Northern Health Region, Virginia HIV/AIDS and STD Trends Data through 2006.
1 The National Response to HIV/AIDS in Brazil Brazilian STD/AIDS Program Ministry of Health.
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Transcript of 1 The National Response to HIV/AIDS in Brazil Brazilian STD/AIDS Program Ministry of Health.
1
The National Response to HIV/AIDS in Brazil
Brazilian STD/AIDS ProgramMinistry of Health
2
• Population (2005) – 185 mln
• Federative Republic with 27 States
• Municipalities - 5,561
• Territory: 8,5 mln sq km
• GNP (2004) US$ 750 bi
• Per capita GNP (2004) - US$ 4,041
• HDI Rank (2005) - 63th (0.792)
Country Profile
3
• Accumulated AIDS cases (06/2005): 371,827
• AIDS incidence rate (2004): 17,2/100,000 inhabitants
• Estimated n. of PLWHA (2004): around 600,000
• Prevalence: (15 to 49 years of age)
•2000: 0.61%
•2004: 0.61%
• Aids deaths (1980-2004): 171,923
• Mortality rate: 6,1/100,000 (2004) inhabitants
Epidemiological Profile
4
Current epidemiological trends
Relative stabilization,
-decreasing: southeast, MSM, IDU
-Stabilized: big cities
Increasingly affecting:
- Heterosexuals
- Women
- Low-income groups
- Smaller cities
5
Total investment in STD/AIDS control program by the Federal Government. Brazil, 1997-2005
Total investment in STD/AIDS control program by the Federal Government. Brazil, 1997-2005
Source: PN STD-AIDS//MOH
11%
89%
National budget
World Bank Loan
Average investment per year:
US$ 400 MILLION
1997 to date: US$ 3.5 billion (HIV response)US$ 2 billion for ART
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Major features of theBrazilian ResponseMajor features of theBrazilian Response
Country-driven approach: Social Control: robust participation by civil society
in decision making and implementation
Balanced prevention and treatment approach
Comprehensive ethical and rights-based approach
Early response by government (since 1983)
Multi-sectoral mobilization
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The 1988 Brazilian Constitution: access to
health is a basic right Main precepts:
- comprehensive approach
- universal access and equity
- civil society participation
Key feature: decentralization Virtuous circle (AIDS Programmes Public Health
System)
The “backbone” of the BrazilianResponse: the Public Health SystemThe “backbone” of the BrazilianResponse: the Public Health System
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• Expand access to prevention commodities (male/female condoms, lubricating gel, harm reduction supplies)
• Extend joint activities with CSO’s, CBO’s, uniformed services, social movements and other government programs
• Implement education programs throughout the public school system at all levels
• Increase coverage in poorest areas, emphasizing counselling and testing through the primary health system
Prevention FrameworkPrevention Framework
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Regular condom use (last 12 mo.)among those aged 16-65 (2005)Regular condom use (last 12 mo.)among those aged 16-65 (2005)
35,4%
23,9%
0%
5%
10%
15%
20%
25%
30%
35%
40%
1998 2005Fonte: Pesquisa CEBRAP, 2005.
10
0
20000
40000
60000
80000
100000
120000
140000
160000
180000
jan
/97
abr/
97
jul/9
7
ou
t/97
jan
/98
abr/
98
jul/9
8
ou
t/98
jan
/99
abr/
99
jul/9
9
ou
t/99
jan
/00
abr/
00
jul/0
0
ou
t/00
jan
/01
abr/
01
jul/0
1
ou
t/01
jan
/02
abr/
02
jul/0
2
ou
t/02
jan
/03
abr/
03
jul/0
3
ou
t/03
jan
/04
abr/
04
jul/0
4
ou
t/04
jan
/05
abr/
05
jul/0
5
ou
t/05
170.000
* Dados preliminares
Projected
Number of patients receiving ARV therapy (1997 – 2005)
11
Average cost of ARV therapy per patient/year (US$). Brazil, 2005
Average cost of ARV therapy per patient/year (US$). Brazil, 2005
6240
5486
4603
3464
2210
1500 1359 1336
2500
0
1000
2000
3000
4000
5000
6000
7000
1997 1998 1999 2000 2001 2002 2003 2004 2005*
Year
Th
ou
san
ds
(US
$)
Introduction of expensive new ARVs• Substantial falls in prices of
second-line patented drugs have ceased
•Number of people using them has increased dramatically
12*Brazilian local production
RITONAVIR (1996)* SAQUINAVIR (1996)* INDINAVIR (1997)* NELFINAVIR (1998) AMPRENAVIR (2001) LOPINAVIR/r (2002) ATAZANAVIR (2004)
ZIDOVUDINE (1993)* ESTAVUDINE (1997)* DIDANOSINE (1998)* LAMIVUDINE (1999)* ABACAVIR (2001)
DIDANOSINE EC (2005)
TENOFOVIR (2003)
NEVIRAPINE (2001)* EFAVIRENZ (1999)
ITRN and ITRNt
ENFUVIRTIDE (2005)
IP
FUSION INHIBITORITRNN
Antiretroviral drugs distributed through the Brazilian public health system (and year of introduction)
Antiretroviral drugs distributed through the Brazilian public health system (and year of introduction)
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Aids Incidence and mortality rates (by 100,000 inhabitants) Brazil, 1986-2004.
* SINAN and SISCEL AIDS cases reported through june 2005.Source: Aids: MS/SVS/PN-DST/AIDS Mortality: MS/SVS/SIM.
86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04
ano
0
5
10
15
20rates
Mortality Aids
14
Total number and estimated value of hospitalizations averted (non-cumulative figures)
Total number and estimated value of hospitalizations averted (non-cumulative figures)
Estimated value of hospitalizations avoided Estimated number of hospitalizations avoided
$0.00
$100,000,000.00
$200,000,000.00
$300,000,000.00
$400,000,000.00
$500,000,000.00
$600,000,000.00
1997 1998 1999 2000 2001 2002 2003 2004
Exp
end
itu
res
(in
US
$)
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
Nu
mb
er o
f h
osp
ital
izat
ion
s
Total:
Hospitalizations avoided: 791,069
Total savings: US$ $2,289,654,584
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South-South Cooperation: Network for Technological Cooperation in HIV/AIDS
South-South Cooperation: Network for Technological Cooperation in HIV/AIDS
Launched in 2004, involving Argentina, Brazil, China, Cuba, Nigeria, Russia, Thailand and Ukraine
Key support provided by the Ford Foundation: US$ 1 million
Objectives: technology transfer, R&D and production:- antiretrovirals - vaccines and microbycides- condoms- laboratory supplies
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The GCTH – Group for Horizontal
Technical Cooperation.
Launched in 1995 to establish direct cooperation between the Latin American and Caribbean State Governments on HIV and AIDS control and prevention.
Objectives:
- Reference for building up regional statements for International Events.
- Courses , Conferences and Forums. - Development of the Price Bank. - Development of web-page and improvement of electronic
communication.
17
Other South-South Cooperation InitiativesOther South-South Cooperation Initiatives
Technical Areas:
Institutional development, management and capacity building
Care and support
Clinical management
Antiretroviral logistics and management
Epidemiological surveillance
Promotion of safer sexual practices
Promotion of human rights
Advocacy and Civil Society participation
Care and support for HIV+ pregnant women and children exposed to HIV
18
International Cooperation with Developed CountriesInternational Cooperation with Developed Countries
Institutions involved:
ANRS (France), CDC, USAID, Ford, GTZ, DFID
United Nations :UNAIDS, UNFPA, UNICEF, UNODC, UNESCO, ILO,
Thematic areas:
Monitoring and Evaluation;Promotion of safer sexual practicesPromotion of human rightsAdvocacy and Civil Society participationScientific and technological development
19
International Center for Technical Cooperation: a Joint Brazil/UNAIDS Initiative
International Center for Technical Cooperation: a Joint Brazil/UNAIDS Initiative
Created in 2005, the ICTC aims to create and strengthen national technical capabilities for implementing comprehensive AIDS responses through horizontal technical cooperation;
Example of activities undertaken: Coordination of technical missions in Honduras, Nicaragua, Peru,
Ecuador and Bolivia Identification of technical assistance needs of Latin American
countries receiving financial support from the Global Fund
Total investments: Brazilian Government (US$ 500,000), UNAIDS (US$ 500,000),
DFID (£ 250,000 - under negotiation), GTZ (€ 250,000 – under negotiation)
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Challenges: to develop new technologies and systems to halt spread
of the HIV/AIDS epidemic
Challenges: to develop new technologies and systems to halt spread
of the HIV/AIDS epidemic Technologies: Prevention (e.g., microbycides, etc)Treatment and care (e.g., new FDCs)Vaccine
Systems:Monitoring and Evaluation and Operational ResearchPersonnel (health and management)Management
21
Brazil’s Recommendations to the 2006 UNGASS
• Universal Access to Prevention, Treatment, Care and Support: “We recognize the importance of intellectual property rights. But no right of a commercial nature can be upheld to the detriment of the right to life and health.” Ambassador Celso Amorim, UNGASS 2006.
• Prevention: “Individual moral values, respectable as they are, cannot be the basis of public health policies. Prevention must reach vulnerable groups – homosexuals, drug users and sex workers(…)” C.A. 2006
• Finance: “Donors must increase the amount of resources available so that health systems can be strengthened (…) Africa is the region that has been most affected. It should continue to deserve priority attention.” C.A. 2006