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Ministry of Health Health Surveillance Secretariat NATIONAL STD/AIDS PROGRAMME

Ministry of Health Health Surveillance Secretariat NATIONAL STD/AIDS PROGRAMME. National Response to HIV and AIDS in Brazil. Population - 169.799.170 (2000) GNP per capita: US$ 2569 (2002) ACCUMULATED AIDS CASES (2003): 310,310 AIDS INCIDENCE RATE (2002): 12.8/100,000

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Ministry of Health Health Surveillance Secretariat NATIONAL STD/AIDS PROGRAMME

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  1. Ministry of HealthHealth Surveillance Secretariat NATIONAL STD/AIDS PROGRAMME

  2. National Response to HIV and AIDS in Brazil

  3. Population - 169.799.170 (2000) • GNP per capita: US$ 2569 (2002) • ACCUMULATED AIDS CASES (2003): 310,310 • AIDS INCIDENCE RATE (2002): 12.8/100,000 • ESTIMATED N. OF PEOPLE LIVING WITH HIV (2003): 600,000 • PREVALENCE: 0.65% (15 to 49 years of age) • AIDS DEATHS (1980-2002): 149,559 • MORTALITY RATE: 6.3/100,000 (2002) BRAZIL

  4. Brazil 600,000 PLHA 1 235,000 (being monitored) 365,000 (majority don’t know they are HIV+) 146,000 (on ARV) 89,000 (without ARV)

  5. BRAZIL Trends of the epidemic • Stabilization • Heterosexualisation • Feminisation • Pauperisation • Interiorisation

  6. 1995-2004 1988-1994 1980-1987 Interiorisation Municipalities with at least one AIDS case Brazil, 1980 - 2004.

  7. Pauperisation % Aids cases over age 19 X schooling Brazil, 1985 - 2002. 100% 80% 60% 40% 20% 0% 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 3º Grau 2º Grau 1º Grau Analfabeto Fonte: PN DST e AIDS – SVS - MS.

  8. Annual mortality rate by sex. Brazil, 1984 – 2002. 16 14 12 10 per 100,000 inhab. 8 6 4 2 0 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 year of death men women Brazil Source: Brazilian STD/AIDS Program

  9. Characteristics of the Brazilian Response • Early government response - since 1983 • Strong participation of civil society in all decision levels • Multi-sectoral mobilization • Specificity of Brazilian culture • Balanced approach between prevention and treatment Human rights perspective in all the strategies and actions

  10. Distribution of Public Resources in external source WB* and Government source. (US$) Million 700 44,2 600 500 57,2 41,0 WB 400 41,4 Federal 44,6 595,5 300 30,7 445,9 394,8 200 359,9 295,0 243,2 100 0 1997 1998 1999 2000 2001 2002 Year Source: IPEA/2001

  11. Health Promotion and Prevention

  12. Health Promotion and Prevention • Promotion of human rights • Implementation of major national media campaigns • Prevention actions for general population and specific groups Early diagnosis of HIV infection • STD diagnosis and treatment

  13. 700 Growth trend of condom use (4.6 x) Condom use (in millions of units) 548 497 430 260 373 Progressive increase of PublicDistribution (20x) 148 325 126 267 80 227 39 186 38 152 13 20 17 Steady growth of Market sales (3x) 13 400 440 334 287 350 371 254 207 169 139 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Sources: DKT and PN-DST/AIDS Access to condoms 700 million / year Marketed Public Distribution

  14. Adoption of Safer Sex practices (1998 - 2003) Use of condom in last sexual intercourse 69% of the population is sexually active With occasional partners (%) With regular partners (%) 64 (1) 21 (1) 1998 1998 79,5 (2) (2) 20,2 2003 2003 0 20 40 60 80 100 0 20 40 60 80 100 Source: (1) CEBRAP/MS/PN-DST-AIDS/SVS (2) MS - IBOPE

  15. Number of Institutions which distribute Female Condoms, per Macro-Region 2000-2003 Distribution of 4 million condoms / year Priority Population: Seropositive women Sex workers IDUs and their partners Women victims of domestic sexual violence 50 130 70 150 120

  16. HARM REDUCTION Support to 125 projects with 65,000 ID users - estimated 20% coverage HIV HCV BEHAVIOR

  17. Access to HIV diagnosisGoal is to test 4.5 million a year • Today 1.8 million people are tested per year • 30% of the sexually active population have taken the test. • 300 and 400 thousand HIV+ are not aware of their status. • Diagnosis is made 4/5 years after infection.

  18. Impact of prevention interventions – vulnerable populations Drop in HIV infection rates • Sex workers – From 17% in 1992 to 6.1% in 2000 • MSM - from 10.8% in 1999 to 4.7% in 2001 • IDU - from 21% of AIDS cases 1994 to 11.4% in 2000

  19. Mother to Child Transmission, Brazil, 1997 to 2003 • Estimated 17thousand pregnant women infected per year * Preliminary data

  20. 16 16 14 12 9.7 10 7.8 8 6 3.7 4 2 0 1998 2000 2001 2002 Tess, 1998; Succi, 2003 (preliminary data) Rate of Mother to Child Transmission (%) per year of birth - Brazil, 1997-2002

  21. Health Care

  22. 1 1 5 1 1 2 3 1 2 1 1 5 3 1 2 1 1 1 1 1 3 1 1 9 1 3 4 1 2 2 1 2 1 1 2 1 1 1 2 2 4 3 4 4 3 11 1 1 1 1 2 2 5 10 3 1 33 6 1 8 3 6 158 49 17 24 6 50 15 18 7 1 11 1 4 14 10 3 9 9 21 1 Access to Treatment 889 services for PLHA HIV/AIDS services Accredited hospitals: 375 Day hospitals: 79 Home care: 54 Outpatient services: 381 Laboratories: Viral Load, CD4+ count and Genotyping Source: UDAT/PN-DST-AIDS. March/2002

  23. PLHA on ARV use Brasil, 1997 a Jun/2004

  24. 16 ARVs distributed • Universal and free of charge access to ARV - federal law Nov.1996 • ZIDOVUDINE (ZDV)* • DIDANOSINE (ddI)* • LAMIVUDINE (3TC)* • STAVUDINE (d4T)* • ABACAVIR • INDINAVIR* • TENOFOVIR • RITONAVIR* • SAQUINAVIR • NELFINAVIR • AMPRENAVIR • NEVIRAPINE* • EFAVIRENZ • LOPINAVIR / r • ATAZANAVIR (*) Brazilian state production available

  25. MEDIAN SURVIVAL AFTER AIDS DIAGNOSIS IN BRAZIL 70 58 60 50 40 Months of survival 30 18 Introduction of Potent ARV Therapy in Brazil 20 5 10 0 1989 1995 1996 Source: Chequer et al, 1992; Marins et al. 2002

  26. 573 215 37% 106 21% 131 23% 19% 121 2003 Access to treatment3 imported drugs take up 63% of the budget - 2003 12 other ARVs 37% Expenditures (in millions of R$) LPV.r+ EFZ+ NFV 63% LPV.r NFV EFZ 12 other ARVs

  27. ARV drug expenditures avoided trough negotiation (In millions of US$), for 2004 - Brazil (Jan/2004)

  28. Expenditures (In millions of US$) with ARV Drugs and Average Number of Patients under treatment - Brazil (1997-2004*) *Data subject to alterations

  29. 4860 4540 4240 3810 3320 2223 2035 1996 1997 1998 1999 2000 2001 2002 Average cost (US$) of ARV per Patient/year - 1996 - 2003* 1630 2003 * Preliminares datas MoH / 2003

  30. Impact of the Brazilian ARV Policy (1996-2002) • reduction of mortality  40% • 90,000deaths prevented • reduction of morbidity  70% • reduction of hospitalizations 80% • 358,000 hospitalizations prevented - average of hospitalizations / patient per year reduced from 1,65 in 1996 to 0,28 in 2003.

  31. Impact of ARV Therapy Policy (1996-2002) • Cost Savings - US$ 2.2 billion • US$ 1.23 billion in hospitals and treatment opportunistic infections • US$ 960 million reduction in drug prices

  32. “Life sleeps in the crude earth, dreams beauty in the flowers, wakes with power in the animals and in man has consciousness of infinite possibilities” Yogananda

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