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The National Response to HIV/AIDS in Brazil

The National Response to HIV/AIDS in Brazil. Brazilian STD/AIDS Program Ministry of Health. Country Profile. Population (2005) – 185 mln Federative Republic with 27 States Municipalities - 5,561 Territory: 8,5 mln sq km GNP (2004) US$ 750 bi Per capita GNP (2004) - US$ 4,041

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The National Response to HIV/AIDS in Brazil

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  1. The National Response to HIV/AIDS in Brazil Brazilian STD/AIDS Program Ministry of Health

  2. Country Profile • Population (2005) – 185 mln • Federative Republic with 27 States • Municipalities - 5,561 • Territory: 8,5 mln sq km • GNP (2004) US$ 750 bi • Per capita GNP (2004) - US$ 4,041 • HDI Rank (2005) - 63th (0.792)

  3. Epidemiological Profile • Accumulated AIDS cases (06/2005): 371,827 • AIDS incidence rate (2004): 17,2/100,000 inhabitants • Estimated n. of PLWHA (2004): around 600,000 • Prevalence: (15 to 49 years of age) • 2000: 0.61% • 2004: 0.61% • Aids deaths (1980-2004): 171,923 • Mortality rate: 6,1/100,000 (2004) inhabitants

  4. Current epidemiological trends • Relative stabilization, -decreasing: southeast, MSM, IDU -Stabilized: big cities • Increasingly affecting: - Heterosexuals - Women - Low-income groups - Smaller cities

  5. Total investment in STD/AIDS control program by the Federal Government. Brazil, 1997-2005 World Bank Loan 11% 1997 to date: US$ 3.5 billion (HIV response) US$ 2 billion for ART Average investment per year: US$ 400 MILLION National budget Source: PN STD-AIDS//MOH 89%

  6. Major features of theBrazilian Response Country-driven approach: • Social Control: robust participation by civil society in decision making and implementation • Balanced prevention and treatment approach • Comprehensive ethical and rights-based approach • Early response by government (since 1983) • Multi-sectoral mobilization

  7. The “backbone” of the Brazilian Response: the Public Health System The 1988 Brazilian Constitution: access to health is a basic right • Main precepts: - comprehensive approach - universal access and equity - civil society participation • Key feature: decentralization • Virtuous circle (AIDS Programmes  Public Health System)

  8. Prevention Framework • Expand access to prevention commodities (male/female condoms, lubricating gel, harm reduction supplies) • Extend joint activities with CSO’s, CBO’s, uniformed services, social movements and other government programs • Implement education programs throughout the public school system at all levels • Increase coverage in poorest areas, emphasizing counselling and testing through the primary health system

  9. Regular condom use (last 12 mo.) among those aged 16-65 (2005) 40% 35,4% 35% 30% 23,9% 25% 20% 15% 10% 5% 0% 1998 2005 Fonte: Pesquisa CEBRAP, 2005.

  10. Number of patients receiving ARV therapy (1997 – 2005) Projected 180000 160000 140000 120000 100000 80000 60000 170.000 40000 20000 0 jul/97 jul/98 jul/99 jul/00 jul/01 jul/04 jul/05 jul/02 jul/03 jan/97 jan/98 jan/99 jan/00 jan/01 jan/05 jan/02 jan/03 jan/04 out/97 out/98 out/99 out/00 out/01 out/04 out/05 abr/97 abr/98 abr/99 abr/00 abr/01 abr/05 out/02 out/03 abr/02 abr/03 abr/04 * Dados preliminares

  11. Average cost of ARV therapy per patient/year (US$). Brazil, 2005 7000 6240 6000 5486 Introduction of expensive new ARVs 5000 4603 4000 • Substantial falls in prices of second-line patented drugs have ceased • Number of people using them has increased dramatically 3464 3000 Thousands (US$) 2500 2210 2000 1500 1359 1336 1000 0 1997 1998 1999 2000 2001 2002 2003 2004 2005* Year

  12. Antiretroviral drugs distributed through the Brazilian public health system (and year of introduction) ITRN and ITRNt IP • ZIDOVUDINE (1993)* • ESTAVUDINE (1997)* • DIDANOSINE (1998)* • LAMIVUDINE (1999)* • ABACAVIR (2001) DIDANOSINE EC (2005) TENOFOVIR (2003) • RITONAVIR (1996)* • SAQUINAVIR (1996)* • INDINAVIR (1997)* • NELFINAVIR (1998) • AMPRENAVIR (2001) • LOPINAVIR/r (2002) • ATAZANAVIR (2004) ITRNN FUSION INHIBITOR • NEVIRAPINE (2001)* • EFAVIRENZ (1999) • ENFUVIRTIDE (2005) *Brazilian local production

  13. Total number and estimated value of hospitalizations averted (non-cumulative figures) $600,000,000.00 180,000 Total: Hospitalizations avoided: 791,069 Total savings: US$ $2,289,654,584 160,000 $500,000,000.00 140,000 $400,000,000.00 120,000 Expenditures (in US$) Number of hospitalizations 100,000 $300,000,000.00 80,000 $200,000,000.00 60,000 40,000 $100,000,000.00 20,000 $0.00 0 1997 1998 1999 2000 2001 2002 2003 2004 Estimated value of hospitalizations avoided Estimated number of hospitalizations avoided

  14. South-South Cooperation: Network for Technological Cooperation in HIV/AIDS Launched in 2004, involving Argentina, Brazil, China, Cuba, Nigeria, Russia, Thailand and Ukraine Key support provided by the Ford Foundation: US$ 1 million Objectives: technology transfer, R&D and production: - antiretrovirals - vaccines and microbycides - condoms - laboratory supplies

  15. The GCTH – Group for Horizontal Technical Cooperation. Launched in 1995 to establish direct cooperation between the Latin American and Caribbean State Governments on HIV and AIDS control and prevention. Objectives: - Reference for building up regional statements for International Events. - Courses , Conferences and Forums. - Development of the Price Bank. - Development of web-page and improvement of electronic communication.

  16. Other South-South Cooperation Initiatives Technical Areas: Institutional development, management and capacity building Care and support Clinical management Antiretroviral logistics and management Epidemiological surveillance Promotion of safer sexual practices Promotion of human rights Advocacy and Civil Society participation Care and support for HIV+ pregnant women and children exposed to HIV

  17. International Cooperation with Developed Countries Institutions involved: ANRS (France), CDC, USAID, Ford, GTZ, DFID United Nations :UNAIDS, UNFPA, UNICEF, UNODC, UNESCO, ILO, Thematic areas: Monitoring and Evaluation; Promotion of safer sexual practices Promotion of human rights Advocacy andCivil Society participation Scientific and technological development

  18. International Center for Technical Cooperation: a Joint Brazil/UNAIDS Initiative • Created in 2005, the ICTC aims to create and strengthen national technical capabilities forimplementing comprehensive AIDS responses through horizontal technical cooperation; • Example of activities undertaken: • Coordination of technical missions in Honduras, Nicaragua, Peru, Ecuador and Bolivia • Identification of technical assistance needs of Latin American countries receiving financial support from the Global Fund • Total investments: • Brazilian Government (US$ 500,000), UNAIDS (US$ 500,000), DFID (£ 250,000 - under negotiation), GTZ (€ 250,000 – under negotiation)

  19. Challenges: to develop new technologies and systems to halt spread of the HIV/AIDS epidemic Technologies: Prevention (e.g., microbycides, etc) Treatment and care (e.g., new FDCs) Vaccine Systems: Monitoring and Evaluation and Operational Research Personnel (health and management) Management

  20. Brazil’s Recommendations to the 2006UNGASS • Universal Access to Prevention, Treatment, Care and Support: “We recognize the importance of intellectual property rights. But no right of a commercial nature can be upheld to the detriment of the right to life and health.” Ambassador Celso Amorim, UNGASS 2006. • Prevention: “Individual moral values, respectable as they are, cannot be the basis of public health policies. Prevention must reach vulnerable groups – homosexuals, drug users and sex workers(…)” C.A. 2006 • Finance: “Donors must increase the amount of resources available so that health systems can be strengthened (…) Africa is the region that has been most affected. It should continue to deserve priority attention.” C.A. 2006

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