Good response = fewer cases

WASHINGTON, D.C. - Dr. Paulo Teixeira, director of Brazil's Sexually Transmitted Disease/AIDS Program, told a CBC 'brain trust' that Brazil's energetic grassroots-oriented program has slashed HIV/AIDS infections in half.

The World Bank predicted in 1992 that approximately 1.2 million Brazilians would be infected with HIV/AIDS by the year 2000.

Instead, said Teixeira, fewer than 600,000 people diagnosed with HIV have become infected, according to current estimates, 50 percent of the number expected.

'We think that this highly significant performance is the result of an effective response,' he said. It is a combination of a broadly based public health program aimed at reducing the incidence of HIV/AIDS, coupled with enhanced diagnosis and early treatment.

Mass campaigns promote safe sex; condoms are provided free; disposable needles and syringes are distributed to drug users to curb transmission of HIV/AIDS through needle-sharing.

For those who have become infected, the Brazilian government has implemented a policy of 'universal and free access to anti-retroviral therapy (ARV) since the early 1990s,' Teixeira said. 'By the end of the year 2000, approximately 100,000 patients were under ARV treatment, freely given by the Brazilian public health system.'

About $300 million were spent on purchasing the 12 drugs that make up the anti-HIV 'cocktail.' Eight of the drugs are locally produced, while the rest are procured internationally. Local production of the drugs reduced the costs by 82 percent between 1996 and 2001, compared to only 25 percent for drugs bought from foreign pharmaceutical companies.

To avoid compulsory licensing of drugs from these private corporations, the Brazilian Ministry of Health used a strategy of negotiating lower prices with several pharmaceuticals. For example, an agreement with Merck Sharp and Dhome Laboratories cut the price of Indinavir by 64.8 percent and Efavirenz by 59 percent. An agreement with Roche Laboratories reduced Nelfinavir by 40 percent.

But Teixeira warned that, with increasing numbers of patients under anti-retroviral therapy, Brazil must reduce the costs of the ARV drugs if it is going to keep its program on track.

That is why Brazil recently rocked the pharmaceutical monopolies by announcing that they will violate 'intellectual property' and drug patents if necessary to produce these life-saving drugs at an affordable cost.

The Brazilian government set up treatment guidelines and established a network of 400 ARV dispensary units around the country. To monitor treatment, it also established a National Network of Viral Load and Lymphocyte Counting Laboratories.

'All this has enabled Brazil to slash its AIDS-related mortality levels by 50 percent,' he said.

'Morbidity has also been deeply reduced by an average of 70 percent, avoiding 234,000 hospitalizations and saving $677 million dollars.'

The incidence of AIDS-related infections also plummeted dropping 80 percent in the last four years in the state of Sao Paulo, where 50 percent of AIDS cases are located. Grassroots activism 'has actually propelled the creation of the National HIV/AIDS Policy,' he said.

Non-governmental organizations and networks of people living with HIV/AIDS participate actively in decision-making and exercise social control.

Only 10 percent of the funds invested in the program to combat HIV/AIDS has come from outside Brazil, Teixeira said, including a four-year $250 million loan in 1994 and another $300 million loan in 1999, both from the World Bank.

Brazil has also attacked the crisis internationally, participating in the International Technical Cooperation Group of Latin America and the Caribbean on HIV/AIDS. Brazil has also promoted their HIV/AIDS program in the Portuguese- speaking nations of Africa, including Angola, Mozambique and the Cape Verde Islands. It also works closely with the U.S. Center for Disease Control.

Brazil, he said, is urging an international movement to press the United Nations, the World Bank and International Monetary Fund, the World Trade Organization, and all other international organizations to approve a 'Global Agreement' for a coordinated fight against HIV/AIDS. It would include the following principles:

A flexible interpretation of the Trade Related Intellectual Property Rights Agreement (TRIPS) in order to guarantee that nothing in it will 'prevent members from taking measures to protect public health.'

The adoption of differential pricing for AIDS drugs to benefit poor and developing countries on an equitable basis.

Support from developed countries and private donors to the U.N. Internation Fund for AIDS, Tuberculosis and Malaria.

Said Teixeira, 'We are sure that, as a follow-up of the U.N. AIDS Conference, the fourth World Trade Organization Ministerial Meeting, scheduled to take place in Qatar next November, will be the turning point to conclude this Global Agreement.'

Rep. Barbara Lee (D-Calif.) and Rep. Jim Leach (R-Iowa) co-sponsored a bill to establish a World Bank AIDS Trust Fund. It was enacted and the World Bank is expected to be fully operational by January 2002. Lee is pressing the House International Relations Committee to approve her bill to provide $1.3 billion to combat the global AIDS crisis.