Brazil’s Antiretroviral Drug Strategy Well-Known, Deserves Further Research, Study Says
The provision of free antiretroviral drugs through Brazil's public health system "continues to be one of the best-known parts" of the country's national HIV/AIDS strategy, which also includes education, prevention and monitoring efforts, according to a study published Nov. 5 in the online edition of the Lancet. The Brazilian government has expanded access to antiretroviral drugs through a program involving both the importation and domestic production of AIDS drugs, but the program continues to be "threatened" by the high cost of acquiring these drugs, author Jane Galvao of the Fogarty International AIDS Training Program at the University of California-Berkeley School of Public Health writes. The Brazilian Ministry of Health currently fully subsidizes the cost of providing antiretroviral drugs to all Brazilians with HIV/AIDS -- approximately 105,000 individuals. The government has argued that providing the drugs improves the quality of life of HIV-positive individuals, reduces the number of AIDS-related deaths and reduces the cost of hospital admissions and treatment for opportunistic infections among people with HIV/AIDS.
However, since the distribution of antiretroviral drugs to the public was authorized in 1996 by Brazilian President Fernando Henrique Cardoso, both the number of HIV-positive people in Brazil and the cost of providing the medicines have increased. Government spending on antiretroviral drugs in Brazil has increased from $34 million in 1996 to $232 million in 2001. Brazil procures most of the drugs from domestic manufacturers; by the end of 2001, the country was producing seven of 13 antiretroviral drugs used in Brazil. In 2000 and 2001, 63% of antiretroviral drugs used in the country were produced by domestic firms, while 37% were imported from international pharmaceutical companies. Although Brazil has negotiated with drug makers to obtain lower prices on some AIDS drugs, Galvao says that it is unclear whether the government will be able to continue its bargaining strategies as new drugs arrive on the market and as the number of people needing antiretroviral treatment continues to rise. Brazil's national HIV/AIDS program "warrants further study with respect to its effectiveness, dynamics and sustainability," Galvao states, concluding, "Although local realities could make it difficult to apply the Brazilian model to other countries, much can be learnt from Brazil's experience" (Galvao, Lancet, 11/5).