AIDS in Brazil

Since former gym teacher Aguinaldo José found out 22 years ago that he was HIV positive, he takes a drug cocktail every day to protect his body from the disease. At the time that his illness was diagnosed, the Brazilian had already been living in Lisbon for four years where he was studying literature.

He stayed another year in the Portuguese capital, where he received his HIV medications for free. "But I was pretty depressed and homesick," he remembers. "I wanted a sense of security, and to be with my family."

In 1990, Gomes returned to Brazil. At the time, little was known about AIDS and fear of the disease was therefore widespread. "I was at the end of my 20s and in a productive phase of my life, and I had to worry about death," says Gomes.

He became more afraid when he discovered that he did not have the right to free medication. This is because his blood count was too high from the drug therapy he previously received in Portugal, and in essence he was still too healthy to be considered in the Brazilian scheme.

"That's when I found myself in a new struggle, trying to convince doctors to prescribe the medication for me," says Gomes. That is when the Brazilian, who is now 51 years old, began to work as an activist in the fight against AIDS.

A few things have since changed in the Brazilian health system when it comes to the treatment of HIV positive people. Today, health care officials proudly point to the declaration by UNAIDS that the country's HIV/AIDS program is a model example. Brazil invests 1.2 billion reais (approximately $ 664 million) each year in the battle against the disease, with activities that include AIDS testing, awareness campaigns, distribution of condoms, supply of medication and treatment of people who are HIV positive. It is estimated that the portion of the Brazilian population that is infected or ill is stagnating at 0.6 percent.

An efficient approach

A key measure in the Brazilian program is general, free access to HIV medications. Brazil was one of the first countries to distribute the medications free of charge, and costs for the drugs will reach 846.7 million reais ($ 468 million) this year. According to Dirceu Grego from the Brazilian Ministry of Health, 97 percent of Brazilians who have been diagnosed with HIV which amounts to 215,000 people, receive the 20 drugs that are currently used in Brazil to treat the disease.

Ten of these medications are produced in Brazil, says Greco. This includes one that has been produced as a generic drug since 2007. "I would have to pay between 6,000 and 8,000 reais each month if I had to pay for the drugs myself," says Gomes. The test he must undergo three times a year to verify the virus genotype in order to determine if his body has become resistant to one of the drugs would cost roughly 2,500 reais.

According to Pedro Chequer, head of UNAIDS in Brazil, a study by his organization shows that the Brazilian government has implemented the tools in the fight against AIDS much more efficiently than countries like Russia. The study indicates that the $ 600 million that Brazil used in 2008 were better applied than the $ 800 million that Russia has invested.

"UNAIDS has concluded that Brazil has a strategic model that is rather well-suited to the reality of the country, as it is designed to optimize the use of resources and concentrates on the part of the population which is the most vulnerable," says Chequer.

HIV tests during the World Cup

But despite such recognition from UNAIDS, Chequer emphasizes that there are a few gaps in the Brazilian program that must be closed. This includes the regional differences when it comes to accessing information.

"Many regions in the north and north-east of Brazil still do not have access to rapid testing, treatment for the disease and the most effective prevention measures," he explains.

The number of people who are not aware that they are HIV positive because they have yet to be tested is estimated to be between 200,000 and 230,000. If this portion of the population were included in calculations, the percentage of people being treated would fall from 97 percent to a rate between 60 and 79 percent.

"The biggest challenge for Brazil now is to expand access to testing so that by 2015, more than 80 percent of all people infected will be able to be treated," explains Chequer. He also indicates that this goal has already been achieved in countries like Botswana, Chile and Cuba.

The Brazilian Ministry of Health guarantees that in 2012 one of the main goals in the fights against HIV will be to increase early recognition. "This is the focus today in all countries," says Greco. He says the government will most likely increase the number of locations at which rapid testing, which provides a result within 30 minutes, is conducted.

According to Chequer, these tests are currently offered in public places and particularly during events like Carnival, gay parades and World AIDS Day on December 1. The Ministry of Health is also planning to offer free tests to fans during soccer's 2014 World Cup in Brazil. "This year three million rapid tests will be conducted and the goal is more than 7.5 million tests next year."

Mário Scheffer, president of the Brazilian NGO Pela Vida, estimates that roughly 45 percent of people who are diagnosed with HIV are too late in coming to medical drop-in centers and therefore do not profit from access to medications at an early stage. "It is necessary to expand the tests and thereby also increase the number of infected people who benefit from the treatment. Despite all our efforts, each year 12,000 people in Brazil die from AIDS."

Partnership with Africa

The Brazilian program has established various partnerships with countries in Latin American and Africa in an effort to exchange information about treatment and HIV prevention. According to the Ministry of Health, Brazil donates medications to 26 nations, including Argentina, Bolivia, Chile and a few African countries with a large portion of HIV-infected inhabitants like Botswana, Kenya and Zambia.

The partnership with Mozambique has led to the Brazilian government approving the technology transfer for the construction of a factory for antiretroviral medications in Maputo. "It's a give and take situation," says Greco. "We will learn from them how to handle situations that are more complex than ours." Greco reports that the pre-production of medications in Mozambique's capital will begin next year.

Supply shortages

Although the Brazilian program for the fight against HIV is viewed as an international model, there is nonetheless internal criticism from organizations that take care of patients. According to such organizations, a major difficulty that patients are confronted with is a lack of supply of medications.

"The government still does not have a structure that guarantees continuity for the purchasing of medications," says Rodrigo Pinheiro, president of the private organization Fórum de ONGs - AIDS. He says that last year there was shortage of medications for four months.

Dirceu Greco acknowledges this shortage and ensures that the government is examining measures that will overcome bureaucracy and avoid temporary shortages of medications in the future.

Mário Scheffer asks that Brazil continues the policy on the obligatory licensing of medications and broadens the national production of generic drugs. According to Scheffer, one of Brazil's strategies in order to be able to offer so many HIV positive medications is the national production of antiretroviral medications. "The policy has hardly been transparent up to now," he says. "Brazil pays a lot for the medications that are produced here."

Despite the criticism, the activists in Brazil who fight for HIV positive people and their rights applaud the country's pioneering spirit. A law guaranteeing free treatment for all people infected with HIV/AIDS has been in place for 15 years. "The guarantee of access to free treatment declared in 1996 was the greatest achievement in the 30 years since the epidemic has appeared in Brazil," says Pinheiro.

For Aguinaldo Gomes, free treatment was critical in gaining control over the disease and continuing to make plans. "I waited one week for death to come, then a month, then three months. Then I noticed that I was still alive. So I began to really live. And 22 years later, I'm still here."

Author: Mariana Santos/Julia Maas (ls)
Editor: Sarah Steffen