BRAZILIAN TREATMENT MODEL: A NEW COURSE FOR GLOBAL AIDS POLICY, THE

Journal of Third World Studies, Spring 2008 by Rey, P J

A NEW APPROACH

Brazil has adopted a radical approach toward combating its AIDS epidemic in the last decade. Not only has it taken a number of preventative measures, but it has adopted the philosophy that a struggle against the disease must also be a fight to save its victims for as long as the most modern medical technology will allow. In its inception, this philosophy diverged from the traditional tactics stipulated by most forms of international aid that emphasized prevention over treatment. The Brazilian policy is particularly insightful given the unique nature of AIDS treatment. Antiretroviral medicines used to extend the lives of HIV-infected people also have the side effect of decreasing transmission rates; thus in the macro view, post-infection treatment is itself a significant form of prevention-a fact overlooked by the current policies of many other nations. In pursuit of this end, Brazil manufactures all AIDS medicines patented before its 1996 Industrial Property Act, which was introduced after it joined the World Trade Organization.1 It also threatens to produce any patent-recognized drugs not affordably supplied by the patentholder. The Brazilian government contends that only a holistic approach to combating AIDS will de-stigmatize the disease, produce effective incentives for testing, provide education to remote target groups, and ultimately decrease death and infection rates. This philosophy is working. The World Bank reported that Brazil's AIDS fatalities were reduced from 15,200 in 1995 to 8,400 in 2001.2Despite the country's unique cultural and economic circumstances, this paper argues that an optimal prevention model can be culled from the Brazilian experience and applied to all countries ravaged by the AIDS pandemic; furthermore, what starts as inwardly motivated action towards the betterment of a state's own domestic affairs (i.e. the advancement of human rights vis-à-vis healthcare) is fundamentally entwined with factors external to the state itself, so that the effectuation of any such program carries global consequences. Particularly, we will explore how the Brazilian government's assertion of human rights claims on behalf of its citizens and its development of internal technological resources have produced a de-marginalizing force for that nation as a global actor over and against market-expansive capitalism as the salient force in the world-system.Finally, by sharing its pharmaceutical manufacturing technology, Brazil may itself be a key to the realization of this model for some less developed countries.

HIV: A BRIEF OVERVIEW

Acquired Immunodeficiency Syndrome (AIDS) first received a distinct clinical category in 1981. It initially manifested itself within the gay community and was subsequently stigmatized by many, who linked it to promiscuous homosexual lifestyles following the sexual revolution of the 1960s and 1970s. It soon became clear, however, that the disease was not merely a result of homosexual practices, as the epidemic spread to two other vulnerable groups: blood transfusion recipients and illegal drug users.3 By 1984, research confirmed the Human Immunodeficiency Virus (HIV) as the source of the disease and the era of prevention and treatment began.4

In 2004, the World Health Organization (WHO) reported an estimated 39.4 million HIV infections globally and 3.1 million AIDS-related deaths.5 Though HIV has been detected in blood, semen, saliva, urine, tears, breast milk, vaginal secretions, lung fluid, and cerebrospinal fluid, transmission most frequently occurs through blood contamination and sexual activity.6 In discordant heterosexual practices, an HIV positive man is more likely to infect his female partner than an HIV positive woman is to infect her male partner.In discordant male homosexual practices, an HIV positive penetrative partner is more likely to infect a receptive partner than an HIV positive receptive partner is to infect a penetrative partner.Anal intercourse carries a greater risk of infection than does vaginal intercourse, because the rectal wall is prone to bleeding.7 In Brazil and similarly patriarchal societies, this presents a particular risk because many men have a wife, a mistress, a homosexual partner relations with heterosexual sex workers, and/or relations with homosexual sex workers; therefore, increased risk of transmission with one partner constitutes an increased risk for all partners.8This social structure supported a shift in the pattern of Brazil's epidemic from a male to female infection ratio of 28:1 in 1986 to 2:1 presently.9 Breastfeeding and childbirth are also routes of transmission, especially in Africa, where the WHO estimates over one million infected children. 10 HIV is a retrovirus, meaning it attacks the immune system. It may take a number of years before the virus fully manifests itself (the median time period for AIDS manifestation in untreated people who were infected at 15-24 years of age is 11 years).Eventually, the weakened immune system renders the victim vulnerable to numerous additional infections, resulting in death.11