1. Ministry of Health Health Surveillance Secretariat NATIONAL STD/AIDS PROGRAMME

2. National Response to HIV and AIDS in Brazil

3. Population - 169.799.170 (2000) GNP per capita: US$ 2569 (2002) ACCUMULATED AIDS CASES (2003): 310,310 AIDS INCIDENCE RATE (2002): 12.8/100,000 ESTIMATED N. OF PEOPLE LIVING WITH HIV (2003): 600,000 PREVALENCE: 0.65% (15 to 49 years of age) AIDS DEATHS (1980-2002): 149,559 MORTALITY RATE: 6.3/100,000 (2002) BRAZIL

4. 1 1 146,000 (on ARV) 146,000 (on ARV) 89,000 (without ARV) 89,000 (without ARV) 365,000 (majority don’t know they are HIV+) 235,000 (being monitored) Brazil 600,000 PLHA

5. BRAZIL Trends of the epidemic Stabilization Heterosexualisation Feminisation Pauperisation Interiorisation

6. Municipalities with at least one AIDS case Brazil, 1980 - 2004. 1980-1987 1988-1994 1995-2004

7. Fonte: PN DST e AIDS – SVS - MS. Pauperisation % Aids cases over age 19 X schooling Brazil, 1985 - 2002. 858687888990919293949596979899000102 0% 20% 40% 60% 80% 100% 3º Grau2º Grau1º GrauAnalfabeto

8. Annual mortality rate by sex. Brazil, 1984 – 2002. Source: Brazilian STD/AIDS Program 0 2 4 6 8 10 12 14 16 84858687888990919293949596979899000102 year of death per 100,000 inhab. men womenBrazil

9. Characteristics of the Brazilian Response Early government response - since 1983 Strong participation of civil society in all decision levels Multi-sectoral mobilization Specificity of Brazilian culture Balanced approach between prevention and treatment Human rights perspective in all the strategies and actions

10. Source: IPEA/2001 295,0 394,8 595,5 445,9 359,9 243,2 44,6 41,0 44,2 57,2 41,4 30,7 199719981999200020012002 Year 0 100 200 300 400 500 600 700 (US$) Million Federal WB Distribution of Public Resources in external source WB* and Government source.

11. Health Promotion and Prevention

12. Promotion of human rights Implementation of major national media campaigns Prevention actions for general population and specific groups Early diagnosis of HIV infection STD diagnosis and treatment Health Promotion and Prevention

13. Access to condoms 700 million / year 13 17 20 13 38 39 80 126 148 260 Progressive increase of Public Distribution (20x) Steady growth of Market sales (3x) 152 186 227 267 325 373 430 497 548 700 Growth trend of condom use (4.6 x) 1994199519961997199819992000200120022003 139 169 207 254 287 334 350371 400 440 Condom use (in millions of units) Sources: DKT and PN-DST/AIDS Marketed Public Distribution

14. Adoption of Safer Sex practices (1998 - 2003) Source: (1) CEBRAP/MS/PN-DST-AIDS/SVS (2) MS - IBOPE Use of condom in last sexual intercourse With occasional partners (%)With regular partners (%) 64 79,5 1998 2003 020406080100 21 20,2 1998 2003 020406080100 (1) (2) 69% of the population is sexually active

15. 70 150 130 120 50 Number of Institutions which distribute Female Condoms, per Macro-Region 2000-2003 Distribution of 4 million condoms / year Priority Population: Seropositive women Sex workers IDUs and their partners Women victims of domestic sexual violence

16. HIV BEHAVIOR HCV HARM REDUCTION Support to 125 projects with 65,000 ID users - estimated 20% coverage

17. Today 1.8 million people are tested per year 30% of the sexually active population have taken the test. 300 and 400 thousand HIV+ are not aware of their status. Diagnosis is made 4/5 years after infection. Access to HIV diagnosis Goal is to test 4.5 million a year

18. Impact of prevention interventions – vulnerable populations Drop in HIV infection rates Sex workers – From 17% in 1992 to 6.1% in 2000 MSM - from 10.8% in 1999 to 4.7% in 2001 IDU - from 21% of AIDS cases 1994 to 11.4% in 2000

19. Mother to Child Transmission, Brazil, 1997 to 2003 * Preliminary data Estimated 17thousand pregnant women infected per year

20. Rate of Mother to Child Transmission (%) per year of birth - Brazil, 1997-2002 Tess, 1998; Succi, 2003 (preliminary data) 16 9.7 7.8 3.7 0 2 4 6 8 10 12 14 16 1998200020012002

21. Health Care

22. HIV/AIDS services Accredited hospitals: 375 Day hospitals: 79 Home care: 54 Outpatient services: 381 Source: UDAT/PN-DST-AIDS. March/2002 Access to Treatment 889 services for PLHA Laboratories: Viral Load, CD4+ count and Genotyping

23. PLHA on ARV use Brasil, 1997 a Jun/2004

24.  ZIDOVUDINE (ZDV)*  DIDANOSINE (ddI)*  LAMIVUDINE (3TC)*  STAVUDINE (d4T)*  ABACAVIR  INDINAVIR*  TENOFOVIR 16 ARVs distributed  RITONAVIR*  SAQUINAVIR  NELFINAVIR  AMPRENAVIR  NEVIRAPINE*  EFAVIRENZ  LOPINAVIR / r  ATAZANAVIR (*) Brazilian state production available Universal and free of charge access to ARV - federal law Nov.1996

25. MEDIAN SURVIVAL AFTER AIDS DIAGNOSIS IN BRAZIL Source: Chequer et al, 1992; Marins et al. 2002 58 18 5 0 10 20 30 40 50 60 70 198919951996 Months of survival Introduction of Potent ARV Therapy in Brazil

26. LPV.rNFVEFZ12 other ARVs Expenditures (in millions of R$) 121 131 106 215 2003 21% 23% 19% 573 37% Access to treatment 3 imported drugs take up 63% of the budget - 2003 LPV.r+ EFZ+ NFV 63% 12 other ARVs 37%

27. ARV drug expenditures avoided trough negotiation (In millions of US$), for 2004 - Brazil (Jan/2004)

28. Expenditures (In millions of US$) with ARV Drugs and Average Number of Patients under treatment - Brazil (1997-2004*) *Data subject to alterations

29. MoH / 2003 3810 4860 4540 4240 3320 2223 2035 1996199719981999200020012002 Average cost (US$) of ARV per Patient/year - 1996 - 2003* 1630 2003 * Preliminares datas

30. Impact of the Brazilian ARV Policy (1996-2002) reduction of mortality  40% 90,000 deaths prevented reduction of morbidity  70% reduction of hospitalizations  80%  358,000 hospitalizations prevented - average of hospitalizations / patient per year reduced from 1,65 in 1996 to 0,28 in 2003.

31. Impact of ARV Therapy Policy (1996-2002) Cost Savings - US$ 2.2 billion US$ 1.23 billion in hospitals and treatment opportunistic infections US$ 960 million reduction in drug prices

32. “Life sleeps in the crude earth, dreams beauty in the flowers, wakes with power in the animals and in man has consciousness of infinite possibilities” Yogananda