-By Elinor Dyer
It has been over thirty years since the start of one of the largest challenges for international public health, and it is still rare that we hear about successful interventions that have been in place since the start of the problem…until now. As a society, we are accustomed reading about the various issues that have exploded from the 1981 AIDS epidemic, which is why it was surprising to see which nation has continued to have the best response. One would think that the leading country would be among those in the first world, but shockingly, the country that has had the most beneficial intervention strategies with this epidemic from the get-go was, and continues to be, Brazil. Since the start of the outbreak in 1982, Brazil’s government has dedicated itself to preventing and treating this disease. By using a multi-step approach of intervention and education programs combined with providing access to free medication, Brazil’s infection rate has significantly declined over the past thirty years while those in countries such as the United States have remained elevated (Gomez).
The shift from a military dictatorship to a democracy three years after the start of the epidemic was the first step to put Brazil in the lead. With the new form of government came a new constitution that made health care a human right. Brazil’s improved government guaranteed access to medicine and healthcare for those with AIDS by passing a federal law that mandated the universal access of antiretroviral medication in 1996, providing everyone with free treatment. When short on money, the national AIDS bureaucracy could lower drug prices by negotiating with pharmaceutical companies. The government took this initiative one step further by promising to produce and distribute generic versions of antiretroviral (ARV) drugs if the companies refused to negotiate. In countries where access to free treatment is not available, like the United States, there is often a waiting list for ARV’s.
By increasing the amount of funding towards prevention, education, and medication, the Brazilian government has continued to keep the spread of disease at it’s lowest. Brazil’s national AIDS bureaucracy created the Fundo-a-Fundo Incentivos program, which provides monthly grants to cities in need. These interventions work closely with civilians while focusing on high-risk groups of gay men and women. In the mid 1980s, the Brazilian government invited gay activists to help create new AIDS policies while learning about health care needs. In my opinion, including living with HIV/ADS in the decision-making process was a good strategy for this nation and is probably why rates declined at such a steep interval. Other education and prevention initiatives include nationwide condom distribution, HIV testing, and campaigns that target vulnerable populations such as sex workers, injecting drug users, and men who have sex with men (Nunn). Because these education and prevention programs were implemented from the start of the epidemic in 1982, Brazil has continued to produce the best outcomes.
This article interested me because it is uncommon to hear of a success story like this one. I was surprised to see that a country like Brazil would have such positive results from these interventions, and overall have the steepest decline in infection rates. Other countries have done a fine job of managing this disease, but Brazil has been committed to ending the spread of HIV/AIDS. The Brazilian government and healthcare system have proven that ARV medication can easily be produced, distributed freely, and be used to stop new infections from occurring altogether. The article made me think further about how smaller nations deal with these types of epidemics. I think that Brazil’s combination of programs has also been successful in getting rid of some of the stigma that comes with having AIDS. Because people are able to receive treatment for free, they may not be ashamed or afraid of going to the doctor. I would recommend this article because we usually hear about the struggles that come with having AIDS and the issues with the healthcare system such as not having access to affordable medication, but Brazil seems to have everything under control. I think that other nations should be taking note on Brazil’s progress because it is important to learn from other nations’ successes.
The video below shows how the decline of infection has been possible and provides first hand accounts of people living with the disease. The interviewees share their positive experiences with the healthcare system. The video opens with a woman providing teenagers with condoms and informative flyers in order to teach them about prevention. It then goes on to visit doctors, pharmacists, and other medical programs that help with the side effects of the drugs. The video really made me think about how important education is for the prevention of the spread of AIDS. Although HIV/AIDS continues to be a global health issue, this small nation has handled it in the best possible way and should be commended.
YouTube Video: Winning Against AIDS—Brazil
Gomez, Eduardo J. “Why Brazil’s response to AIDS worked.” Cnn.com. CNN, 4 June 2011. Web. 9 Feb. 2014.
Journeyman Pictures. “Winning Against Aids – Brazil.” YouTube. YouTube, 11 Jan. 2008. Web. 10 Feb. 2014.
Nunn AS, Fonseca EM, Bastos FI, Gruskin S. “AIDS treatment in Brazil: impacts and challenges.” Health Aff. 2009;28(4):1103–13.