The provision of free antiretroviral drugs through Brazil's public health system continues to be one of the best-known parts of the country's national HIV strategy, which also includes education, prevention, and monitoring efforts, according to a study published November 5 in the online edition of The Lancet. The Brazilian government has expanded access to antiretrovirals through a program involving both the importation and domestic production of anti-HIV drugs, but the program continues to be threatened by the high cost of acquiring these drugs, writes author Jane Galvao of the Fogarty International AIDS Training Program at the University of California, Berkeley, School of Public Health.
The Brazilian Ministry of Health fully subsidizes the cost of providing antiretrovirals to all Brazilians with HIV--approximately 105,000 individuals. The government has argued that providing the drugs improves the quality of life of HIV-positive individuals, reduces the number of AIDS-related deaths, and reduces the cost of hospital admissions and treatment for opportunistic infections among people with HIV.
However, since the distribution of antiretrovirals to the public was authorized in 1996 by Brazilian president Fernando Henrique Cardoso, both the number of HIV-positive people in Brazil and the cost of providing the medicines have increased. Government spending on antiretrovirals in Brazil has increased from $34 million in 1996 to $232 million in 2001. Brazil procures most of the drugs from domestic manufacturers; by the end of 2001 the country was producing seven of 13 antiretrovirals used in Brazil. In 2000 and 2001 63% of antiretroviral drugs used in the country were produced by domestic firms, while 37% were imported from international pharmaceutical companies. Although Brazil has negotiated with drugmakers to obtain lower prices on some drugs, Galvao says it is unclear whether the government will be able to continue its bargaining strategies as new drugs arrive on the market and as the number of people needing antiretroviral treatment continues to rise.
Brazil's national HIV program "warrants further study with respect to its effectiveness, dynamics, and sustainability," Galvao states, concluding that "although local realities could make it difficult to apply the Brazilian model to other countries, much can be learned from Brazil's experience."