Brazil Becomes Model in Fight Against AIDS

[Guest guest]

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

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