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Last Updated: Wednesday, 7 January, 2004, 15:31 GMT
Brazil points to way ahead in Aids battle

By Mark Ashurst
BBC World Service business reporter in Sao Paulo, Brazil

Brazilian youth
Antiretroviral drugs are free in Brazil.

In 2004, millions of people with HIV hope to receive drugs which can all but eliminate the virus which causes Aids from the bloodstream.

The World Health Organisation's target is three million people on treatment by 2005, one of the most ambitious medical projects in history.

At the forefront of this effort to tackle the global Aids epidemic is Brazil where government ministers insist that 99% of those who need antiretroviral drugs get them free of charge.

That is a difficult claim to prove, but nevertheless a sign of confidence that the real and difficult obstacles to the mass roll-out of antiretroviral drugs can be overcome.

Global problem

Some of the doctors, nurses and lab technicians who have pioneered treatment for people with HIV and Aids can be found in a busy Sao Paulo hospital where they are testing blood samples from people with HIV and Aids.

"Sao Paulo has 38 million inhabitants and [... we] can estimate that we have something around 250-300,000 HIV-infected persons living in the state," said Dr Artur Kaleeshman who coordinates work at the Sao Paulo State Sexually Transmitted Disease and Aids Training and Referral Centre.

"The Brazilian constitution states that health is a right of the citizen, that the health system should take, must take, responsibility.

"You cannot just not treat people."

Nigerian Aids patient
The economics will look very different in much of sub-Saharan Africa.
Brazil has blazed a trail that other countries have pledged to follow.

Beyond the hospital environment, warehouses have become new links in a fledgling infrastructure, carrying complex medicines for shipment on government boats to remote corners of the rain forest.

It shows how much Aids has been a catalyst in the globalisation of health.

Companies redefine role

The Aids epidemic has redefined the way health systems work, and with it the way companies which make drugs sell them.

"I think that the tendency was to keep prices relatively high even in developing countries," said Raymond Gilmartin, chief executive of Merck, the US-based pharmaceutical giant.

"But I think that as we've gotten into markets that are much less developed and the countries have a lot less wealth... pricing according to the ability of a country to actually afford the drug and make use of it was a way to maximise social good, but also contributes to the possibility of doing more research."

"In the case of HIV we've done something more extreme," he continued.

"We're offering drugs at a price in which we make no profit."

After long battles at the World Trade Organisation (WTO), developing countries can now import generic copies of patented medicines to combat public health crises.

Rows over pricing and patents remain unsettled, but compared with even a year ago they have been diffused.

Instead, more practical problems will make the difference between who gets help, and who does not - such as infrastructure, know-how, and who pays for what.

Culling costs

Another technological revolution has transformed the treatment given to HIV-positive workers here.

Instead of going to hospital, they're treated at home, with the latest high-tech medicines.

And like the laser-guided production line, the effect has been to drive down costs.

"In the beginning we spent in terms of hospitalisation, we spent 90% more than now," said Dr Murilo Alves Moreira, president of Brazil's National Corporate Counsel on HIV/Aids and the medical manager at the Brazilian unit of the car maker Volkswagen.

Healthy export

Volkswagen is busy exporting what it has learned here to the group's sister factory in South Africa.

Protest in Pretoria, South Africa
Aids has been a catalyst in the globalisation of health.
There is no doubt Brazil has set a brave example in treating people with HIV/Aids, and shown it makes economic sense.

The economics will look very different in much of sub-Saharan Africa, where state health systems are fragile, and where sometimes more than one in three people may be HIV-positive.

That is up to sixty times higher than in Brazil.

That makes the risks of drug-resistance in patients receiving antiretrovirals much higher, and the costs of providing these complex medicines to an ageing, drug-dependent population nearly impossible to predict.

But while policymakers in Sao Paulo may not have all the answers, Brazil's success makes a compelling argument that these risks, albeit still largely unknown, are worth taking.

Brazil's depleted rivers
05 Aug 03 |  Americas

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