Brazil’s Survival Plan for HIV

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• SUSAN DENTZER:

  There is the cosmopolitan glamour of Rio de Janeiro, Brazil's cultural capital, and then, just across the bay, there is the far different world of Sao Goncalo. Gloria Pinheiro lives here, in one of the city's slum neighborhoods, in a home that's really an unfinished construction site.

  Pinheiro's husband, Marco, shown here in one of their wedding pictures, was in the midst of building the house when he died in 2000, one month after being diagnosed with AIDS. He told his wife he had acquired the disease through surgery. She says extramarital sexual relations may have been to blame.

  Now Gloria Pinheiro, who's 46 and the mother of two grown daughters, is battling AIDS, too. For a poor person in a developing country, Pinheiro is fortunate. She's being kept alive by a combination of anti-AIDS drugs, known as a cocktail, provided free by the Brazilian government. Without that assistance to her and to thousands of Brazilians with AIDS, the drugs could cost the equivalent of several thousand dollars a year. Pinheiro gets her medications at a nearby public health clinic, where she also goes for free medical care.

• GLORIA PINHEIRO ( Translated ):

  I depend on the medicines that the Brazilian government gives me, and like most of the people with HIV, we're very poor people. We wouldn't be able to survive without that. If we can't even afford food, there is no way we would be able to afford the medication. Imagine us paying for medication.

• SUSAN DENTZER:

  Brazil is a vast country of more than 170 million people, with extremes of wealth and poverty. An estimated 600,000 Brazilians have HIV, the virus that causes AIDS. Since the first cases were seen here in the early 1980s, the government has embarked on an increasingly aggressive effort to treat those with the disease, and further prevent its spread. That effort has included making cheap generic copies of some anti-AIDS drugs, and pressing global pharmaceutical companies for price cuts on other medications. It's also included concerted efforts at prevention, especially through a national campaign encouraging the use of condoms.

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• SUSAN DENTZER:

  To what degree is Brazil a model for other nations battling HIV and AIDS? Many Brazilians told us that their country's responses had been uniquely shaped by their economy, their culture, and their social ideals. That means that they can't be replicated everywhere. But Brazil still does hold lessons for other nations seeking to fight AIDS, on both the treatment and prevention fronts. Dr. Humberto Costa is Brazil's health minister.

• DR. HUMBERTO COSTA, Health Minister, Brazil:

  The big lesson is that we must see this problem as a problem of all the country, all the people. It's a very big health problem, and we must think about education, we must think about promotion, we must think about prevention, we must think about treatment, and we must think about social rehabilitation.

• SUSAN DENTZER:

  Cristina Pimenta is executive director of ABIA, Brazil's leading non- governmental organization fighting AIDS. She says ABIA teamed up with other groups to fight the disease, amid the advent of democracy and the end of military dictatorships here in the 1980s.

• CRISTINA PIMENTA, Executive Director, ABIA:

  Some of the leaders that worked at ABIA then, were people that were coming from the social movement for the re-democratization of the country, and also other leaders of the gay movement and of the women's movement. We started working on the fight for the rights of people even with HIV not to lose their jobs, and then the fight for proper treatment and health services in the country.

• SUSAN DENTZER:

  The new Brazilian constitution guaranteed the right to health care, so a newly created national health system took on the role of caring for AIDS patients. That was a time when little could be done but treating these patients' secondary infections, like pneumonias, or caring for them as they died. All that changed with the widespread use of so-called anti-retroviral drugs starting in the late 1980s. One was zidovudine, known as AZT. At that time in the U.S., a course of therapy on the drug, depending on the dose, could cost anywhere from several thousand dollars to $10,000 a year. Dr. Paolo Teixeira heads Brazil's national program on sexually transmitted diseases and AIDS.

  DR. PAOLO TEIXEIRA, Director, National Program on AIDS: Brazil adopted since 1991 the clear policy that anti- retroviral drugs should be available for everybody, for every citizen, Brazilian citizen, HIV-positive if necessary.

• SUSAN DENTZER:

  By the mid-'90s, international scientific trials had shown that giving patients combinations of these new drugs, or "cocktails," suppressed the AIDS virus and drastically extended patients' lives. But if Brazil were to offer patients those multiple drugs, its outlays for medications would soar.

• DR. PAOLO TEIXEIRA:

  The conclusion was that it would be absolutely impossible to mount this policy buying drugs from big companies and paying the prices they use to… they use to adopt.

• SUSAN DENTZER:

  So the government decided to begin making its own generic versions instead. To do that, it turned to scientists here at the Oswaldo Cruz Foundation, or Fiocruz, a government-sponsored health agency located in Rio. They soon figured out how to produce generic versions of seven anti-retroviral drugs. Today, government labs in Brazil can produce 12. Jorge Lima de Magalhaes is production manager at the pharmaceutical division of Fiocruz. We asked him how he thought pharmaceutical companies had viewed Brazil's entry into AIDS drug production.

• JORGE LIMA DE MAGALHAES, Production Manager, Fiocruz (Translated ):

  I do think they were surprised when they saw a developing country, like Brazil, that could develop this technology to produce these drugs, and that it was being used in a socially responsible way. It wasn't for profit. It was to meet the needs of the Brazilian people and the people sick with AIDS.

• SUSAN DENTZER:

  Patents had expired or were not in effect on the first drugs Brazil produced, so there were no legal constraints against making generic versions. But then other new costly AIDS drugs came on the market; many of them on patent. Quietly, scientists at Fiocruz figured out how to make those drugs, too. Then the Brazilian government issued global pharmaceutical companies an ultimatum: they could continue to sell the patented drugs to Brazil, but only at deeply discounted prices. If not, Brazil would invoke provisions of global trade law that permitted the country to respond to a public health emergency by making the drugs itself. The companies opted to slash prices.

• DR. PAOLO TEIXEIRA:

  The more recent drugs offered by big companies in '99, 2000, and 2001 that were very, very… that were very expensive, after negotiations, have had their prices also cut in between 45 percent to 48 percent and 70 percent, depending on the drug.

• SUSAN DENTZER:

  Experts say the pressure Brazil exerted on pharmaceutical companies helped to spur global momentum for price cuts. That's resulted in AIDS drug prices for poor countries that are now about a tenth of what they were three years ago. Today, an estimated 130,000 Brazilians are deemed in need of anti-retroviral therapy, and are receiving the drugs. A nationwide computer system links clinics and pharmacies around the country, and helps keep track of which drugs patients receive. The results have been impressive. Teixeira says deaths from AIDS in Brazil have dropped 50 percent to 70 percent, saving an estimated 90,000 lives. That in turn has produced savings from lower hospital costs and other treatments.

• DR. PAOLO TEIXEIRA:

  We concluded that we saved a lot of money. We estimate in five years about $2.2 billion saved only in direct consequence of this strategy. Of course, that we spend, on the other hand, almost the same quantity buying drugs and providing treatment.

• SUSAN DENTZER:

  Brazil's experience has also disproved some pessimistic predictions. Some experts have argued that anti-retroviral drug aren't suited for developing nations. They have questioned whether poor people could comply with the arduous drug-taking therapy. But studies have shown that HIV patients in San Paolo, for example, are more likely than residents of Baltimore to stay on drug regimens, and about as likely as AIDS patients in London. Recently, the Brazilian government notified pharmaceutical companies that it would seek still further price cuts, or make more anti- retroviral drugs on its own.

• DR. HUMBERTO COSTA:

  We want to negotiate the prices. But if they are selling drugs for a very big… a very big price, at a very high price, so we do not have another way without start to produce.

• SUSAN DENTZER:

  Meanwhile, Brazil has also begun pilot programs to train health professionals from ten other Latin American and African nations. It hopes to show them how to administer and monitor treatment with anti-retroviral drugs. For Gloria Pinheiro, the drugs remain a lifeline. Here, she rests on a couch in her home after taking her medication. She told us one pill feels like a bomb going off inside her; another burns her throat.

  ( Speaking Portuguese )

• SUSAN DENTZER:

  Still, she's determined the keep the disease in check. With her daughter's help, she's now learning to read so that she can stay up to date on ways to keep herself healthy.