Brazil: Winning Against AIDS- On BBC-World

Brazil: Winning Against AIDS

Five years ago, the World Bank forecast that Brazil would have 1.2 million HIV-positive people by this year. The Brazilian government responded with a series of bold moves involving the health service and citizens groups across the nation. As a result, the actual number infected is believed to be only 600,000 - half what was forecast. At the heart of Brazil's success is its drug-distribution programme.

HIV/AIDS sufferers in Brazil today get the same treatment as HIV/AIDS sufferers in the USA and Europe - the same, free 'triple cocktail' of anti-retroviral (ARV) drugs, the same clinical care, the same monitoring. So perhaps it's not surprising that Brazil's HIV/AIDS patients have proved just as capable of taking their medicines on time as Americans or Europeans (the failure rate is exactly the same for Los Angeles and Rio), and that since 1997 the Brazilian government's national HIV/AIDS programme has proved its cost-effectiveness - halving the death rate from AIDS, preventing thousands of new patients being hospitalized, and helping to stabilize the epidemic.

The first that Emerson knew he'd developed full-blown AIDS was when five years ago he collapsed with a high fever. "I had ganglion tuberculosis - there seemed to be no way out. I was really, really debilitated. My mother was taking care of me 24 hours a day - my family were already planning the funeral. When I go to the pharmacy I get the drugs for free. I've been taking the drug cocktail for five years without missing a single dose." And these are Brazilian-made ARVs.

Maria's husband died of AIDS, and she is HIV-positive. She had a three-year-old son who also died - of liver disease complicated by an HIV related infection. She's since given birth to her daughter Elena. Maria cannot breast-feed her baby because of the risk of transmission of HIV. She was given ARVs during her pregnancy to protect the baby; she still doesn't know if she's clear. Without the Anti-Retroviral drugs it's unlikely that Maria and Emerson would be alive today.

In 1997, the year that Brazilian patent law came into force, Brazil made a political commitment to make these drugs available to everyone who needed them. So as to be able to afford to do so, Brazil started making its own "generic" medicines - cheaper copies of brand-name drugs registered before 1997. Many drug companies then reduced the price of their pre-1997 drugs sold in Brazil - some by as much as 75%, to encourage Brazil not to manufacture generic copies. Eloan Pinheiro, Director of Far-Manguinhos, the Federal pharmaceutical laboratory, explains: "Any country with the political will could do this because these drugs are actually not hard to make. It just needs a strong health minister, as we have, who's solidly behind the free drugs programme."

Brazil is breaking the virtual price monopoly enjoyed under World Trade Agreements by the major pharmaceuticals companies. They've complained about Brazil's action. But Dr Pinheiro says they have little reason to. "The drug companies say they need to charge high prices in Latin America and Africa to pay for research into new drugs and that if they were to lower their prices to the poorer countries they would lose heavily. In truth the global drugs business is worth US$300 billion and 82% of this market is made up of sales in the USA, Europe and Japan - 82%! So how is it then that we poor countries can cause so much harm to these companies with our share of the market?"

Brazilian Health Minister José Serra puts it in a nutshell: "We've put our case to the world and we've fought for it. And what is our case? It is that access to medicines is a basic human right."

Maria's baby Elena passes her second test and the doctor tells Maria: "There's a 99% chance that your baby is clear." Dr Souza says that through the use of ARVs and other drugs, Brazil has managed to reduce the mother-to-child transmission of HIV down from around 30% to less than 0.2%. And Paulo Teixeira, head of the Ministry of Health AIDS Programme, adds that although the country is spending $300 million a year on HIV drugs, this is money well spent. "We are saving much more than this because we don't have any more hospitalisations. We are not using so many drugs for opportunistic infections and for other health problems." More people with HIV are still doing productive work, and the state is saving money.

Pressed by influential drug companies, the United States government recently threatened to sue Brazil at the World Trade Organisation, but they withdraw the threat at the end of June after Brazil promised further consultation. But it's only a temporary truce.

Another reason for Brazil's success in the fight against AIDS is its mobilisation of voluntary organisations throughout the vast country. Paulo Teixeira says that more than 600 Brazilian NGOs are working in the field of HIV/AIDS and conducting over one thousand projects in all the areas: prevention care, social mobilisation "- and also monitoring the government response."

Some provide support groups, to help people cope with side-effects. Others, like Sempre Viva, help poor people in rural areas - which is badly needed because, as AIDS expert Dr Frederico Rangel, explains: "AIDS is becoming a disease of the poor and it's reaching further and further into the interior of the country."

It is very important that poor people have access to ARVs - it's a political necessity, says Paulo Teixeira: "It means mobilising people to demand their right to have access to the treatment available in developed countries."

José Serra is determined to continue with his policy: "When you give people the proper treatment it humanises them. It improves their self-esteem and self-love. This is very important. If you treat people in this way it helps prevent the spread of HIV."