The devastating news didn't make sense to Brazilian Pierre Freitaz. How was it possible that, at age 17, he was infected with HIV if his only boyfriend seemed fit and healthy?
Freitaz confesses he knew little about the virus when he was diagnosed in 2004. He didn't understand the difference between the infection and the disease it caused: AIDS. He was confused by the lack of obvious symptoms.
"It's like I was living in a different part of the world, and I felt immune."
While Brazil has long been seen as a global model in the fight against AIDS, activists and officials say more and more youths share Freitaz's unawareness of HIV risks, or are unconcerned about them. Even as HIV infection rates have begun declining in many other places, cases have been slowly rising in Brazil—with the sharpest jump among youths 15 to 24.
"The numbers are going up. It's a paradox, a shame. After all the money spent on treatment and implementing a policy for everyone to receive it, we have these disastrous results," said Dr. Caio Rosenthal, a Sao Paulo-based specialist at the Emilio Ribas Institute of Infectious Diseases.
U.N. statistics show 44,000 new infections detected last year in Brazil, up from fewer than 40,000 in 2005—a rate outpacing population growth. The national Health Ministry says overall numbers of HIV infections has reached nearly 800,000. That's half of all the HIV cases in all of Latin America.
By comparison, in the United States, the rate of new HIV cases has dropped by a third over the past decade, according to a study published last month in the Journal of the American Medical Association. About 1.1 million Americans are estimated to be infected with HIV.
When the global AIDS epidemic erupted in the 1980s, officials here reacted quickly. Brazil carried out widespread sex-education campaigns and became the first developing nation to offer free antiretroviral treatment on a large scale. The pace of deaths fell and mother-to-child transmission was cut sharply.
Officials say the persistent rise in cases could be partly the result of better systems for tracking the virus. Others blame religious opposition to sex-education campaigns, or say some youths mistakenly believe that progress in treating AIDS means it's a problem of the past.
Brazil's dominant Catholic church frowns on the use of condoms, but the chief resistance to sex education campaigns has come from evangelical Christians, whose share of Brazil's population has jumped from 5 percent to 22 percent between 1970 and 2010, making them an increasingly influential political force.
Dr. Dirceu Greco, the former head of the Department of Sexually Transmitted Diseases, AIDS and Viral Hepatitis at the health ministry, said opposition by evangelical leaders "caused notorious backtracking" in AIDS policy. Another former leader of the program, Dr. Pedro Chequer, complained that the restrictions have hurt campaigns targeting vulnerable populations such as gays and sex workers.
"There was a very clear setback. Brazil used to be at the forefront, but now it's just like any other country," said Chequer, who is widely seen as Brazil's leading anti-AIDS crusader.
In the past two years, for example, the federal government ordered schools to stop handing out comic books and other materials aimed at youth with stories encouraging the use of condoms to prevent HIV and teenage pregnancies.
Activists also complain the government scrapped the airing of pro-condom TV ads showing gay men hooking up at a nightclub while discussing safe sex. Health officials insist the ads were never intended for major television networks, but rather niche audiences.
The health ministry's current top AIDS official, Fabio Mesquita, said nationwide, prime-time TV campaigns are a thing of the past because his team is studying ways to target younger, more vulnerable populations through the Internet and smartphones.
He placed much of the blame for rising infections on misplaced confidence among younger people who didn't experience the disease's most-deadly era: "The new generation was no longer scared of anything, everything was OK. Having sex without a condom was a risk they were willing to take."
The government says spending on education and prevention is rising, but Mesquita said the fight against HIV must expand beyond safe-sex education: "We have to stop thinking of condoms as the only alternative to prevent the infection."
He said one path is an expanded program to give retroviral drugs to all infected patients, even if there are not yet signs that the virus has weakened their bodies' defense systems. Studies have suggested that HIV positive people who start taking medicines at that early stage are 96 percent less likely to infect others.
Brazil is studying another measure, pre-exposure prophylaxis, which involves a daily pill meant to protect those who are not infected. The U.S. government issued guidelines in May for using that process.
Brazil already has been a leader in treating AIDS. In eight years, it has doubled the number of HIV patients it treats to more than 350,000, at a cost of more than $420 million a year.
Still, many say education campaigns are essential.
"We need to start talking about how to bring back the issue to schools and convince evangelicals to join in so we are all more open about the problem," said Beto de Jesus, who coordinated a project that tested gays and transvestites in mobile health units in several Brazilian cities.
Freitaz, who has lived with HIV for a decade now, is volunteering at Incentive Life Group in Sao Paulo, where one in every six gay men live with HIV. The organization promotes HIV testing so that carriers get treated before they infect others. Freitaz says he often meets young men who are no longer worried about HIV and AIDS.
"They think the medication is as simple as aspirin," Freitaz said. "They have no idea."
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