Brazil’s free AIDS-drug program slashes cases, earns global interest
24 décembre 2000 (Chicago Tribune)
RIO DE JANEIRO, 24 December 2000 (Chicago Tribune)
Patrice M. Jones, Tribune Foreign Correspondent
*For Antonio Carmona, finding out he had AIDS was just the start of an uphill physical, emotional and financial battle to survive.
The physical and emotional battle he expected, but it was the financial toll that in some ways was immediately the most devastating. Only months after finding out he had the disease, the veteran journalist was fighting not only sickness and weight loss but also escalating medical bills that drained his savings and later his family’s.
Fortunately, his diagnosis was made in 1997, only months after Brazil started a controversial policy to manufacture and produce its own generic AIDS medicines and distribute them free to patients. It meant affordable treatment, a shot at a healthier life and, for Carmona, even the financial freedom to help others as an AIDS volunteer.
"It is why I am here today," Carmona said recently, as he took at break from volunteering as a community representative for an AIDS treatment and support group based near Rio de Janeiro.
His story is just one part of a broader fight against AIDS in Brazil, an initiative that at first brought controversy and now praise to Latin America’s most populous country.
Brazil has inched into the spotlight as a model for other developing nations with its multifaceted approach to stabilizing the spread of a disease that was expected to ravage its working-age population only a few years ago. When AIDS first burst onto the world health scene in the 1980s, Brazil was one of the countries hardest hit.
Now, while 20 percent of adults in South Africa are infected with HIV, less than 1 percent of Brazilians are infected, and many countries, including South Africa, are trying to determine how Brazil made it work.
"We have tried to be very aggressive at mobilizing our resources," Paulo Teixeira, head of the Brazilian Health Ministry’s AIDS program, said at a recent Rio de Janeiro international AIDS conference.
"For the last two decades, we have tried to make it easy to talk about condoms, to talk about sex, to talk about sick people publicly," Teixeira said. "And we have always worked with non-profit organizations that go out into the field and provide the personal support and help that we cannot provide."
Even before data began to show the country’s success in fighting AIDS, Brazilian officials were unusually frank in pushing prevention and treatment programs.
This year, despite the Roman Catholic Church’s anti-condom stance, some 10 million condoms were distributed during Carnival festivities. One recent ad campaign warned men that promiscuity could lead to their transmitting the disease to their wives or girlfriends.
Brazilians say the frank talk, which has attacked traditional prejudices about the disease, along with free medicines and community support, has worked.
According to United Nations figures, 600 people in Latin America and the Caribbean are infected each day by the virus that causes AIDS—about one every two minutes. The Caribbean suffers from the world’s second-highest rate of infection after sub-Saharan Africa. Regionally, the nation most devastated is Haiti, where more than 5 percent of the population are infected. Bahamas reports a 4 percent rate of infection.
In Brazil, some 540,000 adults, only 0.6 percent of the population, are registered as HIV-positive, a figure researchers say would have skyrocketed if the rate of new infections had continued unabated since the first cases began to be detected two decades ago.
From the beginning, the mobilization of the gay community and non-profit organizations was critical to Brazil’s fight. Their influence is still strong, particularly as the economic profile of those contracting the disease has changed ; now the hardest hit are the poor.
Brazil’s success has brought international delegations from many countries, including several in Africa. South Africa, particularly, has been interested in finding out the key to Brazil’s success in manufacturing generic drugs that stabilize—but not cure—the condition of many people who have AIDS.
"The Brazilian response is kind of a flagship not only in Latin America and the Caribbean but also at the global level," said Luiz Loures, chief for Latin America and the Caribbean for UNAIDS.
"The Brazilian response is transferable," he added, noting that while Brazil is wealthier than some other developing nations, political will and community support have made the difference in a variety of countries. "We are also looking at other countries, such as Senegal and Uganda, that have taken the lead in Africa or other regions to provide symbols in this fight."
In Brazil, largely because of the wide availability of generic drugs supported by $450 million in government funding for some 93,000 patients, AIDS deaths were cut in half between 1996 and 1999, with the death toll particularly plummeting in cities such as Rio de Janeiro and Sao Paulo.
The government spends about $4,500 per patient each year for typical drug treatment. In the U.S., similar treatment cost between $12,000 and $15,000.
In 1994, Brazil’s government urged domestic pharmaceutical firms to start manufacturing AIDS drugs. Now Brazil makes eight of the 12 anti-retroviral drugs used in the so-called AIDS cocktail. Because of Brazil’s production, prices for AIDS drugs exclusively produced abroad have dipped 9 percent but more than 70 percent for those that compete with Brazilian generic brands. The plummeting prices and Brazil’s firm intention of pushing ahead with manufacturing new drugs has put the nation at odds with pharmaceutical manufacturers.
The overall effort also has been controversial among researchers who have questioned whether Brazil has the technology and infrastructure to produce proper generic equivalents.
"I was against it at first," said Mauro Schechter, one of the world’s foremost AIDS researchers, of Brazil’s program. "I thought it would be very expensive and difficult to establish the necessary lab infrastructure.
"But the program has been very effective," said Schechter, who nonetheless says there is anecdotal evidence that some of Brazil’s generic drugs may not be equivalent to top pharmaceutical brands.
Despite criticism, Brazilian officials have pushed forward, saying they produce quality drugs and arguing that they can produce the drugs because of a provision in World Trade Organization rules for countries to take measures to protect the population in case of a national emergency.
"We believe Brazilian officials have had some good efforts putting resources toward this major problem, but they are still part of the world order and need to work things out with our companies," said Mark Grayson, spokesman for the Pharmaceutical Research and Manufacturers of America in Washington.