Inter Press Service - March 23, 2006
Felipe Seligman and Juliana Lara Resende

"The government campaign in Brazil is straightforward, like nowhere else in Latin America," said Frederico Meyer, a minister at the Permanent Mission of Brazil to the United Nations.

He told IPS that the country's health ministry consistently supports educational campaigns stressing the importance of condom use by everyone, including women and youth.

By contrast, in Argentina, condom advertisements were forbidden a few years ago. But even in an open culture such as in Brazil, stigmas persist. Earlier this month, a condom advertising campaign that portrayed two men kissing each other was removed from the streets by a Brazilian non-governmental organisation calling itself the Self-Regulation Advertising Council.

According to the U.N. Population Fund, condoms "are the only effective means of protecting sexually active people from HIV infection". And Brazil's AIDS programme, which includes the distribution of condoms and affordable anti-retroviral drugs, is being described as the most successful in the developing world.

Other countries do have similar programmes. In China, whose population is 1.3 billion, the national family planning system offers 1.2 billion condoms per year, according to the Permanent Mission of China to U.N.

But in many African nations, the number of condoms distributed is erratic. In Nigeria, 14 million condoms were distributed in 1992, and the number rapidly increased to 227 million, but after that it declined to 68 million in 1998.

In India, only a quarter of the 1.5 billion condoms manufactured each year are appropriately utilised, according to an investigation by an Indian newspaper, The Telegraph.

It said that 200,000 condoms are used for purposes other than fighting AIDS and preventing conception -- for example, by weavers to lubricate looms and polish gold and silver thread used to embroider the saris they produce.

Brazil has been handing out free condoms for over a decade. In 2003, it distributed 259 million condoms, many imported from China and India at a cost of two cents each -- a price that, according to Pedro Chequer, director of the Brazilian STD/AIDS National Programme, "is impossible to achieve inside the country".

The government has also steadfastly adhered to a policy of engaging with so-called "high risk" groups, refusing 40 million dollars in U.S. grants last year because of a new requirement that HIV/AIDS groups seeking funding to provide services in other countries must pledge to oppose commercial sex work.

HIV prevalence among adults in Brazil, whose population is about 187 million, is 0.7 percent, according to the U.N. However, as UNAIDS and the World Health Organisation (WHO) reported last year, Brazil's achievements remain unique in Latin America.

Meyer told IPS the most important difference between Brazil and other countries is that the government views antiretroviral (ARV) drugs access as a human right. It spent 1.8 billion on ARV medications between 1996 and 2002. In the same period, the Brazilian government saved more than 2.2 billion dollars in treating people with HIV who might have been hospitalised with opportunistic diseases.

But Luiz Loures, director of Global Initiatives at UNAIDS, notes that in general, access to generic drugs "is much more difficult today than five years ago".

This has led to a long-running dispute between Brazil and the United States, where many of the large pharmaceutical companies that produce AIDS drugs are based. By threatening to issue so-called "compulsory licenses" that would allow local generic production of patented drugs, Brazil has been able to buy ARV drugs at a far lower cost.

"The costs of ARV treatment per person vary around 500 dollars in Brazil, while in Mexico, for example, it may come to 5,000 dollars," Meyer said. The government's negotiating tactic allowed 170,000 Brazilians to be treated last year.

Still, "the patents must be broken as soon as possible in order to guarantee the sustainability of the programme", Chequer told IPS. "This is not just one more goal, this is a necessity."

According to a Brazilian Health Ministry document, 100 million dollars would be saved by 2011 if Brazil were allowed to manufacture just three of the patented ARV medicines -- Efavirenz, Lopinavir and Tenofovir.

Meanwhile, the inclusion of civil society in making decisions, both through NGOs -- there are more than 600 dealing with HIV in Brazil -- and people living with HIV/AIDS, seems to have helped eliminate the social stigma surrounding the disease. "If it is for saving someone's life, it doesn't matter who it is," said Meyer.

Between 1998 and 2001, the Brazilian government gave civil society organisations nearly 30 million dollars to carry out prevention programmes. This NGO network plays a key role in the distribution of condoms and sterile syringes.

The UNAIDS/WHO 2005 AIDS Epidemic Update reported that injecting drug use is a major factor in Brazil's epidemic. In some areas, it accounts for at least half of AIDS cases. However, the report also shows that three-quarters of the estimated 200,000 drug injectors in Brazil now use sterile syringes. By contrast, injecting drug use is still providing "impetus to the spread of HIV" in Argentina.

Since 1981, HIV/AIDS has killed more than 25 million people around the world. A report by U.N. Secretary-General Kofi Annan last month called it one of the most destructive epidemics in history. The total number of people living with HIV/AIDS has now reached 40.3 million.

Some 2.2 million women infected with HIV give birth each year, and a considerable number of new infections are hitting young people between the ages of 15 and 24, and infants.

In Brazil, according to UNAIDS and WHO, some 600,000 people are living with HIV, representing more than a third of the total number of people living with HIV in Latin America. But thanks to intensive prevention efforts, it is still half the number the World Bank predicted a decade ago.

After Sub-Saharan Africa and South and Southeast Asia, Latin America has one of the most severe epidemics, together with Eastern Europe and Central Asia. The number of new infections in the region rose from 150,000 in 2000 to approximately 240,000 in 2004.

But with a single exception -- husband-to-wife transmission -- all Brazilian indicators are stable or declined over the last few years. The number of deaths has been cut in half, according to the Brazilian Mission to the United Nations. Hospitalisation rates decreased 70 percent between 1998 and 2004, and the average survival rate after diagnosis has risen from five months to nearly five years, UNAIDS reports.

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+UNAIDS (http://unaids.org/en/)

+Brazilian STD/AIDS National Programme (http://www.aids.gov.br/)

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