Brazil celebrates 10 years of universal access to antiretrovirals

BMJ 2006; 333 doi: (Published 09 November 2006) Cite this as: BMJ 2006;333:989
  1. Klaus Morales
  1. 1Belo Horizonte, Brazil

More than 4000 delegates from across Brazil met at a conference this week to celebrate the country's decision in 1996 to offer access to antiretroviral drugs to all its citizens living with HIV or AIDS who need treatment and to discuss future challenges.

“Public policies must combine prevention and treatment simultaneously. They're not competitors, and there is no legitimacy in having prevention programmes if solid treatment strategies do not also exist,” said Mariângela Simão, head of Brazil's sexually transmitted disease and AIDS programme.

A report issued by Brazil's health ministry and distributed at the conference said that about 600 000 Brazilians are HIV positive or have AIDS.

The situation in Brazil is described as a “concentrated” epidemic—one where prevalence in any risk prone subgroup of the population exceeds 5% but where it is less than 1% among pregnant women. The prevalence in Brazil among people aged between 15 and 49 is 0.6%.

About a third of the sexually active population has been tested for HIV. The rate of testing is higher among women because the government gives incentives to pregnant women to be tested.

Delegates found much to celebrate: after universal access to antiretrovirals was introduced the number of deaths from AIDS fell and from 2000 stabilised at about 6.3 deaths per 100 000 people in the population. Until 1995 the mortality was about 9.7 per 100 000.

“Brazil, undoubtedly, is the strongest country in Latin America regarding prevention of HIV and AIDS, and the continent can be considered one of the regions where demands are being met efficiently,” Mrs Simão said.

Latin America has better treatment coverage (62%) of people needing antiretrovirals than sub-Saharan Africa and eastern Europe, where treatment coverage is 11% and 13% respectively. About 175 000 Brazilians are being treated under the universal access policy.

“The budget for the Brazilian AIDS programme was doubled in the last presidential mandate. We're very optimistic after the recent re-election of the president and the government's position on fighting AIDS,” Mrs Simão said.

The HIV and AIDS budget is about 3% of the total healthcare budget, and the country's response to the epidemic has been strengthened by help from various organisations, such as Unicef, the World Bank, and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Marie Pierre-Poirier, representing Unicef, said: “Brazil is not only a reference point in the battle against HIV and AIDS but also an inspiration for other countries in Latin America, Africa, and the rest of the world.”

But conference delegates felt that much still needed to be achieved. The main challenges for the government in the area of sexual health are improving the quality of services for people with AIDS, the battle against homophobia, clarifying the responsibilities of different levels of government, and dealing with the growing number of women with AIDS. Delegates also wanted universal access to antiretrovirals to continue.

Last year Brazil took a step towards allowing exemption from patents for antiretrovirals but then dropped the idea; it continues to negotiate directly with drug companies for better prices. Brazil manufactures eight of these drugs, but the government and Brazilians remain dissatisfied with the current management of patents and intellectual property.

Some Brazilians are also angry about a decision by the country's National Agency for Sanitary Vigilance to ban blood donation by men who have had sex with other men in the past year as well as by their male or female sexual partners. Gay activists protested during the conference's opening ceremony against prejudice and urged the government to rethink the decision.


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