H. E. Minister of Health of Brazil Senator José Serra
Special Session of the General Assembly of the United Nations on HIV/AIDS
New York, 27 June 2001
Twenty years have gone by since the first cases of what became known as AIDS were identified. In such a short time frame, the impact of the epidemic has been devastating. Almost 60 million people have been infected with HIV. Almost 22 million have died. Over 36 million are living with HIV/AIDS and need treatment.
Unfortunately, the dissemination of the epidemic and the death rates related to AIDS are swiftly increasing in the world and this trend will not be reversed unless the international community takes decisive actions to face this huge challenge. Last year, more than 5 million people were infected and 3 million died.
Until very recently, it was a commonplace to affirm that HIV affected the human body's immune system in the same way as the epidemic affected the countries' immune system, which is composed of its people, its economy and its health and education systems.
Nowadays, this assertion does not hold true anymore. Although we do not have a cure for AIDS, we do know that consistent and courageous policies can halt the spread of the disease and let those infected with HIV live a normal and dignified life. To meet these objectives, our commitment must contain four essential elements: prevention, treatment, human rights and resources.
Prevention and treatment are mutually reinforcing and must be considered in an integrated approach. As far as prevention is concerned, there is a wide range of measures that have proved successful, such as: universal access to condoms, women's empowerment, adoption of programs relating to mother-to-child transmission; implementation of strategies directed to the most vulnerable groups and to the groups at highest risk of infection; and the inclusion of issues related to HIV/AIDS in schools' curriculum.
In Brazil, these policies have yielded excellent results, allowing us to control the transmission rate. The number of people living with HIV/AIDS now amounts to less than half of what estimates used to predict. Our integrated approach to prevention and treatment was essential in reaching this success. Because of our policy of ensuring free and universal treatment, the population feels encouraged to accept voluntary and confidential testing, improving notification of aids in earlier stages that otherwise would be hidden. Moreover, people living with HIV/AIDS are kept in close contact with the health system, both the Governmental one and the NGO's having access to information, counseling and preventive supplies; and, following the antiretroviral treatment, they have their viral load brought down. Their self-esteem gets higher; they feel more able and prone than in the past to be more cautions in avoiding contaminating other persons. Thus, treatment has a positive and formidable impact on prevention, which has been rightly recognized by the Special Session.
1996 represents a landmark in AIDS history. It was the year in which the efficacy of the antiretroviral therapy was proved. Since then, every Brazilian living with HIV or AIDS has had free access thereto. Nowadays, almost 100,000 people are taking these drugs in Brazil. Our strategy has been paying off. The death rate has fallen by approximately 50%. Hospitalizations had a 75% drop. Opportunistic diseases have substantially decreased. The epidemic has been stabilized and our public health services are much less overburdened. Actually, providing adequate treatment has even led us to upgrade them.
The reason for the affordability of our policy is the local production of drugs. Brazil produces 8 generic versions of non-patented antiretroviral drugs at low costs. Most of the medicines provided by Brazilian laboratories are much cheaper than those imported. Last year, only 2 imported drugs amounted to as much as 36% of the whole purchase costs of antiretroviral medicines. Nevertheless, effective or potential competition from the local companies is inducing foreign industries to bring their costs down on average by 70%. It is also worth noting that the local proáuction is controlled through the application of the Good Manufacturing Practices, pharmaceutical plants inspection and bio-equivalence testing. No problem related to the quality of medicines has ever been reported.
Moreover, it is important to stress that this production fully complies with the World Trade Organization Trade Related Intellectual Property Rights Agreement. Brazil is a founding member of this agreement and adapted its legislation thereto in 1997, eight years before the 2005 deadline. No one disputes the relevance of the international agreements on intellectual property rights. Patent rules strike a balance between two desirable objectives - on the one hand, the private interest of individual creators, needing funds for innovations and seeking maximum opportunity to exploit their inventions; on the other, the public interest of immediate and widespread dissemination of life-saving technology. The TRIPS Agreement itself, for all its provisions on scientific knowledge protection, contains measures allowing for the promotion of public health. We are pleased that this Special Session has acknowledged the efforts of countries to develop domestic industries in order to increase access to medicines and protect the health of their populations. It has also recognized that affordability of drugs is a significant factor in the fight against the epidemic.
Another essential factor in combating HIV/AIDS is the strict respect for human rights. This approach should be twofold. On the one hand, we must combat the stigma that unfortunately still is associated with HIV/AIDS and eliminate other forms of discrimination that contribute to the spread of the epidemic. On the other, we must take into account that access to medication is a fundamental element in achieving the full realization of the human right to the enjoyment of the highest standard of physical and mental health.
In Brazil, we have also learned how strongly NGOs, in particular those of people living with HIV/AIDS, must participate in this huge effort. In the last seven years, more than 1,500 partnerships with non-governmental organizations have been put in place. This cooperation, in which the government has invested more than 40 million dollars, has proven efficient and creative. Over 600 NGOs work with the government now, highlighting critical issues and contributing to the elaboration and implementation of public policies.
As a matter of fact, cooperation is fundamental both at the national and the international levels. Based on our national experience, the Brazilian government has carried out technical cooperation with Latin American, Caribbean and African countries.
However, a stronger effort is expected from developed countries, which can contribute more to meet the goals established in this Special Session. In this regard, Brazil fully supports the establishment of a global AIDS fund - the resources of which should be commensurate to the magnitude of our challenge - to finance prevention and treatment, particularly for those most in need.
I am also pleased that the Special Session has recognized the principle of differential pricing. Developing countries should not pay as much as developed countries for AIDS-related drugs. I hope that the pharmaceutical companies will take this principle, into account.
Another initiative that should be move forward, and that has been successfully implemented in Brazil, is the establishment of an Internet data bank to disseminate drugs prices in different countries, which would certainly lead to competition and price reduction.
In concluding, let me emphasize that this Special Session represents an important breakthrough in that the international community has agreed upon a set of global principles and strategies regarding HIV/AIDS, even though countries have their particular circumstances. This meeting has shown that there is a way out, that it is possible to fight the epidemic even in the poorest regions.
The Special Session should not be
a final event. On the contrary, it must be a starting point, or rather
a turning point, especially for the most affected countries. The final
document of the Special Session will be a Declaration of Commitment. And
actually all depends on our commitment. A commitment to human rights, prevention,
treatment and affordable medicines. In a word, a commitment to life.