HIV & AIDS in Brazil

1. HIV & AIDS in Brazil Tensions between Brazil and the United States Based on Avert and MinistryofHealthInformation

2. The history of AIDS in Brazil • In 1985, the same year that democracy was restored to Brazil, the government set up the National AIDS Program (NAP) in partnership with civil society groups. • In 1988, a new Constitution of Brazil was established, with a heavy focus on human rights. • Protection against discrimination and defended their right to free healthcare.

3. The history of AIDS in Brazil • In July 1996, the Brazilian Minister of Health announced that ARVs would be provided for free to all people living with HIV that required them. • In the early 1990s, the World Bank had predicted that 1.2 million people in Brazil would be living with HIV by the year 2000.

4. HIV testing in Brazil • Encouraging people to access testing is an important part of worldwide HIV prevention • The Brazilian government has used media campaigns to promote universal HIV testing.

5. AIDS treatment in Brazil • In 1991 the government announced that AZT would make the drug available for free to all Brazilians that required it; • In 1996 the drugs were made available for free throughout the public sector. In following years the national AIDS mortality rate began to decline due to the effectiveness of the treatment. • By 2002 the Ministry of Health estimated that the availability of ARVs had prevented around 358,000 HIV-related hospitalisations, resulting in a saving of more than US$1.1 billion.

6. AIDS treatment in Brazil • Since 1996 Brazil has complied with the international Agreement on Trade Related Aspects of Intellectual Property (TRIPS), which was established to protect the patent rights of pharmaceutical companies. • This agreement limits the production of generic drugs that have already been patented in another country.

7. AIDS treatment in Brazil • To ensure that these drugs are not too expensive, the government has continually put pressure on international pharmaceutical companies to lower their prices; • Compulsory licenses allow countries to override patent laws and produce their own generic (copied) versions of company-owned drugs, and can be issued when the government of a developing country deems it to be a public health emergency.

8. AIDS treatment in Brazil • In May 2007 the Brazilian President Luiz Inacio Lula da Silva announced that Brazil would be issuing a compulsory license to import a lower cost version of the ARV efavirenz, patented by the company Merck.

9. Tensions between Brazil and the United States • In February 2001 the U.S. issued a complaint to the World Trade Organisation, claiming that Brazil’s threats to manufacture generic ARVs undermined the intellectual property rights of drug companies; • By forcing companies to lower their prices, the U.S. argued, Brazil was discouraging the drug industry from researching and producing new ARVs.

10. Tensions between Brazil and the United States • Brazil’s HIV prevention policies, such as its focus on condom promotion, have also been a point of dispute. • The U.S. government promotes abstinence and being faithful to one partner as well as condom use. • Brazil does incorporate these other messages into its prevention schemes, it has placed a heavy emphasis on condom use

11. Tensions between Brazil and the United States • the Brazilian government's focus on preventing HIV among sex workers has clashed with the U.S. policy of refusing aid to any HIV and AIDS prevention schemes that do not explicitly oppose the sex trade. • “Prostitutes are very major partners in this program. They work along with us. We could never say that we are against prostitution, because it is not illegal in Brazil. It’s a tolerated, regulated profession.”Okie S. (May 2006), 'Fighting HIV - lessons from Brazil', The New England Journal of Medicine 354;19

12. What can other countries learn from Brazil's response to AIDS? • Some major elements of Brazil’s success that could possibly be encouraged in other countries are: • A strong relationship between the government, civil society groups and NGOs. • Strong political leadership and will to fight the epidemic. • A tolerant, non-judgemental approach to HIV prevention. • A strong focus on condom promotion. • The provision of free treatment to all, and aggressive efforts to minimise the cost of ARVs. • A commitment to fighting stigma and discrimination, and encouraging a culture where people living with HIV are not looked down upon, but are actively involved in helping the government respond to the epidemic.

13. The future of Brazil’s AIDS epidemic • the infection rate of heterosexual population has increased dramatically; • There is an alarming rise in the percentage of women affected by HIV; • There is evidence that women are less likely to use condoms when having sex with casual partners than men; • The epidemic has also had an increasing effect on poorer members of Brazilian society

14. The future of Brazil’s AIDS epidemic • The optimism surrounding Brazil’s successes in regards to HIV and AIDS may lead to an increase in unsafe sexual practices in coming years; • Providing a high level of access to treatment means the overall cost of treatment is rising; • More and more people are receiving treatment and living longer thanks to ARVs, and more drugs are being added to its treatment guidelines

15. The future of Brazil’s AIDS epidemic • Brazil relies more on locally-produced generic drugs than do other developing countries, when imported drugs are often cheaper, and the cost of manufacturing drugs locally rose in the late 2000s.

16. Intellectual Property in Brazil

17. Intellectual Property in Brazil

18. LifeExpectancy Source: World Report, 2011

19. Healthworkforce Source: World Report, 2011

20. Healthexpenditure Source: World Report, 2011