World Bank - June 27, 2003

The Brazilian Government has placed HIV/AIDS prevention and treatment high on its agenda since the first case was identified in 1983. The Brazilian program is unique in that since 1996, federal law mandates the free provision of Anti-Retroviral Therapy (ART) through the public health system. Another unique feature has to do with the role that civil society has played in public AIDS policy.

Despite the important achievements of the program to date, the challenges facing Brazil continue to be substantial. The number of AIDS cases reported has risen from 550 in 1985, to close to 240,000 in mid-2002. In the United States, the only country in the region with more cases than Brazil, close to 363,000 had been reported by 2001 (CDC).

The objectives of the Brazil STD&AIDS Control III Project are to reduce the incidence of STDs and HIV and improve the quality of life for people living with HIV/AIDS by strengthening the effectiveness and efficiency of the national response, and ensuring its sustainability in the medium and long-term. These objectives will be reached by:

(a) expanding the coverage and quality of interventions;

(b) decentralizing the financing and management of program activities to states and municipalities in accordance with current national health policy;

(c) strengthening program management by establishing an effective M&E capacity and instituting the use of management tools, including performance-based management, focusing on more cost-effective interventions and improving their targeting;

(d) introducing technological innovation and upgrading existing technology in treatment and prevention; and

(e) reducing discrimination and stigma associated with HIV/AIDS.

"The project will benefit the general population, and particularly high-risk groups, by reducing their risk of contracting HIV," said Vinod Thomas, World Bank Brazil Country Director. "The project will also benefit people living with HIV/AIDS by improving their quality of life through the provision of ART, care for opportunistic infections and support for human rights issues."

In addition to activities financed via the 27 state fund-to-fund transfers, the population of the 411 municipalities containing 90 percent of AIDS cases will receive additional funding for direct interventions through specific, municipally-managed HIV/AIDS prevention and treatment activities, financed through federal transfers to municipalities. NGO activities will be financed through the state transfers. NGOs working on HIV/AIDS prevention and care will also benefit by receiving training and technical assistance to improve their prospects for sustainability.

To improve the quality of interventions, the project will support technical training for health sector staff and participating NGOs in prevention, reduction of discrimination, and care. To improve the quality of care in the context of the public health system, the project will strengthen the competency of health sector staff, improve the logistics for the supply of drugs and supplies, upgrade medical equipment and infrastructure where necessary, and strengthen the laboratory network for diagnosis and patient follow-up to reduce waiting time for diagnostic test results.

Coverage of prevention activities will be further extended by working in close partnership with other programs. The amount of funding for NGO subprojects will be increased to expand activities in specific populations. Mass media campaigns will address specific issues and target groups. Access to free condoms will also be increased augmenting the federal government's contribution by ensuring states contribute to 10-20 percent of their needs each year, and through the introduction of a social marketing program for condoms. In treatment and care, access to STD diagnosis and treatment will be expanded, and HIV counseling and testing will be integrated into TB programs.

The project will improve the targeting of interventions by regularly obtaining and analyzing data to determine which populations are affected and where they are located. Strengthening prevention in counseling, treatment and care facilities will reduce risky behavior amongst people living with HIV/AIDS.

The total project cost is $200 million, of which the World Bank will finance $100 million and the Government of Brazil will provide counterpart funding of $100 million.

The World Bank has provided financing in the amount of approximately US$330 million throughout the life of the program, first as a component in an endemic disease control project, and through two loans. The first loan approved in 1993 for US$160 million was designed to test and implement the main strategies to address the epidemic, and the second, approved in 1998 for US$165 million was to expand and consolidate its response. While the focus has been on prevention, the second loan provided the necessary support in training, research, equipment and protocol development for the provision of HAART.

This variable-spread US$ dollar has a repayment period of 15 years, including five years of grace.

Contact:

In Washington - Angela Furtado (202) 473 1909

e-mail: Afurtado@worldbank.org

For more information on this project, please visit:

http://www4.worldbank.org/sprojects/Project.asp?pid=P070827

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