Brazil shares AIDS-fight blueprint

Brazil's much lauded AIDS-fighting program is going global.

Last week, leaders from Portuguese-speaking countries signed on to a program to share in the know-how that has cut Brazil's AIDS-related deaths by more than half over the past eight years.

This deal follows another initiative announced by the head of Brazil's anti-AIDS program at the International AIDS Conference in Barcelona last month. The director of Brazil's STD/AIDS program, Paulo Teixeira, told delegates that Brazil would pledge $1 million – 10 proposed pilot projects worth $100,000 each – to stimulate governments to follow Brazil's lead in taking a proactive role against AIDS.

Brazil has already received 20 formal requests for help, almost all of them from African and Caribbean countries, and expects to choose 10 later this year.

Some say the initiative is not enough for countries like Angola and Mozambique, where AIDS infection rates are 6 percent and 13 percent of the population, respectively. Others hail Brazil's decision to export their experience rather than drugs as another bold move by a nation that has led the way in innovative strategies to fighting AIDS.

"The aim is to give countries the help they need in creating a national capacity as well as demonstrating just how possible it is to undertake these types of treatment in adverse situations," says Dr. Teixeira.

In Brazil, those infected with the HIV virus have free access to a cocktail of anti-retroviral drugs: 115,000 people currently receive the cocktail for free. That's possible because of a controversial law allowing the government to produce generic copies of imported drugs in a national emergency. In 1997, state labs began producing copies of seven of the 12 drugs then used in the cocktail at a fraction of what it would have cost to buy them.

Although the move dramatically reduced the cost of the mixture, international drug companies were still charging high prices for the other drugs. Brazil warned that unless they lowered prices, it would break their patents and begin producing the drugs themselves. The threat worked, and one Swiss and two US pharmaceutical companies last year lowered the cost of five key drugs by 40 to 65 percent. Officials say it now costs this vast South American nation an average of $2,100 to supply each patient annually, less than a fifth of what it costs in the United States.

The strategy has had wide-reaching consequences. In 1995, the World Bank predicted that the number of AIDS cases in Brazil would reach 1.2 million in five years, but the number today is less than half that, Teixeira says. The mortality rate has fallen by 50 percent, and the number of people treated for opportunist infections has tumbled by 80 percent. The average survival time for an AIDS patient has risen from six months to nearly five years.

The balance sheet is equally impressive. In the first four years of the program, administering the cocktail kept 358,000 people out of the hospital and saved the nation $1.1 billion, according to officials.

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