[Pharm-policy] Washington Post: Brazil Becomes Model in Fight Against AIDS

[Thiru Balasubramaniam]

This article talks about the success of Brazil's program to combat AIDS
through the free distribution of generic ARVS.  I would suggest reading
the whole article as only portions have been included in this post.


Thiru



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http://www.washingtonpost.com/wp-dyn/articles/A20559-2000Sep16.html



By Stephen Buckley
Washington Post Foreign Service
Sunday, September 17, 2000



RIO DE JANEIRO-- It was early 1997, and Mauricio Guimaraes lost 88
pounds, watched his shiny brown hair fall out, developed a vicious
neurological illness and sprouted hundreds of blisters on his body. For
years he had denied that AIDS was killing him. He could deny it no
longer.

Then came a miracle in the unlikely form of the Brazilian government. 
That year marked the start of Brazil's controversial policy of producing
generic AIDS medicines and distributing them to patients, free of
charge. For the government, it stood as a turning point in its
commitment to battle AIDS and HIV. For Guimaraes, it meant new life. 

"That medicine meant for me, hope," the 33-year-old actor and activist
said.

Guimaraes' triumph is a tiny part of a larger feat in Brazil, a nation
that has tamed an AIDS epidemic that was predicted to all but destroy
its working-age population. Instead, steady, multi-pronged government
efforts have combined with vibrant--and sometimes
confrontational--community activism to stabilize Brazil's rate of HIV
infection and slash its number of AIDS-related deaths.

Latin America's largest and most populous nation has become such a
showcase in the fight against the disease that other developing
countries, including several in Africa, are trying to adapt the
Brazilian model to their own efforts.

An estimated 580,000 people out of Brazil's population of 167 million
are HIV-positive. Two decades ago, when the first cases of AIDS emerged
in Brazil, health experts forecast that by now, the human
immunodeficiency virus would afflict at least 1.2 million Brazilians. 
Instead, infection rates have returned to 1995 levels. Over the past
five years, the number of AIDS-related deaths has plummeted in Rio de
Janeiro and Sao Paulo, the regions most deeply affected. In Rio de
Janeiro, deaths fell by 40 percent; in Sao Paulo, they dropped by 53.6
percent.

At the heart of Brazil's success is its drug-distribution program. Begun
in 1992, it became dramatically more far-reaching when the government
decided to manufacture its own anti-AIDS drugs. Today, government labs
churn out five generic AIDS medications. Brazil will spend $400 million
this year to distribute medicines to 81,000 AIDS patients. Four years
ago, the country spent half that much but served only 20,000 patients.


The government role has driven prices down. Since 1996, the price of
AIDS drugs manufactured only by international corporations has dipped by
9 percent in Brazil. But the cost of those medications that must compete
with Brazilian generic brands has plummeted by 72 percent. A typical
treatment of antiretroviral drugs--the medicines used in AIDS
cocktails--costs Brazil $4,162 per patient per year; in the United
States, similar treatment generally costs about $15,000.

Brazil's decision to manufacture and distribute medicines incensed
critics here and abroad who predicted that a lack of health-care
infrastructure and the Brazilian government's penchant for corruption
and inefficiency would doom the program. But today the program receives
widespread praise.

"I thought it was going to be a waste of money," said Mauro Schechter, a
Brazilian who is one of the world's foremost AIDS researchers. "But
they've convinced me that it can be done."

"It's a well-organized, well-formulated program that works because the
government has managed to integrate the whole society--especially NGOs,"
said Jorge Werthein, the Brazil representative for UNAIDS, the joint
United Nations program on AIDS.

AIDS patients in Brazil are using brand-name, U.S.-made HIV-AIDS drugs
as well as locally produced generics. Brazil argues that a loophole in
World Trade Organization rules gives it permission to manufacture the
generic medications in a "national emergency." Although pharmaceutical
companies have challenged this approach as a possible violation of world
trade regulations, a spokesman for the leading industry group in the
United States lauded the Brazilian program.

"Five years ago, President [Fernando Henrique] Cardoso realized they
were having a problem, and he made a point to do something about it,"
said Mark Grayson, a spokesman for Pharmaceutical Research and
Manufacturers of America. "Brazilians certainly should be praised for
working on what could have been a terrible situation."

<SNIP>


Brazilian AIDS experts have taken trips to southern Africa, and
representatives from South Africa, where about one in five adults is
HIV-positive, are scheduled to visit by the end of the year to draw
lessons from Brazil's approach. South Africa is especially interested in
Brazil's success in manufacturing and distributing its AIDS medications.

"It makes a lot of sense to look at what Brazil is doing. . . .Something
they're doing is working," said Mbulelo Rakwena, South Africa's
ambassador to Brazil. South Africa has clashed with pharmaceutical
companies over the manufacture of generic AIDS medicines, which the
industry says violates patents.

International experts say that although Brazil is wealthier than most
countries in sub-Saharan Africa, those countries can still emulate
Brazil's determination. "What I like about what they're doing is that
they've had the political will to attack what they rightly perceived as
a serious problem," said Anthony Fauci, a pioneering AIDS researcher
from the National Institutes of Health in Bethesda.

<SNIP>


Staff writers Barton Gellman and Bill Brubaker in Washington contributed
to this report.