AIDS IN BRAZIL NATIONAL RESPONSE

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The Brazilian Response to the HIV/AIDS Epidemic
Prevention, Treatment and Human Rights
Paulo R. Teixeira, MD National STD/AIDS
Program Ministry of Health May/2002
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• BRAZIL MAJOR ASPECTS
• POPULATION (2000) 169,500,000
• GNP PER CAPITA (2001) US 2,914
• LIFE EXPECTANCY (2000) 67 YEARS
• HDI RANK (2000) 74th (0.747)

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• BRAZIL EPIDEMIC PROFILE
• CUMULATIVE AIDS CASES (September/2001) 222,356
• CUMULATIVE AIDS DEATHS (June/2001) 105,595
• ESTIMATED NUMBER OF HIV INDIVIDUALS (2000)
  597,000
• INCIDENCE RATE (2000) 10,5 / 100.000

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BEHAVIORAL INTERVENTION

• GENERAL POPULATION VULNERABLE
  POPULATION

• Poor population
• Women
• Children and Adolescents
• Workers and private sector
• Army
• Rural population and landless agricultural
  workers (MST)

• MSM
• IVDU and general drug users
• Sex workers (male./fem.)
• Prisoners
• Indigenous population
• Mobile populations

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PARTNERSHIPS WITH CIVIL SOCIETY

• Participation and social control
• Guaranteeing human rights for people living with
  HIV and aids
• Support for community projects.

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SUPPORT FOR CIVIL SOCIETY ORGANIZATION PROJECTS
ACCORDING TO MACROREGIONAL DISTRIBUITION
AIDS II Amount of Projects 1.681 Amount of
Resources U 30 million
27
105
113
49
366
322
196
56
716
AIDS I Amount of Projects 559 Amount of
Resources U 10 million
290
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MAJOR ASPECTS IN BRAZILIAN RESPONSE TO HIV/AIDS

• EARLY GOVERNMENTAL RESPONSE
• STRONG CIVIL SOCIETY PARTICIPATION IN ALL
  DECISION LEVELS
• BALANCED PREVENTION TREATMENT APPROACH WITH
  HUMAN RIGHTS PERSPECTIVE IN ALL STRATEGIES AND
  ACTIONS

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BRAZILIAN ARV ACCESS PROGRAM MAJOR ASPECTS (1)

• UNIVERSAL AND FREE OF CHARGE ACCESS TO ARV DRUGS
  POLICY INITIATED IN 1991 (Presidential Decree,
  November/1996)
• NATIONAL ARV TREATMENT GUIDELINES (Adults,
  Children and Pregnant Women)

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Patients on ARV Therapy in the Public Health
System - Brazil, 1997 - 2001
113,000
Source Ministry of Health
preliminary data
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BRAZILIAN ARV ACCESS PROGRAM MAJOR ASPECTS

• NATIONAL NETWORK OF PUBLIC ALTERNATIVE CARE
  SERVICES 900 SERVICES
• NATIONAL NETWORK OF VCT FOR HIV 208 SERVICES
• NATIONAL NETWORKS OF LABORATORY SUPPORT
• HIV VIRAL LOAD 73 LABORATORIES
• CD4 CELL COUNT 65 LABORATORIES
• HIV RESISTANCE TESTING 12 LABORATORIES
• NATIONAL ARV LOGISTIC CONTROL SYSTEM 424
  DISPENSARY UNITS

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• Impact of Antiretroviral Therapy Policy(1996 -
  2001)

• Reduced Mortality ? 40-75
• Reduced Morbidity ? 60-80
• Reduced Hospitalization
• 85 reduction
• 358,000 avoided
• Cost Savings ? U 1.1 billion

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Tuberculosis in HIV Patients.CRT DST/AIDS,
Sao Paulo, Brazil (1994 2000)
Source
V.E.CRT
-
DST/Aids (data
until
12/02/01)
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ARV Drugs Distributed by Ministry of Health -
Brazil (2002)

• ZIDOVUDINE (ZDV)
• DIDANOSINE (ddI)
• ZALCITABINE (ddC)
• LAMIVUDINE (3TC)
• STAVUDINE (d4T)
• ABACAVIR
• INDINAVIR
• RITONAVIR

• SAQUINAVIR
• NELFINAVIR
• AMPRENAVIR
• NEVIRAPINE
• DELAVIRDINE
• EFAVIRENZ
• LOPINAVIR / r

() locally produced version available
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Price evolution (in US) of ARV for adult use
with domestic production. Brazil,1996 - 2001
Source Ministry of Health/Brazil
Estimated data
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preliminary data
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Brazilian MoH Merck, Roche and Abbott
Agreements on ARV Price Reduction (2001/2002)

• 64,8 Price Reduction on Indinavir
• 59,0 Price Reduction on Efavirenz
• 40,0 Price Reduction on Nelfinavir
• 46,0 Price Reduction on Lopinavir/r

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PUBLIC ACCESS TO ARV THERAPY IN 2001
( USA and BRAZIL)
Source Aids Drugs Assistance Program
www.kff.org
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ADHERENCE TO ARV THERAPY IN BRAZIL - THE SÃO
PAULO STUDY

• 8,850 HIV patients evaluated (27 care units).
• Definition of a good compliance more than 80
  of prescribed pills.
• Adherence rate in this study 69
• Major factor associated with adherence quality
  of medical service.

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EVALUATION OF ARV DRUG RESISTANCE PATTERNS
(Brazil, 2001)
Patients under HAART (44) prevalence/profile
very similar to what have been found in
international studies.


Drug naive Patients (lt5) prevalence
significantly lower than observed in Europe and
US studies
Drug naive VCT Centers (n380) collected during
2001
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Expectation of Life at Birth (years) in Different
Developing Countries (1990 - 2005)
Brazil
Source UN World Population Prospects, 2001
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Brazilian Government Investment in STD/AIDS
(1997-2000)
(US) Million
Year
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MAJOR CHALLENGES IN NEAR FUTURE

• Improve diagnosis of HIV Infection (focus on
  early diagnosis and MTC prevention)
• Expand the CD4 and Viral Load Networks
• Monitoring Adherence and Viral Resistance
• Monitoring Quality of HIV Care (Health services,
  OI prophylaxis, ARV management)

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For additional information
www.aids.gov.br