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| DR. PAOLO TEIXEIRA | |
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The director of the Brazilian Ministry of Health's national STDs and AIDS programs talks to Susan Dentzer about his country efforts to treat those infected with HIV. The NewsHour Health Unit is funded by a grant from The Henry J. Kaiser Family Foundation.
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SUSAN DENTZER: So let's go back then to early '80s [when the first AIDS cases were diagnosed in Brazil.] What was the environment at that time?
So one group from the community, homosexual liberation groups leaders, asked to the secretary of health to develop an AIDS program and to propose some kind of intervention. And it's important to say that at this moment we recognized only four cases... Considering these three situations [in Brazil in the early 1980s] -- democratization, public health movement, and the community based movement, we have had a very favorable scenario to make the state really responsible, even considering that the situation was at the very beginning, to include in the first proposal of the program we in fact created a program... human rights, protection of minorities, free access to all the resources and so on. And this, in my understanding, has been responsible for many progress we have had so in this last 20 years. |
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| Brazil guarantees access to treatment | |||||||||||||||||||||||||||||
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SUSAN DENTZER: In 1996 Brazil made a very crucial decision about treatment. Explain again for me what that was.
It has meant to Brazil that it would be ... to adopt their new recommendation, but also that we want to triplicate the amount of money necessary to provide drugs. And the conclusion was that it would be absolutely impossible to mount in this policy buying drugs from big companies and paying the prices they use to adopt. Based upon this proposal, the decision of the Brazilian government has been to make investments in the generic production of these anti-retrovirals as generic drugs, and we started early in '97-'98 to incorporate drugs produced in Brazil. Later, this generated some problem with big companies and some governments from ... particularly because the first drugs we used were not under patent protection... And then there has been inaugurated another period after generic production that was the negotiation with the big companies, using the possibility of producing as generics, but adopting compulsory license, or having good negotiations with the companies. And we are in this process the last almost four or five years, and I think that we will have a lot of negotiating in the future to maintain this process. Everything is ... everything was just to guarantee the universal access and free-of-charge access to ARV treatment for everybody in Brazil. |
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| Keeping down the cost of treatment | |||||||||||||||||||||||||||||
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DR. PAOLO TEIXEIRA: It has been fantastic. Drugs we produced as generics, after two, three years, have had their prices cut by 85 percent. The more recent drugs offered by big companies in 1999, 2000, and 2001 that were very expensive, after negotiations and considerations about the possibility of compulsory licenses, have had their price also cut in between 45-48 percent and 70 percent, depending on the drug... The commitment -- the Brazilian commitment is to provide all the available drugs - available worldwide, and we know that each year we will have one or two new drugs costing a lot. So all this process of trying to produce negotiation with big companies and also negotiation about intellectual property agreements in general ... is for us a daily process, and we understand that this will have to maintain all this process for many years in the future. SUSAN DENTZER: Tell me exactly what has resulted in the decline in mortality, the decline in hospitalization, and the savings that have accrued.
Second, the rate of hospitalization has decreased from 1.6 for each patient in one year to 0.22, 0.23 -- that means almost everybody is receiving their treatment in an ambulatory structure, and we have many other indicators. For example, we have data showing that the number of retirements in consequence of AIDS decreased very, very strongly. The unemployment has been reduced and so on. And finally, that was not the first intention, but in consequence of all these, not spending money ... for ... [treating] infections, not spending money on hospitalization, and so on, I mean, direct costs of health assistance, we concluded that we saved a lot of money. We estimate in five years about $2.2 billion dollars saved [as a] direct consequence of this strategy. Of course, we spend on the other hand, almost the same quantity buying drugs and providing treatment, but in fact, it is a clear, very good cost-benefit relation, and this observation has been vital for us too, as a new argument that was not expected before, but a new argument that is very, very important to facilitate the expansion of the access to treatment, and not only to maintain Brazil, but also in other countries, particularly developing countries. |
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| Different approaches to HIV prevention | |||||||||||||||||||||||||||||
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SUSAN DENTZER: On prevention, much of the emphasis has been encouraging the use of condoms, which, of course, is a very controversial matter in the United States, and even now in discussions about global initiative. Behind that seems to be a much greater acceptance of human sexuality than perhaps is the case, certainly in the United States. What is the Brazilian understanding of human sexuality, and how that must fit into prevention approaches on HIV AIDS?
Of course, we have had for this time some authorities from the church saying that no, that was not the rule. But in general, they run a lot of projects of intervention, of prevention -- the church and Catholic organizations, and almost all of them included the promotion of safe sex ... So it is a Brazilian privilege, yes. |
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| A model for the rest of the world? | |||||||||||||||||||||||||||||
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DR. PAOLO TEIXEIRA: That's right. Actually, Brazil has a consistent and aggressive policy, and I'm sure that our experience can be used as a model in other developing countries. There is one special aspect that stands out in the Brazilian party. We work together with prevention, treatment, and human rights, and that's what developed. SUSAN DENTZER: Brazil has announced again recently that it seeks further price reductions in three particular anti-retroviral drugs ... and that it also has the capacity to make those drugs itself, which is, of course, the hammer that has been used in these negotiations previously. What is the state of those negotiations? Is Brazil likely to achieve further price cuts, and if not, will you, in fact, produce those drugs? This policy is very clear. The first component is to negotiate, and the second component is to assess the possibility of producing them here. There is no secret the price is not good now, and the strategy is to -- if we don't get a good price, we can ask for compulsory alliance or permission. SUSAN DENTZER: We have heard some reports as we have gone around from place to place about at least some degree of, for lack of a better word, corruption involving the anti-viral drug distribution system, that some drugs are being siphoned off for sale to other countries, that some individuals may be committing fraud against the system by getting extra prescriptions filled and selling those. To what degree do you believe that is a problem, and if so, what is the agency doing about it?
Actually, we know that these drugs are not obtained by having a double prescription. Actually, we know that some patients are selling their own drugs, and it's a very serious problem, because their health will be harmed. We have some legal proceedings in order to investigate and avoid those procedures, but our major concern is the health of the patients. |
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DR.
PAOLO TEIXEIRA: Well, first, we heard about the AIDS case at the end
of '82 and at the beginning of '83... 
DR.
PAOLO TEIXEIRA: Well, Brazil adopted since '91 the clear [inaudible]
that anti-retroviral drugs should be available for everybody, for every
Brazilian citizen ... And then in '96 ... at the International AIDS
Conference, a very clear and strong recommendation about the adoption
of combined therapy, triple therapy [was presented.]
SUSAN
DENTZER: Give me a sense of how the prices have fallen now for the average
patient on a per year basis.
DR.
PAOLO TEIXEIRA: Yes, after about five years using triple therapy, or
combined therapy, we started to see very, very clear results ... of
this policy. The first one that was the decrease of mortality. We have
had different situations in some regions of Brazil, but the average
decrease was about 50 percent. In some areas it has been 70 percent
and this is fantastic. It means more than 80,000 lives saved in that
very short period.
DR.
PAOLO TEIXEIRA: ...[Y]es, we have to recognize that the Brazilian context
is more flexible, the Brazilian culture is more tolerant in talking
about sex and sex behavior, is not considered aggressive by people in
general, and that has allowed us to develop all of these forces year
by year, until the situation where everybody accepts these strategies,
particularly considering the very clear effects that safe sex can have
in the expansion of the HIV AIDS epidemic. And it is very important
to observe also that even the Catholic Church that adopted some very
conservative positions in many countries, in Brazil has been very favorable
to all the governmental NGOs interventions, including that involved
the promotion of condoms.
SUSAN
DENTZER: Does [your recent award from the Global Health Council] not
also signify that Brazil is now being held up as an example of how developing
nations may attack this problem? 
DR.
PAOLO TEIXEIRA: It's clear in the Brazilian public that we have to negotiate
the price of the three drugs. We know that the price should be lower.
DR.
PAOLO TEIXEIRA: We also have that information, but we know that this
production is very, very little, so nothing comparing to the total production.
So actually we have that information, but we know that this production
is nothing, just so minimal that it's actually nothing comparing to
the total production of drugs.