HIV/AIDS in Brazil
The first
The Brazilian experience is frequently cited as a model for other developing countries facing the
Prevalence
In 2019, Brazil had 920,000 people living with HIV/AIDS.[1] In 2019, 0.60% of the population had HIV/AIDS.[1] In 2019, there were 14,000 deaths from HIV/AIDS.[1]
History
Brazil's first AIDS case was reported in 1982. Brazil's AIDS response was crafted in 1985, just after Brazil had returned
The program was reorganized again in 1992 with more emphasis on linkages between government and NGOs.[3][4] AIDS Project I garnered $90 million in domestic funds and a $160 million loan from the World Bank between 1992 and 1998. AIDS Project II was funded by of both domestic funds and a World Bank loan totalling $370 million between 1998 and 2002.[4]
In 1990—a year when more than 10,000 new cases were reported—the World Bank estimated that Brazil would have 1,200,000 in infections by 2000. However, by 2002, there were fewer than 600,000 estimated infections, less than half the prediction.[5]
Government policies
Universal ARV provision
The single most controversial element of the Brazilian HIV/AIDS response remains the free, universal provision of
ART was traditionally considered too expensive in resource-poor settings in
In the context of Brazil, some have challenged the degree to which improvements in public health can be attributed to ART as opposed to other factors. For example, a 2002 World Bank Policy Research Working Paper, states:[11]
- The impact caused by the introduction of therapeutic measures, like the antiretrovirals in their different compositions and associations and/or health promotion and protection measured, though evident, has not been completely explored yet.
A 2003 study, using data from diagnoses occurring in Brazil in 1995 and 1996, found that antiretroviral treatment was the single greatest predictor of survival.[12] The authors demonstrate that variables like year of diagnosis, higher education, sexual exposure category, gender, the presence of specific pathogens all appeared to predict survival in a univariate analysis; however, in a multivariate analysis only antiretroviral treatment, diagnostic criteria, and transmission category remained significant.[13] The authors conclude that no factor other than ART "could reasonably explain the very large increase in survival observed" between the 1980s and 1996.[14]
Social policies
Brazil's response has been characterized by reaching out to groups which account for a high percentage of AIDS transmission, including relationships with
In 1988 comprehensive screening tests were implemented nationwide in blood banks, following a similar program in São Paulo in 1986. The results of these programs were not realized fully until 2000 as a result of the incubation period of the virus, but new cases from blood transfusion became virtually non-existent at that time and new and more effective nucleic acid testing is being considered.[15][17] Mother-to-child transmission was similarly practically eradicated, falling to a transmission rate of 3%, a level comparable to most developed countries, with the implementation of zidovudine treatment regimes to mother and child and recommendations against breastfeeding.[18]
International conflict
Drug patents
The average annual cost of ART per patient in 1997 was $4,469—compared to over $10,000 in most of the
Article 71 of the 1997 Brazilian patent law requires that foreign products be manufactured in Brazil within three years of receiving a
Prodded by domestic pharmaceutical lobbies, the U.S. challenged Article 68 within the framework of the
Brazil argued that the law only applied to cases where the patent holder abuses their economic power, a loophole specifically allowed by the TRIPS agreement.
- If this trend proceeds, it will be a global pandemic of AIDS that will grow uncontrollable because the Brazilian move will destroy the whole legal order that is the basis for developing new drugs and continuing research.
The pharmaceutical companies were not just afraid of the immediate loss of the Brazilian market, but with the larger implications of other developing countries following Brazil's example. Large developing countries, like India, with large industrial capacities and evolving intellectual property regimes are the true elephant in the room.[27]
Brazil invoked the Article 71 for the first time on August 22, 2001, when
Brazil carried out such a compulsory licensing threat for the first time in May 2007, on efavirenz, produced by Merck.[29]
The agreements signed on November 14, 2001, at the WTO conference in
]Prostitution
Two 2003 United States laws—one related to AIDS, the other to sex trafficking—required all recipients of U.S. assistance to sign a pledge denouncing prostitution, even if U.S. funds are not used for projects directly related to prostitution.[30] In 2005, Brazil wrote to the United States Agency for International Development (USAID) declining to condemn prostitution, effectively rejecting the remainder of a grant for $48 million between 2003 and 2006.[30] In 2006, USAID officially declared Brazil ineligible to renew the AIDS prevention grant because Brazil would not condemn prostitution as "dehumanizing and degrading."[31]
Brazil considered its partnerships with prostitutes—in distributing contraceptives, educating the public about the disease, and voluntary testing—critical to its overall AIDS prevention strategy. One Ministry of Health pamphlet depicts a character, "Maria Sem Vergonha" (Portuguese for "Maria that knows No Shame", but also a pun on the Brazilian name of the flowering genera "Impatiens spp.", maria-sem-vergonha), a scantily-clad sex worker who encourages prostitutes to take pride in their work and use condoms.[31]
Pedro Chequer, director of Brazil's National AIDS Control Programme, was quoted as saying "we can’t control [the disease] with principles that are
A "Brazilian model"
Brazil's Health Minister, José Serra, said in 2001, "Our example could serve as a model for other countries in Latin America, the Caribbean, even Africa. Everyone in the world has the right to access these therapies."[33] Some scholars, such as Levi and Vitória, argue that the Brazilian model can only be applied to other countries with similar level of economic development and civil society sectors.[34] Galvão argues that the unique local conditions in Brazil complicate the application of the Brazilian experience to other regions with their own local problems and structures.[35]
A
See also
References
- Abadía-Barrero, César Ernesto. (2003). "The Cultural Politics of the Brazilian AIDS Social Movement: A Local and Global Revolution." Latin American Studies Association.
- Bastos Barcellos; Inácio Francisco; Christovam Lowndes; Catherine M.; Friedman Samuel R. (1999). "Co-infection with malaria and HIV in injecting drug users in Brazil: a new challenge to public health?". Addiction. 94 (8): 1165–1174. PMID 10615731.
- Brazilian National STD/AIDS Programme. (2003). AIDS Treatment.
- Colebunders R.; Verdonck K.; Nachega J.; Kothari P. (2000). "Impact of new developments in antiretroviral treatment on AIDS prevention and care in resource-poor countries". AIDS Patient Care STDs. 14 (5): 251–257. PMID 10833812.
- Gentile, Carmen. (2005, June 3). "Brazil Says it will Break AIDS Drug Patents." VOA News.
- Gilman, Susan. (2001). "Brazil, AIDS, and Intellectual Property." TED Case Studies, No. 649, January.
- Lawson, Mary. (2004, February). "Brazil — And the Burden of AIDS." The Worldly.
- Levi Guido Carlos; Vitória Marco Antonio A (2002). "Fighting against AIDS: the Brazilian experience". AIDS. 16 (18): 2373–2383. PMID 12461410.
- Marins Jose Ricardo P.; Jamal Sanny Y; Chen Leda F.; Barros Marilisa B.; Hudes Esther S.; Barbosa Aristides A.; Chequer Pedro; Teixeira Paulo R.; Hearst Norman (2003). "Dramatic improvement in survival among adult Brazilian AIDS patients". AIDS. 17 (11): 1675–1682. S2CID 7147908.
- Ministry of Health of Brazil. (2001, June). National AIDS Drugs Policy. Brazil: Ministry of Health of Brazil.
- Ministry of Health of Brazil. (2002). Brazilian HIV/AIDS Vaccine Plan. Brazil: Ministry of Health of Brazil.
- Ministry of Health of Brazil. (2003). Brazilian STD/AIDS Policy. Brazil: National STD/AIDS Programme.
- Ministry of Health of Brazil. (2006, March 15). Declaration by the Brazilian Government on harm reduction as a public health strategy, presented at the United Nations Economic and Social Council 49th session of the Commission on Narcotic Drugs. Brazil: Ministry of Health of Brazil.
- Nemes Maria I.B., Carvalho Heráclito B., Souza Maria F.M. (2004). "Antiretroviral therapy adherence in Brazil". AIDS. 18 (suppl 3): S15–S20. S2CID 27328346.)
{{cite journal}}
: CS1 maint: multiple names: authors list (link - Novaes, Hillegonda Maria Dutilh, Luna, Expedito J. A., Goldbaum, Moisés, Kilsztajn, Samuel, Rossbach, Anaclaudia, Carvalheiro, José de la Rocha. (2002). "The Potential Demand for an HIV/AIDS Vaccine in Brazil." World Bank Policy Research Working Paper 2940.
- Oliveira-Cruz V.; Kowalski J.; McPake B. (2004). "The Brazilian HIV/AIDS 'success story' — can other do it?". Tropical Medicine and International Health. 9 (2): 292–297. S2CID 38455359.
- Oxfam GB. (2001, May). "Drug Companies vs. Brazil: The Threat to Public Health."
- Pachovski, Slavi. (2005, June 16). Remarks at the National Press Club. "The Future of U.S.-Brazil Trade Relations I the Shadow of Brazil’s Piracy of American Intellectual Property."
- Pan American Journal of Public Health. (2001). "Brazil fights for affordable drugs against HIV/AIDS." 9 (5): 331–337.
- Phillips, Michael M., and Moffett, Matt. (2005, May 2). "Brazil refuses U.S. AIDS funds, rejects conditions." Wall Street Journal.
- Reel, Monte. (2006, March 2). "Where Prostitutes Also Fight AIDS." Washington Post. p. A14.
- Szwarcwald, CL. (2002). "The impact of national production of ARV drugs on the cost of ARV therapy in Brazil, 1997-2000." Presented at the XIV International AIDS Conference.
- Schwartz, Karyn. (2001). "Brazil: A Model Response to AIDS?." NewsHour.
- Teixeira, Paulo R. Vitória, Marco Antônio, and Barcarlo, Jhoney. (2004). "Antiretroviral treatment in resource-poor settings: the Brazilian experience." AIDS 18 (suppl 3): S5-S7.
- Wadia, Roy. (2001, August 16). "Brazil’s AIDS policy earns global lauds Archived 2007-02-11 at the Wayback Machine." CNN.
Notes
- ^ S2CID 227296365.
- ^ a b Teixeira et al., 2004, S6.
- ^ a b Levi and Vitória, 2002, p. 2373
- ^ a b c Levi and Vitória, 2002, p. 2374.
- ^ a b c Ministry of Health of Brazil, 2003.
- ISSN 1984-8250.
- ^ Levi and Vitória, 2002, p. 2378.
- ^ Colebunders et al., 2000.
- ^ Nemes et al., 2004, S15.
- ^ Teixeira et al.,2004, S7.
- ^ Novaes et al., 2002, p. 10
- ^ Marins et al., 2003, p. 1675.
- ^ Marins et al., 2003, p. 1678-1680.
- ^ Marins et al., 2000, p. 1681.
- ^ a b c d Levi and Vitória, 2002, p. 2375.
- ^ Washington Post, 2 March 2006
- ^ Levi and Vitória, 2002, p. 2376.
- ^ Levi and Vitória, 2002, p. 2377.
- ^ a b Szwarcwald, 2002.
- ^ a b c d Gilman, 2001; Brazilian National STD/AIDS Programme, 2003
- ^ Gentile, 2005.
- PMID 15933232.
- ^ Oxfam GB, 2001, p. 6.
- ^ Oxfam GB, 2001, p. 10-11.
- ^ Oxfam GB, 2001, p. 3.
- ^ Pachovski, 2005.
- ^ Oxfam GB, 2001, p. 2.
- ^ quoted in Wadia, 2001.
- ^ The Economist. May 12, 2007. "Brazil's AIDS programme: A conflict of goals." p. 42.
- ^ a b c Phillips and Moffett, 2005.
- ^ a b c Reel, 2006.
- ^ Just Say Não Archived 2010-04-16 at the Wayback Machine, The Nation, 12 May 2005
- ^ Wadia, 2001.
- ^ Levi and Vitória, 2002.
- ^ Galvão, 2002