Ministry of Health Health Surveillance Secretariat NATIONAL STD/AIDS PROGRAMME

National Response to HIV and AIDS in Brazil

Population (2000) GNP per capita: US$ 2569 (2002) ACCUMULATED AIDS CASES (2003): 310,310 AIDS INCIDENCE RATE (2002): 12.8/100,000 ESTIMATED N. OF PEOPLE LIVING WITH HIV (2003): 600,000 PREVALENCE: 0.65% (15 to 49 years of age) AIDS DEATHS ( ): 149,559 MORTALITY RATE: 6.3/100,000 (2002) BRAZIL

,000 (on ARV) 146,000 (on ARV) 89,000 (without ARV) 89,000 (without ARV) 365,000 (majority don’t know they are HIV+) 235,000 (being monitored) Brazil 600,000 PLHA

BRAZIL Trends of the epidemic Stabilization Heterosexualisation Feminisation Pauperisation Interiorisation

Municipalities with at least one AIDS case Brazil,

Fonte: PN DST e AIDS – SVS - MS. Pauperisation % Aids cases over age 19 X schooling Brazil, % 20% 40% 60% 80% 100% 3º Grau2º Grau1º GrauAnalfabeto

Annual mortality rate by sex. Brazil, 1984 – Source: Brazilian STD/AIDS Program year of death per 100,000 inhab. men womenBrazil

Characteristics of the Brazilian Response Early government response - since 1983 Strong participation of civil society in all decision levels Multi-sectoral mobilization Specificity of Brazilian culture Balanced approach between prevention and treatment Human rights perspective in all the strategies and actions

Source: IPEA/ ,0 394,8 595,5 445,9 359,9 243,2 44,6 41,0 44,2 57,2 41,4 30, Year (US$) Million Federal WB Distribution of Public Resources in external source WB* and Government source.

Health Promotion and Prevention

Promotion of human rights Implementation of major national media campaigns Prevention actions for general population and specific groups Early diagnosis of HIV infection STD diagnosis and treatment Health Promotion and Prevention

Access to condoms 700 million / year Progressive increase of Public Distribution (20x) Steady growth of Market sales (3x) Growth trend of condom use (4.6 x) Condom use (in millions of units) Sources: DKT and PN-DST/AIDS Marketed Public Distribution

Adoption of Safer Sex practices ( ) Source: (1) CEBRAP/MS/PN-DST-AIDS/SVS (2) MS - IBOPE Use of condom in last sexual intercourse With occasional partners (%)With regular partners (%) 64 79, , (1) (2) 69% of the population is sexually active

Number of Institutions which distribute Female Condoms, per Macro-Region Distribution of 4 million condoms / year Priority Population: Seropositive women Sex workers IDUs and their partners Women victims of domestic sexual violence

HIV BEHAVIOR HCV HARM REDUCTION Support to 125 projects with 65,000 ID users - estimated 20% coverage

Today 1.8 million people are tested per year 30% of the sexually active population have taken the test. 300 and 400 thousand HIV+ are not aware of their status. Diagnosis is made 4/5 years after infection. Access to HIV diagnosis Goal is to test 4.5 million a year

Impact of prevention interventions – vulnerable populations Drop in HIV infection rates Sex workers – From 17% in 1992 to 6.1% in 2000 MSM - from 10.8% in 1999 to 4.7% in 2001 IDU - from 21% of AIDS cases 1994 to 11.4% in 2000

Mother to Child Transmission, Brazil, 1997 to 2003 * Preliminary data Estimated 17thousand pregnant women infected per year

Rate of Mother to Child Transmission (%) per year of birth - Brazil, Tess, 1998; Succi, 2003 (preliminary data)

Health Care

HIV/AIDS services Accredited hospitals: 375 Day hospitals: 79 Home care: 54 Outpatient services: 381 Source: UDAT/PN-DST-AIDS. March/2002 Access to Treatment 889 services for PLHA Laboratories: Viral Load, CD4+ count and Genotyping

PLHA on ARV use Brasil, 1997 a Jun/2004

 ZIDOVUDINE (ZDV)*  DIDANOSINE (ddI)*  LAMIVUDINE (3TC)*  STAVUDINE (d4T)*  ABACAVIR  INDINAVIR*  TENOFOVIR 16 ARVs distributed  RITONAVIR*  SAQUINAVIR  NELFINAVIR  AMPRENAVIR  NEVIRAPINE*  EFAVIRENZ  LOPINAVIR / r  ATAZANAVIR (*) Brazilian state production available Universal and free of charge access to ARV - federal law Nov.1996

MEDIAN SURVIVAL AFTER AIDS DIAGNOSIS IN BRAZIL Source: Chequer et al, 1992; Marins et al Months of survival Introduction of Potent ARV Therapy in Brazil

LPV.rNFVEFZ12 other ARVs Expenditures (in millions of R$) % 23% 19% % Access to treatment 3 imported drugs take up 63% of the budget LPV.r+ EFZ+ NFV 63% 12 other ARVs 37%

ARV drug expenditures avoided trough negotiation (In millions of US$), for Brazil (Jan/2004)

Expenditures (In millions of US$) with ARV Drugs and Average Number of Patients under treatment - Brazil ( *) *Data subject to alterations

MoH / Average cost (US$) of ARV per Patient/year * * Preliminares datas

Impact of the Brazilian ARV Policy ( ) reduction of mortality  40% 90,000 deaths prevented reduction of morbidity  70% reduction of hospitalizations  80%  358,000 hospitalizations prevented - average of hospitalizations / patient per year reduced from 1,65 in 1996 to 0,28 in 2003.

Impact of ARV Therapy Policy ( ) Cost Savings - US$ 2.2 billion US$ 1.23 billion in hospitals and treatment opportunistic infections US$ 960 million reduction in drug prices

“Life sleeps in the crude earth, dreams beauty in the flowers, wakes with power in the animals and in man has consciousness of infinite possibilities” Yogananda