“There is no Brazilian model. What we have been doing is to put into practice principles that have long been recognised by the international community,” declared Dr Paulo Teixeira, Director of the Brazilian STD/AIDS Programme in Thursday’s plenary.

Teixeira spoke on the issue of scaling-up and programme implementation based on the lessons of the Brazilian experience. Brazil has been held up as a model for other countries to follow in the struggles against HIV and AIDS at the country level.

“At the very core [of Brazil’s programme] is the Universal Declaration of Human Rights, adopted more than 54 years ago. None of these outcomes could have been achieved without embracing a balanced prevention and treatment approach and the firm advocacy of the human rights of people infected and affected by HIV/AIDS,” said Teixeira.

Brazil has implemented a comprehensive prevention programme focusing on condom use. It has achieved a significant reduction in the rate of incidence particularly in more vulnerable populations, including men who have sex with men, sex workers and injection drug users. Seventy percent of all public and private schools teach HIV/AIDS prevention reaching 30 million students.

Their prevention approach emphasizes the need to direct special attention to vulnerable populations, ensure access to prevention supplies – specifically condoms, syringes and needles – and include prevention activities in health care services.

“No time can be spent with ambiguous prevention messages. HIV transmission happens [primarily] through sexual contact and prevention is made through condom use. Other alternatives, such as postponement and abstinence are indubitably incompatible with our global reality. The alleged ethical and religious character of such initiatives is today one of the main enemies of effective prevention,” stated Teixeira.

He emphasized that countries must mobilise the necessary political commitment to bring together national resources and to decisively fight against cultural, religious and legal barriers to prevention.

“Controlling the AIDS epidemic also [requires] mobilising the entire national capacity to offer antiretroviral treatment, even when the optimal infrastructure is not available,” said Teixeira.

The number of AIDS deaths has fallen dramatically since the adoption of antiretroviral therapy. Survival has increased dramatically. The average survival time before the availability of combined therapies was less than six months and now is close to five years, a twelve-fold increase reported Dr Ricardo Marins in a poster at this conference. Quality of life for persons living with AIDS has also improved significantly. Most patients continue with their employment and interacting with family and friends.

Teixeira noted that we cannot lose sight of the relevance of adopting strong strategies to lower the price of antiretorivals. In Brazil, the average treatment cost per patient each year decreased by half in recent years. This occurred as a result of two related factors.

Firstly, investments were made by the Ministry of Health to establish domestic national laboratories. Brazil distributes fifteen antiretroviral drugs of which eight are locally produced.

Secondly, Brazil has effectively negotiated price reductions with Abbott, Merck and Roche to cut the price of four drugs by more than 50%. Teixeira indicated that “national production under compulsory licensing has been a strong argument to push these companies to the negotiation table.”

Brazil has 600,000 persons living with HIV and has had more than 220,000 cases of AIDS reported to the Ministry of Health since the beginning of the epidemic. This is less than 50% of the number predicted by the World Bank a few years ago. Current estimates place the prevalence rate in the total adult population at around 0.6%. However, Teixeira noted: “we cannot ever forget that behind such figures there are real people.”

The Brazilian policies have also managed to keep the average longevity of the country’s population nearly at the same level over the past decade.

“The current level of international funding directed to fight AIDS in the developing world is simply outrageous,” said Teixeira, and the “key lies in mobilising a new Marshall Plan to scale up national responses in poor countries, as it was done by the United States to Western Europe right after World War II.”

“We nowadays face a tragedy of similar proportions. We need the United States, along with Japan and Western Europe, to assume, at last, their responsibility in changing this dramatic situation.”

“The vast majority of infected people worldwide simply lack the minimum resources necessary to intervene in the field, no matter how much the prices of antiretrovirals are reduced. Rich countries are rich because they drain the greatest part of the world’s wealth in royalties, diamonds, profits and interest rates.”

Besides the Global Fund, he noted the need for the United Nations to scale up their programs in the areas of technical and financial assistance. In an effort to assist other countries, Brazil is sharing its experience with other developing nations. In the past three years, they have initiated more than 30 different cooperation projects with other developing countries.

Teixeira noted Brazil’s “willingness to actively take part of other initiatives, both bilateral and multilateral, to increase the global availability of generic drugs and to reduce international prices.”

“This is not a game where there are winners and losers. Without urgent decisive action, the entire humankind will be defeated.”

AIDS 2002 Conference News produced by Health & Development Networks/Key Correspondent Team