one of the first antiretroviral drugs available to treat HIV

AIDS treatment in Brazil

When AZT (one of the first antiretroviral drugs available to treat HIV) was first developed in the late 1980s, small quantities were made available for free in São Paulo state. In 1991 the government announced that it would make the drug available for free to all Brazilians that required it. ³⁶ Although there were a number of problems with AZT, the government’s decision to distribute it universally set the precedent that people living with HIV had a right to receive treatment.

In 1996 HAART was developed, revolutionising HIV treatment. Once again, the drugs were made available for free throughout the public sector. In following years the national AIDS mortality rate began to decline due to the effectiveness of the treatment.³⁷ By 2002 the Ministry of Health estimated that the availability of ARVs had prevented around 358,000 HIV-related hospitalisations, resulting in a saving of more than US$1.1 billion. ³⁸

By the end of 2007, it was estimated that 181,000 people living with HIV in Brazil were receiving ARVs – 80% of those requiring the drugs. ³⁹ This level of treatment coverage is more typical of a developed nation than a middle-income country such as Brazil.

A major factor in Brazil’s success has been its ability to produce several AIDS drugs locally. Brazil has a large pharmaceutical industry and around 40 percent of ARVs currently purchased by the government are manufactured domestically.⁴⁰ Since 1996 Brazil has complied with the international Agreement on Trade Related Aspects of Intellectual Property (TRIPS), which was established to protect the patent rights of pharmaceutical companies. This agreement limits the production of generic drugs that have already been patented in another country. Several ARVs that are produced generically in Brazil were patented before the TRIPS agreement, which means that they can legally be copied. ⁴¹

Transport union members educate a truck driver about HIV and AIDS, Sao Paulo, Brazil

However, some of the ARVs required for the Brazilian treatment program have to be obtained internationally. To ensure that these drugs are not too expensive, the government has continually put pressure on international pharmaceutical companies to lower their prices. A major tool in these negotiations has been a clause in the TRIPS agreement that allows developing countries to issue 'compulsory licenses' for drugs. Compulsory licenses allow countries to override patent laws and produce their own generic (copied) versions of company-owned drugs, and can be issued when the government of a developing country deems it to be a public health emergency. Many developing countries are hesitant to actually issue compulsory licenses, because of fears about damaging trade relations with drug companies and governments such as the U.S. who are keen to protect pharmaceutical patents. For years the Brazilian government frequently threatened to invoke compulsory licenses for AIDS drugs, without actually going ahead, and this led to significant price reductions.⁴²

“Brazil’s unprecedented accomplishments in AIDS treatment have profoundly influenced global AIDS and health policy.”

In May 2007 however, the Brazilian President Luiz Inacio Lula da Silva announced that Brazil would be issuing a compulsory license to import a lower cost version of the ARV efavirenz, patented by the company Merck. This followed Thailand's decision five months earlier to break patent for the same drug, along with others. The Brazilian government had previously been in talks with Merck on lowering the price of efavirenz, and although the company had offered to sell the drug at a lowered price, the government argued that these reductions did not go far enough. The Brazilian government estimated that their decision would save them $240 million by 2012, when Merck's patent on the drug expires, and would help them to improve the provision of ARVS.⁴³

As expected, the government's decision to break the patent on efavirenz received a mixed reaction. AIDS activists and many officials involved in the global fight against AIDS applauded the move. Michael Weinstein, president of AIDS Healthcare Foundation, which operates clinics in Latin America, called it: