HIV in Brazil Ana Paula Pfitscher Cavalheiro Infectious Disease Resident at Hospital de Clínicas de Porto Alegre

HIV in Brazil Population:192 million 85% urban Life expectancy: 66.7 y 1/3 poor (family income < 160 €/m) 1988 Constitution: “Health is a right for all and a obligation of the state” 1985: Civil society + Government -> the National AIDS Program 80s: Spread information about STD-AIDS 1991: AZT free access 1996: HAART free access Present: HAART, CD4/VL, genotyping in cases of viral failure, drugs for treatment of HAART side effects

HIV in Brazil HIV Estimated prevalence: 630,000 people (<1% of adult population) Half of predicted in the early 90s by the World Bank AIDS Prevalence: 0.6% of total population + 25-49y Increasing between women, heterosexuals, socially excluded and older than 50 y 190,580 on HAART treatment By 2002 ARVs had prevented ~358,000 HIV-related hospitalisations, resulting in a saving of more than US$1.1 billion

Source of HIV acquisition

HIV in Brazil HIV test is free of charge and can be done in primary care units, hospitals or and STD/AIDS counseling testing centers 38% of sexually active population has already been tested at least once Mean first CD4 (without HAART): 316 35% less than 200 Pregnant women are usually tested for STDs and HIV as part of their regular follow-up But in 2007 only 62% had been tested for HIV before labour Recommendation not to breastfeed Provision of infant formula to all children born from HIV + mothers Reduction of vertical transmission 581 in 2004 and 320 in 2006

Brazilian Guideline AZT, 3TC, TNF, ddI, ABC EFZ, NVP When start treatment: Symptomatics Asymptomatics CD4 > 500: no ART CD4 350-500: ART if Nephropaty, HCV or HBV coinfection, VL >100.000, > 55y, high risk of CVD, any cancer CD4 <350: ART AZT, 3TC, TNF, ddI, ABC EFZ, NVP ATV, LOP/r, SQV, /r, DRV , IDV T20 Raltegravir Etravirine

Key points of National AIDS Program Show that you´ve grown up and know what you want. In this Carnival use condom. HIV in Brazil Key points of National AIDS Program Prevention: promote frank talk about safe sex focus on condom promotion Brazil is the world’s largest condom importer buying 1.2 billion in 2009 state-run factory produces 100 million condoms a year focus on preventing HIV among sex workers Treatment: ARV drugs are provided free to everybody who needs; aggressive efforts to minimise the cost of ARVs

Thank you! Condoms after 50: Try it! Living with AIDS is possible, living with prejudice is not. Thank you! Condoms after 50: Try it! Sources: aids.gov.br, avert.org datasus.gov.br, ioc.fiocruz.br