Brazil fights back against HIV and AIDS

Brazil’s vigorous response to the HIV/AIDS pandemic has won world-wide recognition. Civil society has played a crucial role in shaping the country’s national AIDS programme, debating drug patents and urging support for the public health system. However, poor rural populations still need social welfare, low-cost drugs and high-quality health services.

A study from UNESCO, supported by testimonyfrom over 300 non-governmental organizations (NGOs), provides a detailedhistory of the Brazilian response to the AIDS challenge and identifies lessonsthat are globally relevant. The authors show that measures to tackle AIDS hingeon the quality and equity of public health systems. No programme can succeed –or remain successful – without ongoing investments in service quality and inhealth professionals.

Recognisinghealth as a human right, Brazil moved rapidly todistribute free drugs, to remind patent-holders of their international socialresponsibilities, to promote local production and to encourage the World Bankto provide funding. Programmes focused on high-risk groups – male homosexuals,injecting drug users and sex professionals. Supplies of HIV tests were madeavailable to pre-natal clinics.

UNESCO has worked in partnership with Brazil to designyouth-focused education to create a culture of tolerance, anti-stigma andnon-discrimination against homosexuals. Policymakers – such asparliamentarians, journalists and young entrepreneurs – have also been targeted.The campaign has been linked with social movements to strengthen Braziliandemocracy and encourage respect for human rights. NGOs have expanded the AIDS policy debateto embrace issues of governance, human rights and equity in health provision.

The authors report that:

• Provision of intensive antiretroviral therapy reduced the 1995 moralityrate of 12 deaths per 100,000 to 6.3 deaths per 100,000 in 2000.
• Led by homosexual-focused agencies and those working with drug-users,the number of NGOs increased, many set up in response to availability ofgovernment and World Bank funding.
• Indigenous Brazilians, truck-drivers, members of the landless movementand prisoners are among the marginalised groups not receiving enough attention.
• NGOs fear for the sustainability of long-term programmes, worried thatfunds for condoms, syringes and continued free access to anti-retroviraltherapy (ART) will be insufficient as AIDS patients live longer and the numberof virus carriers rises.

Brazil hasnot yet won the war against the pandemic. Rates of infection among women, ruralpopulations and those living in the country’s vast interior are rising. Worldintellectual property rules allow Brazil toproduce only eight of the fifteen drugs required for combined ART, forcing thecountry to spend significant resources to purchase the remainder on theinternational market.

It is important to:

• acknowledge the ‘feminisation’ of AIDS, learn more about women living withAIDS and review traditional models of prevention and promotion of a healthysexual life
• remember that the efficiencyof drugs and patients’ ability to fight opportunistic infections cruciallydepend on good nutrition and hygiene: the epidemiccannot be fought without pro-poor changes to economic policy
• guarantee free access toanti-retroviral combined therapy drugs
• invest more in prevention,testing and treatment, especially in remote areas
• ensure that decentralisationdoes not lead to lack of coordination
• support research and ensuredissemination and learning from results.