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Navigating Challenges, Brazil Steps Up AIDS Response

Elizabeth Whitman

UNITED NATIONS, Jun 25 2011 (IPS) - Long heralded as a model for the global response to HIV/AIDS, Brazil is intensifying its actions, at home and abroad, in the face of potential setbacks including an arising need for new treatment regimens, the resultant increase in drug prices and the debate over intellectual property rights.

Not only has the government set human rights at the core of its public health system, committing itself to universal treatment access for persons living with HIV, but it has also challenged aspects of global international property provisions, which in other countries have hindered access to the affordable generic drugs that have been so crucial to Brazil’s success.

According to the Brazilian Ministry of Health, the infection rate in Brazil has remained stable since 2003, and the mortality rate stabilised in 1998. Last year 630,000 in the country were estimated to be infected with HIV.

Much of Brazil’s achievement in stabilising the epidemic has been attributed to the government’s providing free universal access to antiretroviral (ARV) drugs that reduce the amount of HIV virus in the body, delaying the onset of AIDS. Most recently, ARVs were shown to reduce transmission of HIV by 96 percent. The free treatment reaches about 210,000 citizens in Brazil today.

New measures

Recently, the Brazilian government announced that it would donate two dollars to the UNITAID treatment access coalition for every passenger flying abroad. Travelers themselves have the option of donating that amount to the government. The money will to go to developing countries, particularly in sub-Saharan Africa, to fight AIDS.

Alexandre Padilha, Brazil’s minister of health, told IPS that this year, his country has also been trying to strengthen its response by focusing on women and youth, particularly with education campaigns regarding violence against women.

“Our public programmes are very closely connected to youth and women nowadays,” he said in an interview. They specifically target young women and girls, “empowering them to ask for the use of condoms,” he added.

Moreover, many youth “lack awareness of the risks of infections and the risk of HIV/AIDS, so we are trying to reinforce among youth the importance of the use of condoms and the importance of safe sex.”

On an industrial front, Brazil established a state-owned condom factory in 2008. It uses latex from native rubber trees, thus offering an option for HIV prevention that is both sustainable and economically beneficial to the country.

Intellectual property debates and generic drugs

Brazil’s success in stymieing new infections and reducing vertical (mother to child) transmission rates can also be attributed to its aggressive campaign for affordable generic drugs, whose production and accessibility have been complicated by intellectual property right laws.

Generic drugs worldwide have played a significant role in HIV treatment because they are more affordable than brand-name drugs. They have also served as competition to bring down the price of non- generics.

The problem is that developed countries with corporations that hold patents for ARV medicines have often resisted the production of generic rugs by pushing for stricter intellectual property rights, such as longer patent terms, in free trade agreements and other negotiations.

But a study conducted by Oxfam on a free trade agreement between the U.S. and Jordan concluded that the TRIPS-plus rules in the agreement had contributed to increases in medicine prices, and that the rules “will delay or prevent use of public health safeguards to reduce he price of new medicines in the future.”

Developing countries less able to afford expensive brand name drugs have pushed back, taking advantage of flexibilities – fairly and legally – within the World Trade Organization’s Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement. One of the flexibilities allows governments to issue compulsory licenses to manufacture or import generic versions of drugs for public health purposes.

Brazil has been a leader in taking advantage of these flexibilities, and its efforts have paid off. In the early 2000s, a WTO panel ruled that for the Brazilian government to allow Brazilian firms to copy patented foreign pharmaceutical products and sell them as generics was acceptable, and did not violate the TRIPS agreement, according to Roy Nelson, associate professor at the Thunderbird School of Global Management.

The European Union and the United States have fought most diligently for stricter intellectual property rights, known as TRIPS plus provisions. TRIPS plus provisions were a hot topic of debate during the High Level Meeting on AIDS held at the United Nations in New York at the beginning of this month.

These additional restrictions have proved a stumbling block in other arenas as well. Specifically, free trade negotiations between the EU and Mercosur, a bloc of Latin American countries, stalled yet again last week.

According to Scripintelligence, a news, analysis, and data provider for the pharmaceutical industry, and MercoPress, a South Atlantic news agency, Mercosur countries, Brazil included, are reluctant to accept EU demands for stricter patent rights, although this concern was not the only cause reason negotiations failed to proceed.

“Negotiations between Mercosur and the EU to suspend tariff and nontariff barriers between the economic blocs may inhibit local production of drugs, especially generics,” Padilha told IPS. In order to ensure the affordability of HIV/AIDS drugs, the Brazilian government, he said, “adopts strategies for negotiating prices” with companies holding drug patents.

Brazil respects intellectual property, he insisted, “But we defend that intellectual property laws have to be compliant to help public health priority.”

Rohit Malpani, senior policy advisor for Oxfam America, told IPS, “Brazil and all developing countries are facing enormous challenges to provide affordable access to anti-retroviral treatment.”

Not only must the government continue providing care while simultaneously expanding access to treatment, he said, but existing patients will also eventually have to switch to more expensive second and third line ARVs, boosting expenses further.

“Brazil must continue to use flexibilities to reduce the costs of these medicines even as the country continues to evolve into a wealthier, emerging market country,” he concluded.

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