The Politics and History of AIDS Treatment in Brazil

The Politics and History of AIDS Treatment in Brazil Amy Nunn, Center for AIDS Research, Brown University Medical School, Providence In 1992, the World Bank warned that Brazil would face enormous challenges confronting the AIDS crisis, and forecast that Brazil would have 1.2 million people living with HIV by the year 2000. Today, AIDS prevalence in Brazil is approximately 660,000, and Brazil is home to the oldest and one of the largest public AIDS treatment programs in the developing world. Challenging the conventional wisdom that AIDS treatment was infeasible in developing countries, Brazil has halved AIDS-related deaths and dramatically reduced AIDS-related morbidity. Today, Brazil’s AIDS program is considered a global model. The first book to narrate Brazil’s complex and inspiring history, __The Politics and History of AIDS Treatment in Brazil__ traces development of Brazil’s AIDS treatment policies during the country’s tumultuous path to democracy as its government redefined access to health care as a basic right. Meticulously researched, and drawing on dozens of interviews with politicians, activists, people living with HIV/AIDS, pharmaceutical executives and health care providers, this profound volume explains the key role of Brazil in raising global AIDS consciousness. __The Politics and History of AIDS Treatment in Brazil__ also explores the global implications of Brazil’s program and identifies the challenges ahead for addressing HIV/AIDS in the developing world. In clear, accessible detail, The Politics and History of AIDS Treatment in Brazil examines: * Brazil’s long history of AIDS treatment in the context of progressive social movements. * The coalition-building between politicians, activists and government agencies in developing the country’s National AIDS Program. * The role of the executive, legislative and judicial branches of government in promoting access to drugs for AIDS treatment in Brazil. * The government’s controversial decisions to produce generic AIDS drugs and challenge multinational pharmaceutical corporations regarding AIDS drug prices. * Brazil’s ongoing efforts to promote global access to AIDS treatment and the country’s contributions to international health, human rights, and trade law related to access to medicines. * The impact of the Brazilian experience on global AIDS drug prices and global AIDS treatment policy. The Politics and History of AIDS Treatment in Brazil contains invaluable lessons for readers across disciplines, particularly researchers and practitioners in health policy, global health, HIV/AIDS, political science, and Latin American studies. "This is an exceptional academic work, one that deserves to be widely read, and that in my opinion will come to be considered the leading historical study on the social and policy response to the HIV/AIDS epidemic in Brazil – and one of the major policy studies on the response to the AIDS epidemic anywhere in the world." Richard Parker, Mailman School of Public Health, Columbia University With foreword by former Brazilian President Fernando Cardoso. Annotation The Politics and History of AIDS Treatment in Brazil Amy Nunn, Center for AIDS Research, Brown University Medical School, Providence In 1992, the World Bank warned that Brazil would face enormous challenges confronting the AIDS crisis, and forecast that Brazil would have 1.2 million people living with HIV by the year 2000. Today, AIDS prevalence in Brazil is approximately 660,000, and Brazil is home to the oldest and one of the largest public AIDS treatment programs in the developing world. Challenging the conventional wisdom that AIDS treatment was infeasible in developing countries, Brazil has halved AIDS-related deaths and dramatically reduced AIDS-related morbidity. Today, Brazil s AIDS program is considered a global model. The first book to narrate Brazil s complex and inspiring history, The Politics and History of AIDS Treatment in Brazil traces development of Brazil s AIDS treatment policies during the country s tumultuous path to democracy as its government redefined access to health care as a basic right. Meticulously researched, and drawing on dozens of interviews with politicians, activists, people living with HIV/AIDS, pharmaceutical executives and health care providers, this profound volume explains the key role of Brazil in raising global AIDS consciousness. The Politics and History of AIDS Treatment in Brazil also explores the global implications of Brazil s program and identifies the challenges ahead for addressing HIV/AIDS in the developing world. In clear, accessible detail, The Politics and History of AIDS Treatment in Brazil examines: Brazil s long history of AIDS treatment in the context of progressive social movements. The coalition-building between politicians, activists and government agencies in developing the country s National AIDS Program. The role of the executive, legislativeand judicial branches of government in promoting access to drugs for AIDS treatment in Brazil. The government s controversial decisions to produce generic AIDS drugs and challenge multinational pharmaceutical corporations regarding AIDS drug prices. Brazil s ongoing efforts to promote global access to AIDS treatment and the country s contributions to international health, human rights, and trade law related to access to medicines. The impact of the Brazilian experience on global AIDS drug prices and global AIDS treatment policy. The Politics and History of AIDS Treatment in Brazil contains invaluable lessons for readers across disciplines, particularly researchers and practitioners in health policy, global health, HIV/AIDS, political science, and Latin American studies. 'This is an exceptional academic work, one that deserves to be widely read, and that in my opinion will come to be considered the leading historical study on the social and policy response to the HIV/AIDS epidemic in Brazil and one of the major policy studies on the response to the AIDS epidemic anywhere in the world.' Richard Parker, Mailman School of Public Health, Columbia University With foreword by former Brazilian President Fernando Cardoso Introduction 18 Ezio’s Story 18 AIDS in Brazil 19 The AIDS Crisis and Democratization in Brazil 27 Brazil 27 Building Democracy in Post-Authoritarian Brazil 31 The State and Public Health 34 AIDS in Brazil 36 Brazil’s AIDS Program 38 Democratization and Institutional Precursors to AIDS Treatment in Brazil 46 Sanitarista Health Reform Objectives 46 Reformers Working Within the State 48 Brazil’s First Public and Civil Society Partnerships for AIDS 49 The Evolution of Sanitarista Strategiesin Postauthoritarian Brazil 51 AIDS Activism in Rio de Janeiro State 53 The 1988 Constitution and the Right to Health 55 Development of Brazil’s First AIDS Treatment Institutions in a New Democracy 60 Social Movements Infiltrate the State 60 Early Federal AIDS Programs 61 The Genesis of the AIDS Movement 64 Committing to Treat AIDS 69 National AIDS Program Partnerships with the AIDS Movement 76 Mounting Pressure for AIDS Treatment and Brazil’s First World Bank Loans for AIDS 79 Legislative Reforms and AIDS Treatment in the 1990s 90 Public/Private Partnerships to Develop AZT 91 Public Production of AZT 93 Industrial Property Law 9.279 95 Fernando Henrique Cardoso’s 1994 Presidential Victory 95 Brazil and the World Trade Organization 97 Law 9.279’s Implications for AIDS Treatment 99 Political Action and Chronic Shortages in Drug Supplies for AIDS Treatment 100 Sarney’s Law: Law 9.313 102 Cumulative Impacts of the Industrial Property Law and Sarney’s Law 106 Development of Brazil’s Contemporary AIDS Treatment Institutions 110 Sanitarista Leadership in the National AIDS Program Bureaucracy 110 World Bank AIDS II Loans 115 AIDS II and the AIDS Movement 117 The Evolving Political Context of the Late 1990s 119 The 1998 Drug Policy Reforms 123 A Decisive Step: José Serra and the Domestic Production of ARVs 124 Brazil’s Contributions to Global Essential Medicines Institutions 134 Growing Political Momentun for Affordable Access to Medicines 134 The Global AIDS Treatment Movement 135 Global Launch of Generic ARVs 136 The Global Fund to Fight AIDS, Tuberculosis, and Malaria 138 José Serra’s Essential Medicines Strategy 138 Brazil’s Efforts to Change Global Essential Medicines Institutions in 2000 141 Brazil’s Contributions to Global Essential Medicines Institutions in 2001 142 Intellectual Property and Human Rights Resolution 146 US Drops WTO Dispute 149 The UN General Assembly Special Session on HIV/AIDS 150 World Trade Organization 151 Price Declines for ARVs in Brazil 154 The Symbiotic Relationship between José Serra and the AIDS Movement 155 Brazil’s Contributions to Essential Medicines Institutions from 2002 to 2006 157 Brazil’s Enduring Legacies 158 Conclusion 163 Building Brazil’s AIDS Treatment Institutions 164 Costs and Compulsory Licenses 166 Looking Ahead 170 Global Impact 172 Implications for Other Countries 173 Study Strengths and Limitations 177 The Brazilian Model 179 Brazil's public policy response to the AIDS epidemic preceded those of many developing countries. During my tenure as President, in 1996, Brazil adopted a law guaranteeing free and universal access to AIDS treatment for all people living with HIV/AIDS. Brazil became the first developing country to provide publicly-financed AIDS treatment for all people living with HIV/AIDS. We now have one of the world's most successful AIDS programs that is considered a model for other dev- oping countries. Today, 185,000 people receive life-saving AIDS cocktails in Brazil, and thousands of lives have been saved. But this was not an easy battle. There were many challenges along the way. Twenty years ago, Brazil's achie- ments today might have seemed impossible. During the 1980s, in Brazil, as elsewhere, there was overwhelming stigma associated with AIDS; people living with HIV often lost their jobs and died quickly before the advent of life-saving antiretroviral drugs. Brazil's AIDS movement was extraordinarily important in promoting progressive AIDS policies; associations of people living with HIV were the first to denounce pervasive AIDS-related discri- nation and called public attention to the importance of AIDS. Activists protested in the streets for over a decade, engaged the media, and framed AIDS as a human rights issue. Front Matter....Pages i-xxiii Introduction....Pages 1-9 The AIDS Crisis and Democratization in Brazil....Pages 11-29 Democratization and Institutional Precursors to AIDS Treatment in Brazil....Pages 31-44 Development of Brazil’s First AIDS Treatment Institutions in a New Democracy....Pages 45-74 Legislative Reforms and AIDS Treatment in the 1990s....Pages 75-94 Development of Brazil’s Contemporary AIDS Treatment Institutions....Pages 95-118 Brazil’s Contributions to Global Essential Medicines Institutions....Pages 119-147 Conclusion....Pages 149-169 Back Matter....Pages 171-186