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The Brazilian initiative to distribute AIDS drugs caused negative
reactions among the
international scientific community. If not
properly administered the drugs could generate mutant forms
of
virus. Those fears, however, proved to be unfounded.
Poor countries can also fight AIDS effectively.
by:
Andrea
Garrafa Gouveia
The Aids History in Brazil
The first case of AIDS was identified in Brazil in 1980. Homosexual, highly educated and wealthy men were the
most affected group by that time. After 1985, heroin users started to gain a bigger share of the class of AIDS infected groups
and the proportion of cases spreading through heterosexual contact also became bigger. While women and lower-income
populations were increasingly contracting the virus, drug users, homosexual men, and prostitutes continued to represent the
major risky groups for getting and transmitting the disease.
When the first cases of AIDS were identified in Brazil, the disease was mostly concentrated in the States of São
Paulo and Rio de Janeiro. However, by the end of the 90's, as the virus was spread, every Brazilian state had already
identified AIDS cases (Brazilian Ministry of Health, 2000).
The Brazil response to the AIDS epidemic was very effective and started at the end of the 1980's, through a
collective effort towards building a national program to combat Sexually Transmitted Disease and AIDS. The civil society and the
people living with HIV virus were very active players in this fight, which advanced significantly at the second half of the 1990's.
The National Sexually Transmitted Diseases (STD) and AIDS Program was created based in the principle that the
prevention to the disease should not be decoupled from the assistance to people already infected by the virus. Significant
government resources have been applied to the program in order to prevent the spread of HIV. The increasing involvement of NGOs
has made the program able to reach marginalized groups, who are more vulnerable to infection. The action plan set by the
program has as main characteristics:
Guarantee of human rights to those leaving with HIV;
Establishment of voluntary counseling and testing centers, guaranteeing free testing for the
population;
Guarantee of free access to all of the available resources to treat the disease, such as medicines;
Intervention methods of education to change risky behaviors;
Increased condom availability as well as syringes and needles;
National communication system to disseminate information on HIV/AIDS.
In 1991, responding to demands of some sectors of civil society, the Brazilian government started the distribution
of Zidovudine, or AZT, to the thousands living with AIDS that had been prescribed treatment, increasing their hopes. This
initiative caused negative reactions among the international scientific community, who feared that Brazil would not be able to
administrate correctly the use of the drugs. This could generate the creation of mutant forms of virus resistant to the medicines
and thus the whole project would be unsustainable. .
Nevertheless, the time showed that the policy adopted in 1991 and updated the following years was sustainable,
reflecting the ability of limited-resources countries to reduce the impact of such a dangerous epidemic. In 1996, including
protease inhibitors (PIs) in the package of medicines available to the population, the Ministry of Health increased the amount
of antiretroviral (ARV) distributed, and has maintained this policy for each new medicine discovered by scientists.
These ARVs are an assemblage of drugs gathered together that attack the virus quickly and violently; 8 of them, out
of a total of 15, are manufactured in Brazil. Farmanguinhos (Rio de Janeiro), Lafepe (Pernambuco) and FURP (São Paulo)
are the manufacturers that possess the technology to produce these drugs, including the most recent ones. The national
manufacturing resulted in a fall in the prices of the drug by more than 70
percent, which made it possible to the government
to distribute the drugs gratuitously to the population. Moreover, Big Pharmaceutical Companies such as Roche and Merk,
under the risk of having the patents disrespected, decided to negotiate lower prices with the Brazilian government.
Nowadays, the universal and free distribution of ARVs by the public health system consists in one of the most
relevant aspects of the AIDS policy adopted by Brazil (15 types of ARVs have been distributed to more than 115 thousand
people.) Since 1996, this policy has been responsible for the drop of more than 50 percent of the deaths for AIDS and reduced
by more than 80 percent the hospitalization rate associated with AIDS complications.
Besides, there was a decrease by 60 to 80 percent in the demand for treatment of AIDS-related diseases such as
tuberculosis and pneumonia. A time length and complexity of hospitalization cases were also reduced, reflecting a
significant improvement in the quality of life of the people leaving with AIDS. In the last five years, 358 thousand hospitalizations
were avoided, and because of that the country saved US$ 1 billion in investment
resource. Thanks to the joint efforts of the government and the NGOs in Brazil, which were effective in selling to the
population the importance of the use of condoms and of safer injection habits for drug addicts, the HIV infection rates represented
a substantial decline among homosexuals, prostitutes, and intravenous drug users (World Bank, 1999a); the infection of
HIV among prostitutes dropped from 18 percent in 1996 to 6.1 percent in 2000. Among homosexuals, the reduction was
from 10.8 percent in 1999 to 4.7 percent in 2001; and finally, among the ones who are addicted to intravenous drugs, the
infection rate decreased, from 21.4 percent in 1994 to 11.4 percent in 2000 (Ministry of Health, 2002).
According to a 1992 projection by the World Bank, it was predicted in 2000 Brazil would have 1.2 million people
infected with AIDS. However, the country jumped into the new century with less than 600 thousand cases, the number of
infected people being estimated at 597 thousand, which represents a reduction in the infection rate of more than 50 percent.
To be continued. Next: "The FTAA and the Brazilian AIDS case"
Andrea Garrafa Gouveia just finished her Master's Degree in International Commerce and Policy at George
Mason University. She welcomes comments at
afgarrafa@yahoo.com
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