1. The Brazilian Response to AIDS Mauro Teixeira de Figueiredo Head of the Division for Technical Cooperation International Advisory Ministry of Health Main strategies

2. The epidemic in Brazil

3. Brazil

4. Total number of People Living with HIV (2006): 630,000 HIV Prevalence: 0.61% (15-49) Female: 0.42%; Male 0.82% Cumulative number of AIDS cases (06/2008): 506,499 Incidence per 100.000 (2007): 17.8 Mortality coefficient per 100.000 (2007): 5.8 Cumulative number of deaths (2007): 205,409 Key figures

5. Key features of the Brazilian epidemic Stabilized incidence, mortality coefficient, and HIV prevalence Concentrated epidemic Pauperization Interiorization Feminization Reduction for IDU Incidence on the rise for people of 50+ Incidence on the rise for young MSM

6. MAJOR ASPECTS IN BRAZILIAN RESPONSE TO HIV/AIDS UNIFIED HEALTH SISTEM - SUS EARLY GOVERNMENTAL RESPONSE – SINCE 1983 STRONG CIVIL SOCIETY PARTICIPATION IN ALL DECISION LEVELS MULTISECTORIAL MOBILIZATION BALANCED PREVENTION & TREATMENT APPROACH FIGHT AGAINS HIV AND AIDS AS A STATE POLICY, WITH ROBUST GOVERNMENTAL INVESTMENT Human Rights perspective in all the strategies and actions

7. Government UN Theme Group Civil Society AIDS Business Coalition The strategic triangle to struggle HIV and AIDS – Since the beginning of the epidemic NGO Commission (CAMS) Ministry of Health Other Ministries and governamental institutions Ministry of Health Other Ministries and governamental institutions International Organisations Finantial and technical support to projects from NGO Investment on communication and international relations strategies

8. 1. Federal Government: - National policy formulation - Technical Guidelines - Monitoring and Evaluation - Allocating funds to states and municipalities - NGO financing - Antiretroviral treatment - Tests 2. State - Medicines for opportunistic infection and STI NGO financing 3.Municipal Governments: - Coordination of local health services - The three-level management structure of the Brazilian Response Existence of Committees for coordination of the three level of management

9. State and Municipal AIDS Programs work closely with the NAP and in accordance with the National Strategic Plan Strong participation of civil society in planning and implementation through: a. Control bodies for monitoring the public health system b. National AIDS Commission c. NGO Commission c. Direct financing Joint work with Civil Society and State and Municipal AIDS Programs

10. Activities and approaches of the Brazilian STD and AIDS Program

11. 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 Prevention strategies centered on condom use - Access to condoms Harm reduction policy Activities and approaches of the Brazilian STD and AIDS Program

12. Universal Treatment of people living with AIDS Access to HIV diagnosis – goal is to test 4,5 million a year Impact of prevention interventions – vulnerable populations Prevention actions for general population and specific groups Early diagnosis of HIV infection Reduction of mother to child transmission Research and Development of Vaccines Sharing experiences – South-South Cooperation Activities and approaches of the Brazilian STD and AIDS Program

13. Impact of the Brazilian ARV Policy (1996-2002) reduction of mortality 50% deaths prevented 90,000 reduction of morbidity 70% reduction of hospitalizations 80% 633,180 hospitalizations prevented - average of hospitalizations / patient per year reduced from 1,65 in 1996 to 0,25 in 2003.

15. ...Anti-retrovirals Universal and free of charge access to ARV - ruled by Federal Law Nov.1996 Incentives to Public-Private Partnerships aiming at local production of ARVs Negotiations for price reduction Regulation of article 6 of the Doha Declaration (right to import and export patented drugs) Presidential Decree authorising importation in case of Compulsory Licensing

16. Treatment budget Annual expenditure: 400$ million Average annual cost per patient (2008) –1st line – 667$ –2nd line – 2114$ (25% of patients) Compulsory licensing of Efivarenz –Most used imported ARV (approximately 75.000 patients) –Price prior to compulsory licensing in 2006/2007: 1,56$ –Price after compulsory licensing in May 2007: 0.45$ to 0,47 –Estimated savings until 2012: 236,8$ million –National production

17. ... Vaccines Incentives for R&D projects carried out by public research institutes Implementation of Training and Technical Assistance Projects Participation alongwith Civil Society and Communities

18. Thank You mauro.figueiredo@saude.gov.br Phone# 5561-3315-3805 mauro.figueiredo@saude.gov.br