Brazil's courage

FOR countries in Asia that are at a critical point in their efforts to curb the spread of HIV/AIDS, Brazil, Uganda, Senegal, Botswana and Cuba offer valuable lessons.

A decade ago, the World Bank warned Brazil to be prepared to deal with over a million AIDS cases by the turn of the century. No such epidemic broke out. Then the United States threatened to drag Brazil to the World Trade Organisation for the "breach" of the Trade-related Intellectual Property Rights (TRIPS) agreement. Ignoring such threats and warnings and taking international support to avail itself of cheaper, generic drugs, the country made AIDS drugs accessible to all.

But the suffering continues. It has lost 100,000 people to the deadly virus. Poverty, unemployment and violence prevailed and the public health system is starved of funds. More than 100,000 HIV-positive people are receiving drugs, but another half a million infected are not benefiting from government programmes.

The struggle against HIV/AIDS, however, continues. Brazil decided to invest in drug therapies in a big way, so that the people get what they need, including support and clinical treatment. The free distribution of anti-retroviral (ARV) drugs to 110,000 registered HIV patients in 2001 by the Health Ministry went a long way in treating patients. It also encouraged more people to go in for tests, which helped in curbing the spread of the disease. Treatment has been followed by prevention strategies, with equal concern and respect for human rights issues.

It was a crucial and courageous decision of the government to start producing the AIDS drugs in 1996, before it signed the TRIPS agreement. Surprisingly the prices of the drugs dropped by 80 per cent. It was a win-win situation, and the patients/public health systems could afford it.

The country could also avoid paying steep royalties to the companies when making generic copies.

There are several cost calculations in this: the Brazilian government saves $250 million a year by not paying for the high-priced, patent-protected imported drugs. The reduction in the incidence of AIDS-related diseases has helped it save $224 million a year.

The public sector drug laboratories and companies have a strong and determining presence in the production of AIDS-related drugs. They currently produce 8 of the 14 ingredients that make up the so-called AIDS cocktail. The government labaratory is diligently working to crack the secret of drugs like Efavirenz and Nelfinavir in order to threaten to break their patents. They negotiate with the suppliers for better prices, or produce the drugs locally. The government has also forged alliances with other progressive initiatives. It allied with the Medecins Sans Frontieres (Doctors without Frontiers) and entered into agreements with four African countries - Angola, Mozambique, Guinea Bissau and Sao Tome - for technical cooperation in producing AIDS drugs. Several other countries, such as Namibia, Zimbabwe, South Africa, Kenya, Nigeria and Botswana, are importing Brazil's AIDS drugs.

The infection rate remains at a low 0.6 per cent. When millions of suffering people across the South cannot afford to buy AIDS drugs, Brazil has tried to provide them free of cost to the needy people by manufacturing the drugs locally, by investing in public health systems and by mobilising the people.