attention, biologic reais from the Sao Paulo City Govern- ment. It represented a decisive contribu- als in 2001. Over seven hundred profes- accidents with HIV and Hepatitis “B” tion for introducing some projects that had sionals have taken part on one of those and“C”, and drug policy have also been part already been developed. Its aplication has training practices. of the agenda, which counted over one thou- priviledged competence, effectiveness Courses have been designed to atend the sand participants. It is the main concern of and the maintenance of actions in the needs of physicians, multiprofessional the training area to guarantee an ongoing STD/AIDS area. teams, and the lab staff. Those courses in- professional upgrading in order to develop cluded diagnosis and treatment issues, re- the Continuing Educadtion program. This ception and advising, content collection and upgrading aims not only at enbettering the material reading. Concerning Harm Reduc- STD/AIDS centers, but also at integrating tion, courses have been designed for a wid- this area into the Family Health Program er public. Besides the STD/AIDS group, (Programa Saúde da Família – PSF). Prevention and popularization actions of Partnership and the work

The production of informative and edu- democratization cational material and the popularization of the actions and programs are one of the ac- Bearing in mind the Sao Paulo city rum’s mediation, but it also promoted a tivities of STD/AIDS. This work also has government policies, the STD/AIDS area straight relationship with the various as objective the collaboration with the Con- is opening for the participation of enti- entities that work in different sections sultantship of Communication of the Mu- ties from the civil society in its activi- and regions in the city. This process is nicipal Health Office in dealing with the ties, and has also been present at those committed to a proposal of the Munici- press. It gives support to the technicians of entities’ activities, as a means for col- pal Health Department to guarantee the STD/AIDS in the elaboration of articles and lective action. This dialogue had been participation and social control into the it coordinates the creation, composition, st long interrupted, due to the isolation pro- STD/AIDS area. In 2002, the 1 Munic- graphic project, edition and publication of moted by the last municipal administra- ipal AIDS Conference will be held, specific materials of the area as pamphlets, tions. Restoring such communication which shall count on a wide participa- videos, bulletins, newspapers etc. based on the Sao Paulo NGOs-Aids Fo- tion from the civil society.

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institucional_eng1.p65 6 28/6/2002, 01:41 Nutrition and AIDS

Open doors and out for the streets! The IV STD/AIDS Prevention Congress in Cuiabá, held in September 2001, opted for the This is the direction of STD/AIDS municipal services, for the introduction of a national consensus to guaran- integration of attenders and their communities. tee the distribution of lactation inhibitor to HIV infected mothers. It also guarantees special for- mula of infant nutrition supplies to their babies. Such procedure has been referred to in the work presented by the Nutrition and AIDS Study Group of the City of Sao Paulo STD/AIDS. Be- cause of the significant increase of HIV infect- ed women, and also the consequent risks of mother to child transmission, the Sao Paulo Their group’s research has been of great contribution. Rythm Pharmacy, 10 The STD/AIDS Pharmacy area received the Lawes Pharmaceutical Excellency Award in 2001. It was delivered at the XII Sao Paulo Pharmaceutical Seminar, in recognition to the Photo - SAE Cidade Líder Cidade - SAE Photo quality of services and for the contribution of The SAE Cidade Líder and young members from the group Força Ativa have intro- Pharmacy professionals to the fight against ducted workshops on sexuality, prevention and coordination of STD/AIDS. Over one STDs and HIV/AIDS hundred students from the Dr. José Augusto César Salgado Municipal School have discussed drug use, violence at home, sexual abuse, life valorization, body responsibil- Folha’s Opinion ities, their “first time”, pregnancy and condoms. The celebration for the end of the activ- (Folha de is one of most important newspaper in Brazil) ities took place at the Educative Action auditorium, an NGO from Sao Paulo that works with yougsters and education. “With a seven year delay, the City of Sao Paulo Government has at last started the dis- tribution of syringes to injected drug users. The girls Zone “... This attitude must be praised, specially for its multidisciplinary groups, which enlarg- es the scope of such action... “...Nowadays, effective Harm Reduction Pro- In the SAE Cam- grams are proved to be crucial in pursuing the pos Elíseos, the traves- AIDS epidemic control by the public sector” ties of the downtown Folha de Sao Paulo editorial th area find room for page 2, September 24 , 2001. health care and living. There, is Christimas Chamber’s attention to... Party. The City of Sao Paulo STD/AIDS’ coordi- nation has received some Municipal Chamber support, given by the city supervisor Claudio Fon- seca in 2001. The city supervisor Carlos Neder has made another motion through the Rolleston Award – International Award for Harm Reduc- tion – granted by Dr. Fábio Mesquita, the current Sao Paulo STD/AIDS coordinator. Apart from such reconnaissance, the STD/AIDS has had the support of different Sao Paulo city counselors, who are very attentive to works developed by the Photos - SAE Campos Elíseos - SAE Photos municipal administration in the health area.

Drug Policy World wired The Sao Paulo City Government sanctioned The SAE Betinho Servicers Association, ceived certificates at the end of last year. the 13.321 law, for the creation of a Municipal in Sapopemba, has been offering courses This association keeps the web site Council of Public Policies for Drugs and Al- on adult education for attenders, which goes www.crbetinho.hpg.com.br . Computers for cohol, by the city supervisor Lucila Pizani, on February 6th. For the first time in Brazil the from first letters to computer lessons. The collective use give them the access to Internet quenstion is given an appropriate focus: the one first “graduates” from those courses re- and to own eletronic addresses. of public policy.

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institucional_eng1.p65 7 28/6/2002, 01:42 Right now! Of parents and children Every day is the perfect day, and every time is a good time! However, sometimes some special care concerning STDs, HIV/AIDS is even better. As, for instance, a condom! Valentine’s Day Seduction and Prevention Prevention is the general solution. Foto - Valdeneia Barbosa/ASCOM/SMS - Valdeneia Foto During the “Valentine’s Day” celebration, Dona Santa, in honor of her son Paulo Bonfim the distribution of chocolat and condoms On January 31st, the Paulo César Bon- could tell the message: safe pleasure, so fim Prevention and Assistance Center was everybody can do fine. inaugurated in Lapa, Sao Paulo. Its name is in honor of the first municipal coordinator, the “any time” militant against HIV/AIDS in Sao Paulo, who passed away in 1992, st when he was 37 years old . The presence of December 1 . Mrs Edelza Maria Santa Santos Bonfim, who, coming from Ilheus – Bahia, in honor Peace, love and condoms of her son, transformed the ceremony into an act of thanking and renewing municipal The International World AIDS Day was responsibilities against HIV/AIDS. celebrated with “forró”, theater plays, an In October, SAE Herbert de Souza’s 10th arts’ exhibition, a book release and plenty Anniversary, in Sapopemba has brought us the of condoms. In the Ibirapuera Park, millions memory of Betinho. The participation of of people took part in the celebration and Daniel de Souza has reinforced that social com- reinforced the importance of a collective ac- promise and dedication in the fight against tion together with civil community organi- HIV/AIDS epidemic, come from father to son. zations and health care services in the pre- vention from AIDS. Peace, love and condoms made up a In the oven lot of people’s mind. Photos- Josane Cavalheiro/ASCOM/SMS Josane Photos- The City of Sao Paulo STD/AIDS Assistance area is elaborating a textbook on Mother to Child Transmission. It shall be released in March, Carnival in celebration to the International Women’s Day. On behalf of the International Day of Heath, Condom’s party on April 7th, the area of survaillance is prepar- ing a new Epidemic Bulletin issue. Two hundred thousand condoms have been dis- In May, it is time for the project designed to tributed during Carnival in Sao Paulo this year. One the Sao Paulo radio braodcasting profession- hundred thousand in the Sambódromo – Sao pau- als, the SDT/AIDS Radio. lo’s Carnival catwalk –, together with pamphlets In June, Sexually Transmitted Diseases are informing the services’ addresses. The other half going to be the theme for a textbook on differ- has been distributed in neighboorhoods where Car- ent ways of love. This is a gift for “Lover’s Day”. nival parades were also performed.

This rendering account journal brings a bit of many people’s work and help in a year STD/AIDS of Sao Paulo City Health Department job. The City of Sao Paulo Health Department, through the coordination of the STD/ Rua General Jardim, 36 Zip 01223-010 AIDS of Sao Paulo, would like to thank everybody and it also hopes to keep on having the Phone #. 11 3218-4000 support of the following institutions and entities: [email protected] • UNESCO Government, specialy to the camarades Marta Suplicy – Mayor Eduardo Jorge – Head of the Municipal Health Department • UNAIDS from the City of Sao Paulo Health Paulo Capucci – Coordinator of development of the • STD/AIDS Nacional Coordination Department. Descentralized Management program– Cogest • STD/AIDS State Coordination • STD/AIDS service staff Fábio Mesquita – Technical Assistant of the STD/AIDS • The NGOs’ Court House of the State of Sao • To the city of Sao Paulo population, for Thematic Area Paulo whom we work STD/AIDS of Sao Paulo City • Partner Interprises, such as DKT, Johnson, • To the STD/AIDS public services’ users, Health Department Journal Gessy Lever and Nestlé particularly to HIV infectted and injected Texts and edition – Celia Regina de Souza • The City of Sao Paulo Chamber. drug users, who have become the agents of Design Production – Eduardo Joly •The staff from the City of Sao Paulo their lives and of health in our city. With the support of: 8

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