HIV/AIDS in Brazil: the Struggle for Affordable Anti-Retroviral Drugs

Brazil has been one of the most successful public health campaigns against the HIV epidemic. Through progressive policies and an emphasis in solidarity and equity, the National AIDS Program manages to achieve similar results to developed countries. Brazil has achieved significant results against the HIV/AIDS epidemic. They have halved the mortality rate, “cut the HIV/AIDS hospitalization rate by 80%” and highly reduced prenatal transmission from 1996 to 2001. Wide access to antiretroviral therapy has played a huge role in these statistics and improving patient’s lives. Brazil achieved this through producing “cheaper generic equivalents of the medicines” made by wealthier countries, which reduced treatment costs by 70% and made antiretroviral therapy (ART) affordable for many more patients (Revista Panamericana De Salud Pública, 2001).

In the early 1990s, drug companies overseas held the rights to the patents for antiretroviral drugs. São Paulo state’s government already provided the ART drugs free of charge, but the drugs were expensive for the government. To feasibly uphold the federal constitution that stated health is a universal right and duty of the State, in 1996 Brazil overcame the patent laws surrounding intellectual property of industrialized goods by following one of the exceptions. Since the patent holders did not manufacture the patented antiretroviral drugs, in Brazil within three years after the patent was registered, the Brazilian government could authorize another company to produce the product in the case of national emergency or public interest. By 2000, Brazilian laboratories were able to produce and distribute 7 of the 12 antiretroviral drugs. By the next year, the state government convinced the one company with two ART drug patents to significantly reduce their prices and used the law passed in 1996 to allow a laboratory of the Oswaldo Cruz Foundation to produce a generic Nelfinavir ART drug. Since 1996, Brazil has provided a free universal access to the ART drug for anyone living with HIV/AIDS (Nunn et al., 2009).

Improvement in the prevention and surveillance program was seen as secondary to the universal access to treatment. Prior to the distribution of the generic drugs, there was a heightened risk of vertical transmission of HIV, with 65 percent of such transmission occurring during delivery and 35 percent in the uterus during the gestation period (De Brito et al., 2006). Several factors were associated with increased vertical transmission including breast milk and the rupture of amniotic membrane.

However, since 1997 there was seen a progressive reduction in maternal-infant transmission secondary to the administration of the ART drug (De Brito et al., 2006). Brazil’s effective approach gained support of many international health bodies despite the United States’ and pharmaceutical companies’ opposition. Despite the Brazilian Ministry of Health’s success with generic ART drugs and the immediate great decrease in AIDS mortality, HIV continues to spread, and the Ministry continues to face limits in resources (Passarelli, 2003; Petersen, 2006).

Much of the success with the ART drug was based on the strong civil movement that emerged in Brazil in response to the AIDS crisis. Brazilian people’s strong structured social support and nongovernmental organization fought for governmental implementation, prevention programs, and treatments (Nunn et al., 2009). The demand for treatment enabled Brazil’s success in providing universal free access to antiretroviral drug. The HIV/AIDS epidemic is a multifaceted problem and overlaps with other health and social issues. Studies show HIV is more likely to be spread between people of lower social and economic demographics (Petersen et al., 2006). Patients with HIV have a high risk to be infected with other diseases, especially tuberculosis (TB). On a positive note, antiretroviral therapy (ART) has been shown to help TB patients as well as HIV patients. However, despite the link between ART and improved TB results, collaboration between TB and HIV programs is difficult. While ART is supposed to be offered for free to coinfected patients and to be recommended to TB patients, only about half of patients used ART despite the high link between ART in the second to eighth week of TB diagnosis and treatment and positive TB results. In the future, communication between programs on the municipal level and training should be increased (Hacker, 2004; Torrens, 2016).

ART is highly beneficial to HIV and HIV-TB coinfected patients, but critics are concerned. Many authors caution that the epidemic will worsen if the infrastructure in these developing countries does not minimize drug resistance in HIV strains through ART usage. Contrary to their concerns, ART resistance in Brazil has not grown to the proportions of developed countries (Revista Panamericana De Salud Pública, 2001). Partial and salvage therapies are available for patients who develop resistance to ART. Multiple studies indicate developed drug resistance levels to one or more ART drugs in Brazil mirrors the developed world. More recent studies indicate that after 1996, transmitted resistance has increased in Brazil with similar rates to the resistant strain infection rates of up to 20 percent of untreated HIV carriers in Europe and the United States. However, Brazil’s quality in care also measure up to the developed worlds. In range, monitoring, and estimated time on partial therapy for Brazilian patients, Brazil’s health care effectively limits the growth in ART resistance that can happen in developing countries (MacCarthy, 2016; Petersen, 2006). Regardless Brazil unprecedented success served as an example for AIDS treatment in developing countries; reduced global prices for the antiretroviral therapy and implemented new public health infrastructure (Nunn et al., 2009).

Related Articles

• HIV/AIDS in Brazil: Lessons for Policy

Additional Resources

Berkman, A., Garcia, J., Muñoz-Laboy, M., Paiva, V., & Parker, R. (2005, July). A critical analysis of the Brazilian response to HIV/AIDS: Lessons learned for controlling and mitigating the epidemic in developing countries.

Brazil: Winning Against AIDS (2000). Video, http://tve.org/film/brazil-winning-against-aids/

Galvão, J. (2005, July). Brazil and access to HIV/AIDS drugs: A question of human rights and public health.

Petersen. Assessing HIV resistance in developing countries: Brazil as a case study, 151.

References

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Brazil fights for affordable drugs against HIV/AIDS. (2001). Revista Panamericana De Salud Pública, 9(5), 321-327.

De Brito, A., De Sousa, J., Luna, C., & Dourado, I. (2006). Trends in maternal-infant transmission of aids after antiretroviral therapy in brazil. Revista De Saúde Pública, 40, 18-22.

Hacker, M. A., Petersen, M. L., Enriquez, M., & Bastos, F. I. (2004). Highly active antiretroviral therapy in Brazil: The challenge of universal access in a context of social inequality. Revista Panamericana De Salud Pública, 16(2), 78-83.

Khogali, M., Verdonck, K., & Bissell, K. (2016). HIV testing, antiretroviral therapy, and treatment outcomes in new cases of tuberculosis in Brazil, 2011. Revista Panamericana De Salud Pública, 39(1), 26-30.

MacCarthy, S., Hoffmann, M., Nunn, A., Silva, L., & Dourado, I. (2016). Barriers to HIV testing, linkage to care, and treatment adherence: A cross-sectional study from a large urban center of Brazil. Revista Panamericana De Salud Pública, 40(6), 418.

Nunn, A., Da Fonseca, E., Bastos, F., & Gruskin, S. (2009). Aids treatment in brazil: Impacts and challenges. Health Affairs -Millwood Va Then Bethesda Ma-, 28(4), 1103-1113.

Passarelli, C. A., & Terto Jr, V. (2003). Non-governmental organizations and access to anti-retroviral treatments in Brazil. Divulgação em Saúde para Debate, 27, 252-264.

Petersen, M. L., Boily, M., & Bastos, F. I. (2006). Assessing HIV resistance in developing countries: Brazil as a case study. Revista Panamericana De Salud Pública, 19(3), 146-156.

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