Brazil sets example for taming AIDS in Latin America countries

RIO DE JANEIRO, Brazil -- A decade ago, health experts predicted an AIDS explosion in Latin America, striking hardest at Brazil, with its teeming population and sexual permissiveness.

But the explosion never came, and experts say Brazil's handling of the problem may keep it from ever happening.

"If you look over the map of HIV/AIDS in Latin America it looks like the African map from 15 years ago," said Paulo Lyra, a consultant on Latin America for the Pan American Health Organization.

"But what's different with Latin America is that it is by far the developing region with the most access to antiretroviral treatment."

Antiretroviral drugs reduce the HIV in the bloodstream, making HIV infection a chronic disease rather than a terminal one.

In Latin America and the Caribbean, about 400,000 people are believed to need AIDS drugs and about 55 percent are getting them. In Africa, an estimated 4.4 million people need drugs but only 2 percent are getting them.

The biggest success story is Brazil, thanks to a program of crisis management that has been praised by AIDS experts.

With a population of nearly 180 million, Brazil has by far the largest number of patients. By manufacturing cheap generic versions of the otherwise expensive AIDS drug cocktail and offering them free to all who need them, the country has put itself at the forefront of Latin America's war on AIDS.

Brazil's drug industry faced a threat when the country entered the World Trade Organization, which mandates compliance with trademark rules. But it was able to negotiate deep discounts with pharmaceutical makers simply by threatening to break the rules if treatments became too costly.

Brazil was a global pioneer in the manufacture of cheap generic AIDS drugs and still manufactures those patented before it signed its intellectual property law. It distributes these to patients who have not yet developed resistance and need more advanced drugs.

Brazil spends about 1.5 percent of its health budget, or $175 million a year, on anti-AIDS drugs.

The giveaway cut the death rate in half in just four years, saving an estimated 100,000 lives. Since then, the death toll has crept back up, but only gradually.

In 2002, the last year for which numbers are available, 11,047 Brazilians died from the disease, only slightly more than the 11,024 who died in 1997.

In 1990, the World Bank estimated Brazil would have 1.2 million people infected with HIV by 2000. Today, authorities estimate the total is about half that many.

Proportional to population, Brazil has had far less than its share of the 100,000 people who died of AIDS across Latin America and the Caribbean last year.

Its neighbors have taken heart from Brazil's example.

Experts who argued that treatment was too expensive and complicated in the largely impoverished region now hold up Brazil's program as a model.

The Brazilian government funds five pilot programs in Latin America, providing free anti-AIDS drugs and expertise.

Most of these programs only treat about 100 patients, except in Bolivia and Paraguay, where the total number of patients is only about 500. Brazil treats nearly everyone.

Also contributing to Brazil's success is its frank, often graphic AIDS propaganda, and the distribution of millions of free condoms at festivals such as the Mardi Gras carnival.

Still, some 80 percent of Brazilians are Roman Catholic, and although their church has not come out strongly against the condom program, distribution is less widespread outside the cities.

There are no guarantees that Brazil has been spared for good, warns Mauro Teixeira, an adviser with the Brazil Anti-AIDS program.

He points to the tiny southern African kingdom of Swaziland, which he says had a 4 percent infection rate 10 years ago and today is at 40 percent.

"There's nothing to say there won't be an explosion, if something isn't done," he said.