1. 1 The National Response to HIV/AIDS in Brazil Brazilian STD/AIDS Program Ministry of Health

2. 2 Population (2005) – 185 mln Federative Republic with 27 States Municipalities - 5,561 Territory: 8,5 mln sq km GNP (2004) US$ 750 bi Per capita GNP (2004) - US$ 4,041 HDI Rank (2005) - 63 th (0.792) Country Profile

3. 3 Accumulated AIDS cases (06/2005): 371,827 AIDS incidence rate (2004): 17,2/100,000 inhabitants Estimated n. of PLWHA (2004): around 600,000 Prevalence: (15 to 49 years of age) 2000: 0.61% 2004: 0.61% Aids deaths (1980-2004): 171,923 Mortality rate: 6,1/100,000 (2004) inhabitants Epidemiological Profile

4. 4 Current epidemiological trends Relative stabilization, -decreasing: southeast, MSM, IDU -Stabilized: big cities Increasingly affecting: - Heterosexuals - Women - Low-income groups - Smaller cities

5. 5 Total investment in STD/AIDS control program by the Federal Government. Brazil, 1997-2005 Source: PN STD-AIDS//MOH 11% 89% National budget World Bank Loan Average investment per year: US$ 400 MILLION 1997 to date: US$ 3.5 billion (HIV response) US$ 2 billion for ART

6. 6 Major features of the Brazilian Response Country-driven approach:  Social Control: robust participation by civil society in decision making and implementation  Balanced prevention and treatment approach  Comprehensive ethical and rights-based approach  Early response by government (since 1983)  Multi-sectoral mobilization

7. 7 The 1988 Brazilian Constitution: access to health is a basic right  Main precepts: - comprehensive approach - universal access and equity - civil society participation  Key feature: decentralization  Virtuous circle (AIDS Programmes  Public Health System) The “backbone” of the Brazilian Response: the Public Health System The “backbone” of the Brazilian Response: the Public Health System

8. 8 Expand access to prevention commodities (male/female condoms, lubricating gel, harm reduction supplies) Extend joint activities with CSO’s, CBO’s, uniformed services, social movements and other government programs Implement education programs throughout the public school system at all levels Increase coverage in poorest areas, emphasizing counselling and testing through the primary health system Prevention Framework

9. 9 Regular condom use (last 12 mo.) among those aged 16-65 (2005) Regular condom use (last 12 mo.) among those aged 16-65 (2005) 35,4% 23,9% 0% 5% 10% 15% 20% 25% 30% 35% 40% 19982005 Fonte: Pesquisa CEBRAP, 2005.

10. 10 0 20000 40000 60000 80000 100000 120000 140000 160000 180000 jan/97 abr/97 jul/97 out/97 jan/98 abr/98 jul/98 out/98 jan/99 abr/99 jul/99 out/99 jan/00 abr/00 jul/00 out/00 jan/01 abr/01 jul/01 out/01 jan/02 abr/02 jul/02 out/02 jan/03 abr/03 jul/03 out/03 jan/04 abr/04 jul/04 out/04 jan/05 abr/05 jul/05 out/05 170.000 * Dados preliminares Projected Number of patients receiving ARV therapy (1997 – 2005)

11. 11 Average cost of ARV therapy per patient/year (US$). Brazil, 2005 6240 5486 4603 3464 2210 1500 13591336 2500 0 1000 2000 3000 4000 5000 6000 7000 199719981999200020012002200320042005* Year Thousands (US$) Introduction of expensive new ARVs Substantial falls in prices of second-line patented drugs have ceased Number of people using them has increased dramatically

12. 12 * Brazilian local production  RITONAVIR (1996)*  SAQUINAVIR (1996)*  INDINAVIR (1997)*  NELFINAVIR (1998)  AMPRENAVIR (2001)  LOPINAVIR/r (2002)  ATAZANAVIR (2004)  ZIDOVUDINE (1993)*  ESTAVUDINE (1997)*  DIDANOSINE (1998)*  LAMIVUDINE (1999)*  ABACAVIR (2001) DIDANOSINE EC (2005) TENOFOVIR (2003)  NEVIRAPINE (2001)*  EFAVIRENZ (1999) ITRN and ITRNt  ENFUVIRTIDE (2005) IP FUSION INHIBITORITRNN Antiretroviral drugs distributed through the Brazilian public health system (and year of introduction) Antiretroviral drugs distributed through the Brazilian public health system (and year of introduction)

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14. 14 Total number and estimated value of hospitalizations averted (non-cumulative figures) Total number and estimated value of hospitalizations averted (non-cumulative figures) Estimated value of hospitalizations avoidedEstimated number of hospitalizations avoided $0.00 $100,000,000.00 $200,000,000.00 $300,000,000.00 $400,000,000.00 $500,000,000.00 $600,000,000.00 19971998199920002001200220032004 Expenditures (in US$) 0 20,000 40,000 60,000 80,000 100,000 120,000 140,000 160,000 180,000 Number of hospitalizations Total: Hospitalizations avoided: 791,069 Total savings: US$ $2,289,654,584

15. 15 South-South Cooperation: Network for Technological Cooperation in HIV/AIDS South-South Cooperation: Network for Technological Cooperation in HIV/AIDS Launched in 2004, involving Argentina, Brazil, China, Cuba, Nigeria, Russia, Thailand and Ukraine Key support provided by the Ford Foundation: US$ 1 million Objectives: technology transfer, R&D and production: - antiretrovirals - vaccines and microbycides - condoms - laboratory supplies

16. 16 The GCTH – Group for Horizontal Technical Cooperation. Launched in 1995 to establish direct cooperation between the Latin American and Caribbean State Governments onHIV and AIDS control and prevention. Objectives: - Reference for building up regional statements for International Events. - Courses, Conferences and Forums. - Development of the Price Bank. - Development of web-page and improvement of electronic communication.

17. 17 Other South-South Cooperation Initiatives Technical Areas: Institutional development, management and capacity building Care and support Clinical management Antiretroviral logistics and management Epidemiological surveillance Promotion of safer sexual practices Promotion of human rights Advocacy and Civil Society participation Care and support for HIV+ pregnant women and children exposed to HIV

18. 18 International Cooperation with Developed Countries International Cooperation with Developed Countries Institutions involved: ANRS (France), CDC, USAID, Ford, GTZ, DFID United Nations :UNAIDS, UNFPA, UNICEF, UNODC, UNESCO, ILO, Thematic areas: Monitoring and Evaluation; Promotion of safer sexual practices Promotion of human rights Advocacy and Civil Society participation Scientific and technological development

19. 19 International Center for Technical Cooperation: a Joint Brazil/UNAIDS Initiative International Center for Technical Cooperation: a Joint Brazil/UNAIDS Initiative Created in 2005, the ICTC aims to create and strengthen national technical capabilities for implementing comprehensive AIDS responses through horizontal technical cooperation; Example of activities undertaken:  Coordination of technical missions in Honduras, Nicaragua, Peru, Ecuador and Bolivia  Identification of technical assistance needs of Latin American countries receiving financial support from the Global Fund Total investments:  Brazilian Government (US$ 500,000), UNAIDS (US$ 500,000), DFID (£ 250,000 - under negotiation), GTZ (€ 250,000 – under negotiation)

20. 20 Challenges: to develop new technologies and systems to halt spread of the HIV/AIDS epidemic Technologies: Prevention (e.g., microbycides, etc) Treatment and care (e.g., new FDCs) Vaccine Systems: Monitoring and Evaluation and Operational Research Personnel (health and management) Management

21. 21 Brazil’s Recommendations to the 2006 UNGASS Universal Access to Prevention, Treatment, Care and Support: “We recognize the importance of intellectual property rights. But no right of a commercial nature can be upheld to the detriment of the right to life and health.” Ambassador Celso Amorim, UNGASS 2006. Prevention: “Individual moral values, respectable as they are, cannot be the basis of public health policies. Prevention must reach vulnerable groups – homosexuals, drug users and sex workers(…)” C.A. 2006 Finance: “Donors must increase the amount of resources available so that health systems can be strengthened (…) Africa is the region that has been most affected. It should continue to deserve priority attention.” C.A. 2006