Brazil's nearly two-decade effort totreat people living with HIV and AIDS shows that developing countries cansuccessfully combat the epidemic. Inexpensive generic medicines are a largepart of the solution, say researchers from Brown University and the HarvardSchool of Public Health.
Brazil did this, researchers said, largely by pursuing controversialpolicies that prompted pharmaceutical companies with exclusive drugs tolower their prices dramatically and generic companies to develop lower-costalternatives for use in emerging markets.
"Brazil has proved it is possible to treat people with AIDS in developingcountries," said lead author Amy Nunn, assistant professor of medicine(research) at The Warren Alpert Medical School of Brown University. Sheadded that the country saved more than $1 billion as a result of bargainingwith multinational pharmaceutical companies, resulting in significantchanges in global AIDS policy. That effort, Nunn said, has had a wide impact.
"Before Brazil's efforts, as recently as the year 2000," she said, "mostpeople living with HIV/AIDS in developing countries died without receivingtreatment."Details of their findings will be published in the July/August issue ofHealth Affairs
. Francisco Bastos, a well-known AIDS epidemiologist at theOswaldo Cruz Foundation in Rio de Janiero, and Elize da Fonseca at theUniversity of Edinburgh in Scotland also participated in the research.
Senior author Sofia Gruskin is an associate professor of health and humanrights at the Harvard School of Public Health in Boston, where the initialresearch began. One of the biggest advances in Brazil's push to address the advance of HIVand AIDS came in the 1990s, when the country passed a law guaranteeing free,universal access to drugs for AIDS treatment.
The country also beganproducing generic AIDS medicines in public factories. Brazilian authoritiesalso pressured drug companies to reduce their prices drastically forpatented medicines by threatening to produce generic versions of thosedrugs.
Brazil was working to contain the virus years before taking that step.Researchers noted that Brazil began its HIV education and preventioncampaigns early in the 1980s, focusing on condom distribution and HIVtesting. Health officials also targeted prevention campaigns to thosevulnerable to contracting HIV, including sex workers, injecting drug usersand men who have sex with men.
The results were enormously beneficial. Researchers said the country¹streatment initiatives also helped minimize the spread of the virus inBrazil. In doing so, health officials proved AIDS treatment was possible ina developing country.
The example helped prompt sweeping changes in globalpublic health policy and foreign aid relating to global health, withBrazil¹s actions as an example of how to make HIV/AIDS policies moreeffective. Gruskin said that Brazil also spearheaded important changes in globalhealth, trade policies, and international human rights protections relatedto medicines, and the country forced greater transparency about global drugprices.
An example of the change: Since 2003, the United States and other developedcountries once opposed to Brazil¹s policies have invested billions ofdollars annually to provide generic AIDS medicines to people in developingcountries.At home, Brazil kept its HIV/AIDS epidemic confined to .5 percent of thepopulation.
Today, about 660,000 Brazilians live with the disease.Nunn said the study's findings show that developing countries around theworld can dramatically reduce AIDS-related deaths by treating patients. Sheadded that the research highlights the value of strategic global politicalengagement by developing countries.Still, there are challenges ahead.
The study shows that the cost of treatingHIV/AIDS patients in Brazil has risen in recent years. The long-term costsof treating people living with HIV/AIDS will continue to rise in othercountries as more people receive treatment, life expectancy is extended, andpatients require more costly and often patented medicines.