Guest guest Posted January 2, 2001 Report Share Posted January 2, 2001 Dear Forum members, Brazil's AIDS treatment program with antiretroviral drugs has been so successful in reducing deaths that some sub-Saharan African countries are trying to emulate it. Perhaps, Indian AIDS NGOs, policy makers and UNAIDS staff should take a good look at the the Brazil model. Moderator. Brazil Becomes Model in Fight Against AIDS By Buckley. Washington Post Foreign Service Sunday, September 17, 2000; Page A22 RIO DE JANEIRO –– It was early 1997, and Mauricio Guimaraes lost 88 pounds, watched his shiny brown hair fall out, developed a vicious neurological illness and sprouted hundreds of blisters on his body. For years he had denied that AIDS was killing him. He could deny it no longer. Then came a miracle in the unlikely form of the Brazilian government. That year marked the start of Brazil's controversial policy of producing generic AIDS medicines and distributing them to patients, free of charge. For the government, it stood as a turning point in its commitment to battle AIDS and HIV. For Guimaraes, it meant new life. " That medicine meant for me, hope, " the 33-year-old actor and activist said. Guimaraes' triumph is a tiny part of a larger feat in Brazil, a nation that has tamed an AIDS epidemic that was predicted to all but destroy its working-age population. Instead, steady, multi-pronged government efforts have combined with vibrant--and sometimes confrontational--community activism to stabilize Brazil's rate of HIV infection and slash its number of AIDS-related deaths. Latin America's largest and most populous nation has become such a showcase in the fight against the disease that other developing countries, including several in Africa, are trying to adapt the Brazilian model to their own efforts. An estimated 580,000 people out of Brazil's population of 167 million are HIV-positive. Two decades ago, when the first cases of AIDS emerged in Brazil, health experts forecast that by now, the human immunodeficiency virus would afflict at least 1.2 million Brazilians. Instead, infection rates have returned to 1995 levels. Over the past five years, the number of AIDS-related deaths has plummeted in Rio de Janeiro and Sao o, the regions most deeply affected. In Rio de Janeiro, deaths fell by 40 percent; in Sao o, they dropped by 53.6 percent. At the heart of Brazil's success is its drug-distribution program. Begun in 1992, it became dramatically more far-reaching when the government decided to manufacture its own anti-AIDS drugs. Today, government labs churn out five generic AIDS medications. Brazil will spend $400 million this year to distribute medicines to 81,000 AIDS patients. Four years ago, the country spent half that much but served only 20,000 patients. The government role has driven prices down. Since 1996, the price of AIDS drugs manufactured only by international corporations has dipped by 9 percent in Brazil. But the cost of those medications that must compete with Brazilian generic brands has plummeted by 72 percent. A typical treatment of antiretroviral drugs--the medicines used in AIDS cocktails--costs Brazil $4,162 per patient per year; in the United States, similar treatment generally costs about $15,000. Brazil's decision to manufacture and distribute medicines incensed critics here and abroad who predicted that a lack of health-care infrastructure and the Brazilian government's penchant for corruption and inefficiency would doom the program. But today the program receives widespread praise. " I thought it was going to be a waste of money, " said Mauro Schechter, a Brazilian who is one of the world's foremost AIDS researchers. " But they've convinced me that it can be done. " " It's a well-organized, well-formulated program that works because the government has managed to integrate the whole society--especially NGOs, " said Werthein, the Brazil representative for UNAIDS, the joint United Nations program on AIDS. AIDS patients in Brazil are using brand-name, U.S.-made HIV-AIDS drugs as well as locally produced generics. Brazil argues that a loophole in World Trade Organization rules gives it permission to manufacture the generic medications in a " national emergency. " Although pharmaceutical companies have challenged this approach as a possible violation of world trade regulations, a spokesman for the leading industry group in the United States lauded the Brazilian program. " Five years ago, President [ Henrique] Cardoso realized they were having a problem, and he made a point to do something about it, " said Mark Grayson, a spokesman for Pharmaceutical Research and Manufacturers of America. " Brazilians certainly should be praised for working on what could have been a terrible situation. " Bolstered by physicians, 133 testing and counseling centers and generally cooperative pharmacies, the program has distinguished itself from numerous government-sponsored health efforts that have failed to reach their intended target--Brazil's poor and working class. At a support group meeting at a public health clinic in Rio de Janeiro's hardscrabble North Zone this week, participants said they rarely have trouble getting their medicine. Without the medicine, they said, they almost surely would be struggling to stay alive. That is the case for de Medeiros, one of the support group participants. Diagnosed with HIV 10 years ago, she thought she had only days to live. And when HIV transformed into full-blown AIDS in 1995, she again saw death looming around the corner. " I never thought I'd have a life after HIV, " said Medeiros, 47, who lives on a $200 monthly pension. Now she has enough energy to go to several support meetings a week, where, to her surprise, " I've ended up discovering how to help other people. " Likewise, Guimaraes said that without the government program, he would have to spend $1,200 a month on the 20 pills he takes every day. " But every single time I go to the pharmacy, my medication is there, " he said, " and it's fantastic. " Today Guimaraes boasts a ponytail, has gained back the weight he lost and, aside from hundreds of black-green scars peppering his legs, he bears few visible signs of his brush with death. The activist flushes with anger when he hears people say that he receives free medicine. He points out that his tax dollars paid for the medication and reminds people that groups such as Pela Vidda, where he volunteers, were among the most aggressive in pressing the government to keep its promise to AIDS patients. Even government officials acknowledge that without such groups, the AIDS program would have faltered. These groups " really put a lot of pressure on the government to clarify its position on AIDS, " said o Teixeira, who directs Brazil's national AIDS efforts. A decade ago, roughly 200 nongovernmental organizations in Brazil had AIDS programs; today some 600 do. Aided by World Bank loans totaling $325 million, the groups have touched parts of Brazil that the government has not had the time, funds or personnel to reach. They carry out needle-exchange programs, distribute condoms, organize support groups, provide counseling and have kept AIDS at the top of the public health agenda. The Catholic Church formed its own commission, one of the few church-led AIDS panels in a developing country. The National Business AIDS Council started prevention efforts in 3,000 companies. Transvestites and prostitutes who work in private organizations are often consulted when the government crafts AIDS-related policies. " There really has been a coming together " between government and private efforts, said Souza, president of Pela Vidda in Niteroi, a city adjacent to Rio de Janeiro. " Things are now unbelievably better than they were at the beginning of the decade. " Brazilian AIDS experts have taken trips to southern Africa, and representatives from South Africa, where about one in five adults is HIV-positive, are scheduled to visit by the end of the year to draw lessons from Brazil's approach. South Africa is especially interested in Brazil's success in manufacturing and distributing its AIDS medications. " It makes a lot of sense to look at what Brazil is doing. . . . Something they're doing is working, " said Mbulelo Rakwena, South Africa's ambassador to Brazil. South Africa has clashed with pharmaceutical companies over the manufacture of generic AIDS medicines, which the industry says violates patents. International experts say that although Brazil is wealthier than most countries in sub-Saharan Africa, those countries can still emulate Brazil's determination. " What I like about what they're doing is that they've had the political will to attack what they rightly perceived as a serious problem, " said Fauci, a pioneering AIDS researcher from the National Institutes of Health in Bethesda. AIDS patients such as Guimaraes say they depend on that political will, as well as support groups and positive thinking to keep them alive. The activist, meanwhile, has no time to lose. He teaches English classes and volunteers at Pela Vidda 50 hours a week. He also has written a play about AIDS prevention and spends much of his time rehearsing, performing and trawling for sponsors. " I wake up every day to do this kind of work, " he said. " What was killing me is now giving me life. " Staff writers Barton Gellman and Bill Brubaker in Washington contributed to this report. © 2000 The Washington Post Company ===== __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.