Inter Press Service - November 30, 2004
Mario Osava

The process of compulsory licensing will be completed in the first half of 2005, in order for the country to begin domestic production of "between three and five" of the antiretroviral drugs that are currently imported at "excessively high prices," said Pedro Chequer, coordinator of the Health Ministry's programme on Sexually Transmitted Diseases and AIDS.

Under Brazilian law, patents can be disregarded in case of health emergencies, like the AIDS epidemic.

This is known as "compulsory licensing", which gained recognition by the World Trade Organisation (WTO) after a Brazilian-led campaign by a number of developing countries and international non-governmental organisations.

But the government would also accept voluntary licensing by the patent-holders, added Chequer.

The aim is to produce the drugs in question in Brazil, and the government has laboratories that are equipped to do so, said the official.

The objective is to reduce costs, to guarantee the survival of the programme that makes antiretroviral drugs universally available free of charge in this country of nearly 180 million, said Chequer.

Antiretroviral drugs slow down the development of the disease and lengthen the lifespan of those living with HIV/AIDS.

The prices charged by the transnational pharmaceutical companies are excessively high and are threatening Brazil's AIDS programme, he said.

Five or six years ago, 50 percent of the programme's budget went towards importing those drugs that Brazil does not produce, but that proportion has climbed to 80 percent today, and continues rising, the official pointed out.

The government currently distributes 15 different antiretroviral drugs to 151,000 people living with HIV/AIDS, at a cost of 567 million reals (200 million dollars) this year, as part of the Health Ministry programme that is internationally regarded as a model to be emulated.

Several countries in South America have similar programmes, including Argentina and Uruguay.

Most of the antiretroviral drugs made available in Brazil are of low cost, because they are not protected by patents (generics), are produced nationally, or were purchased at a significant discount negotiated with foreign pharmaceutical manufacturers.

In the past few years, the Health Ministry has used the tactic of negotiating discounts, sometimes by threatening to break patents. Some of the antiretroviral medicines are purchased today at less than half of the original price.

But the inclusion of new drugs needed for treating AIDS patients with different needs and reactions, or due to the growing resistance of HIV to the existing drugs, has led to an increase in imports and driven up the costs of the programme.

Chequer, who has headed the programme for the past three months, believes the option of negotiating price reductions has been exhausted.

If the country does not produce these medications itself, it remains a hostage to imports, which endangers the programme, he said, stressing that this time Brazil is not merely making threats to obtain larger price cuts.

Brazil already pays lower prices than those charged in industrialised countries for antiretroviral drugs, and it cannot expect to achieve the subsidised prices that the drug giants offer in Africa, because the conditions are different, argued Gabriel Tannus, president of Interfarma, Brazil's pharmaceutical manufacturers association, in an interview with the daily newspaper Folha de Sao Paulo.

Tannus also warned of a risk that domestically produced drugs could be of poor quality, as is apparently the case with several generic medications in India.

Three pharmaceutical companies in that country have stopped producing generic antiretrovirals, after the World Health Organisation (WHO) found flaws in the tests carried out to determine whether they were as effective as the original drugs produced by the patent-holders.

On Tuesday, the day before World AIDS Day, Chequer released Brazil's annual epidemiological bulletin, which shows that the number of new cases of HIV/AIDS is levelling off, although infection rates are on the rise among women, blacks and mixed-race Brazilians, and the poor.

Of the 362,364 cases recorded from 1980 to June 2004, men account for 69.3 percent. However, women represent a growing proportion of cases. Last year, one woman was infected for every 1.5 men, compared to one per 3.5 ten years ago.

A total of 18,457 men were newly diagnosed with the disease in 1999 and 19,648 in 2003, compared to 9,948 and 12,599 women, respectively.

For the first time, the rate of HIV/AIDS among Brazilians of African descent (those who are included in the categories of "black" and "brown" in the Brazilian census) was reported.

This sector of the population accounted for 33.2 percent of men living with HIV/AIDS in Brazil in 2000 and 37.3 percent last year. Among women, that proportion rose from 35.6 percent to 39.4 percent in the same period.

Poverty and low educational levels are decisive factors in the spread of the epidemic among some population groups, like blacks and mixed-race Brazilians and the poor, said Chequer.

But among other high-risk groups, like gays and intravenous drug-users, infection rates are dropping, he added.

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+ Health Ministry AIDS Programme - in Portuguese (http://www.aids.gov.br)

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