1. HIV in Brazil Ana Paula Pfitscher Cavalheiro
Infectious Disease Resident at Hospital de Clínicas de Porto Alegre

2. HIV in Brazil Population:192 million 85% urban Life expectancy: 66.7 y
1/3 poor (family income < 160 €/m)
1988 Constitution: “Health is a right for all and a obligation of the state”
1985: Civil society + Government -> the National AIDS Program
80s: Spread information about STD-AIDS
1991: AZT free access
1996: HAART free access
Present: HAART, CD4/VL, genotyping in cases of viral failure, drugs for treatment of HAART side effects

3. HIV in Brazil
HIV
Estimated prevalence: 630,000 people (<1% of adult population)
Half of predicted in the early 90s by the World Bank
AIDS
Prevalence: 0.6% of total population y
Increasing between women, heterosexuals, socially excluded and older than 50 y
190,580 on HAART treatment
By 2002 ARVs had prevented ~358,000 HIV-related hospitalisations, resulting in a saving of more than US$1.1 billion

4. Source of HIV acquisition

5. HIV in Brazil
HIV test is free of charge and can be done in primary care units, hospitals or and STD/AIDS counseling testing centers
38% of sexually active population has already been tested at least once
Mean first CD4 (without HAART): 316
35% less than 200
Pregnant women are usually tested for STDs and HIV as part of their regular follow-up
But in 2007 only 62% had been tested for HIV before labour
Recommendation not to breastfeed
Provision of infant formula to all children born from HIV + mothers
Reduction of vertical transmission
581 in 2004 and 320 in 2006

6. Brazilian Guideline AZT, 3TC, TNF, ddI, ABC EFZ, NVP
When start treatment:
Symptomatics
Asymptomatics
CD4 > 500: no ART
CD : ART if
Nephropaty, HCV or HBV coinfection, VL > , > 55y, high risk of CVD, any cancer
CD4 <350: ART
AZT, 3TC, TNF, ddI, ABC
EFZ, NVP
ATV, LOP/r, SQV, /r, DRV , IDV
T20
Raltegravir
Etravirine

7. Key points of National AIDS Program
Show that you´ve grown up and know what you want. In this Carnival use condom.
HIV in Brazil
Key points of National AIDS Program
Prevention:
promote frank talk about safe sex
focus on condom promotion
Brazil is the world’s largest condom importer buying 1.2 billion in 2009
state-run factory produces 100 million condoms a year
focus on preventing HIV among sex workers
Treatment:
ARV drugs are provided free to everybody who needs;
aggressive efforts to minimise the cost of ARVs

8. Thank you! Condoms after 50: Try it!
Living with AIDS is possible, living with prejudice is not.
Thank you!
Condoms after 50: Try it!
Sources: aids.gov.br, avert.org datasus.gov.br, ioc.fiocruz.br