Brazil pushes AIDS fight beyond borders

Brazil pushes AIDS fight beyond borders

Little about the Evandro Chagas Hospital housed in a sagging castle or the crumbling brick walls of the Far-Manguinhos drug laboratory suggest that Brazil is on the cutting edge in the fight against AIDS.

But inside the shabby buildings, doctors, scientists and government officials have turned Brazil's AIDS program into a model for developing countries around the world and a beacon of hope for AIDS activists in industrialized nations.

And now, Latin America's biggest country is leading a fight to ensure all developing nations, from South Africa to Haiti to India, are guaranteed access to cheap AIDS drugs.

In a first step, the U.N. Human Rights Commission backed on Monday a Brazilian resolution calling on all states to promote access to AIDS treatment.

When the AIDS crisis exploded on the global health scene in the 1980s, Brazil was seen as one of its main casualties. But within a decade, Brazil stopped the disease in its tracks.

At the heart of Brazil's success is a program which provides AIDS drugs free of cost, and the country's decision to start manufacturing them rather than pay high industry prices.

"We can show developing countries that fighting AIDS is possible even in the conditions that these kind of countries face," said Paulo Teixeira, the director of Brazil's internatinally-hailed AIDS program.

"We are already negotiating with numerous African countries to provide technical and practical assistance," he said.

And the thousands of Brazilians who never expected to be alive in 2001 are proof that a third-world country can give AIDS a first-world treatment.


"The doctor didn't bet anything on my survival," said Sonia Maria Fonseca, who was diagnosed with the HIV virus in 1993, just a few days after her husband died of what doctors initially thought was pneumonia.

"It was like being struck with one bomb after another," the elfin former public servant said. By 1997, Fonseca was stretched out in a hospital, weighing just 77 pounds (35 kg).

But then, as part of Brazil's new AIDS program the Evandro Chagas Hospital started treating Fonseca with a triple cocktail - the combination of antiretroviral drugs that has given AIDS victims around the world a second shot at life. Instead of paying up to $15,000 a year, Fonseca received them for free.

"I wouldn't be alive if it weren't for the program. I couldn't have afforded the treatment," Fonseca said. "But it just seems to me that everybody has the right to live."

Fonseca is just one of 95,000 Brazilians treated under the program - which combined with aggressive prevention efforts has kept HIV infection to less than one percent of the population in Brazil, contradicting dire forecasts.

In absolute numbers, Latin America's largest country suffers from a high rate of AIDS infection, with 200,000 cases of HIV registered and estimates of up to 540,000 total cases.

But it has become a model in the AIDS fight with only 0.6 percent of the adult population infected. That compares with an estimated 36 percent of infection in Botswana, the world's highest rate, and about 20 percent in South Africa.

Brazil spends $300 million a year to offer free treatment and drugs, but says the program more than pays for itself by reducing hospitalizations, cutting transmission rates and enabling thousands of people to remain in the workforce.


But the program isn't without its critics.

To bring prices on AIDS drugs down, Brazil started urging state laboratories to produce at least those drugs that were commercialized by May 1997 - which aren't protected under Brazil's patent law - and now Brazil makes eight of the 12 antiretroviral drugs used in the so-called AIDS cocktail.

With heightened competition, the price of those drugs has plummeted 80 percent. A typical treatment now costs about $4,400 a year compared to up to $15,000 in the United States.

To bring prices down even more, Brazil said last year it would violate the patents on the remaining four drugs if their makers didn't offer to lower prices themselves, a step which officials said would not break any laws.

Brazil requires foreign firms to manufacture drugs - or any other patented product - within Brazil or lose that right to a local competitor after three years. Brazil can also get compulsory licenses to produce drugs when a national emergency is invoked, paying royalties to the patent holder.

Brazil's stance has pitted it against drug companies and the United States, which spurred the World Trade Organization to establish a dispute panel to look at Brazil's patent law.

The U.S. government and drugs companies say they do not object to Brazil's AIDS program, but to its patent laws. Without patents, companies would have no incentive to research new medicines, they say.

"We support Brazil's leadership in the AIDS fight," said Greg Reaves, a spokesman for U.S. drug maker Merck and Co. "But we believe patent protection and affordable pricing are compatible."


But Brazil has not backed down. Eloan dos Santos Pinheiro, the feisty scientist in charge of research and drug development for the country's AIDS program, was preparing to produce two patented drugs in June despite the WTO investigation.

"We can't be at the mercy of these big multinationals," Santos Pinheiro said from her office at Far-Manguinhos state laboratory, a cluster of squat, crumbling buildings in a working class Rio neighborhood that looks more like a brick factory than a cutting-edge research center.

The U.N. resolution passed this week was seen as a victory against Washington. It called on all countries to ensure "that the application of international agreements is supportive of public health policies which promote broad access ... to affordable pharmaceuticals and medical technologies."

Brazil rallied the support of 52 countries with only the United States abstaining.

On the home front, Brazil celebrated another victory when Merck agreed last month to slash prices on Efavirenz, one of the drugs Far-Manguinhos was going to make, by 59 percent.

But Brazil says that the battle has only just begun and is pushing for an international accord that would spell out guarantees of low drug prices for developing countries and the right to manufacture drugs in emergencies.

The accord, which Brazil has pitched to the United Nations and the WTO, would also commit rich countries to providing technical support and AIDS research for developing economies and to creating an AIDS fund.

"These issues now have to become a global commitment not just isolated victories," Teixeira said.

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