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.

But while those numbers have attracted praise from world leaders and international organizations, some activists say Brazil should offer more immediate assistance for its most desperate neighbors. "As the leader in the fight against AIDS in the region, Brazil should make major and more efforts," says Renate Koch, the executive director of the Venezuela nongovernment organization (NGO) Citizens Action Against AIDS. "Specifically, Brazil should assist those countries in the region that are making efforts but do not find ways to start, be it for lack of political will or economic problems."

Echoing calls from other Latin American AIDS activists, Ms. Koch called on Brazil to sell its generics at cost or donate supplies to the Latin American nations worst hit by the disease.

Brazil has taken such measures in the past. One of the first examples came last year when it gave some $50,000 worth of antiretroviral drugs to a project in South Africa by Doctors Without Borders (MSF), an NGO. MSF took the drugs to a Cape Town slum where doctors treated 100 patients. The experiment was a success, with the average weight of each patient increasing 22 pounds in just six months and the rate of opportunistic infections dropping 72 percent.

"The results were excellent, even better than expected," said Michel Lotrowska, one of the experts monitoring the project. "It was important to show that antiretroviral therapy can work in poor settings."

Despite the initiative's success, Teixeira says Brazil can't continue to pursue such approaches in the long-term. Doubling Brazil's production, he says, would provide drugs for only a handful of the 40 million people diagnosed with AIDS worldwide, while draining resources that go to fight other diseases endemic to Brazil such as malaria. By contrast, the main purpose of Brazil's recent proposal is to give developing nations first-hand evidence they can use when seeking funding for future AIDS programs.

"It is much more concrete going to a donor and saying we have a project here in our country that gave us these results, and I now want the funding to increase it and develop it," he says.

Many pharmaceutical companies, however, argue that it is more efficient for developing countries to deal directly with private drug firms in their battle against AIDS. "There's a place for generics, but there is also a place for the brand-name pharmaceuticals," says Mark Grayson, spokesman for Pharmaceutical Research and Manufacturers of America, an industry group. "We make the best products in the world and our products are priced ... in a way that it might be much more cost-effective for many of these countries to be purchasing from us rather than trying to come up with their own industry."

Mr. Grayson cites the Accelerated Access Initiative, a 2-year-old program started by 5 UN agencies and 6 pharmaceutical companies to help developing countries improve their overall medical infrastructure. An agreement was reached last month with several Caribbean countries, where the rate of diagnosed AIDS incidences trails only sub-Saharan Africa. The deal will reduce drug costs by as much as 90 percent, and provide the region with improved capacity for patient care.

"We don't just give lower prices. We actually go in an try to help with distribution systems," Grayson says.