To: KyrosL who wrote (32028 ) 4/22/2003 4:24:56 AM From: elmatador Respond to of 74559 The Brazilian model to combat the AIDS menace Miami Herald - Tuesday, July 3, 2001 Trudy Rubin -------------------------------------------------------------------------------- SAO PAULO, Brazil -- Instead of debating for three days in New York over what to do with the money in an international AIDS fund, this week's special United Nations assembly on AIDS should have met in Brazil. Brazil is the only developing nation that has found a successful formula to combat AIDS. In 1994 the World Bank projected that Brazil would have 1.2 million HIV-positive cases by 2000, but the rate seems to have stabilized at half that number. Unless the Brazilian strategy is broadly adopted, neither cheaper drugs nor higher contributions to the newer U.N. AIDS fund will check this plague. So what have the Brazilians learned? Talks with Brazilian Health Minister Jose Serra, national AIDS program officials and doctors at an AIDS clinic in Brazil's largest city, Sao Paulo, focus on three key principles. Principle one is committed political leadership from the top down, starting with President Fernando Henrique Cardoso. Compare this to South Africa, where President Thabo Mbeki still doubts HIV causes AIDS and prevention lags because of his lukewarm commitment. Or Kenya, where President Daniel arap Moi blocks AIDS prevention. Africa's most successful prevention program is in Uganda, where President Yoweri Museveni has personally led the campaign. Principle two is the heavy involvement of civic and community organizations, which are essential for reaching and helping the the poor take the complicated drug regimen. At the spanking-clean Center for Reference and Training, an AIDS clinic in crowded Sao Paulo, the director, Dr. Artur Kalichman, talked about how non-governmental organizations help in reaching high-risk groups. "We work with NGOs which are accustomed to working with the homeless and know how to get them to take their medicines." Such civic groups, he says, are more willing than conventional health workers to distribute "Kama Sutra cards" with images of safe sex to saunas frequented by gays, or materials with pictures rather than words to poor illiterates in the slums. A Brazilian quality that helps make HIV-AIDS treatment easier is an openness to talking about sex. This contrasts with many African countries, where admitting to having HIV-AIDS is still taboo, and sex education in the schools is forbidden. Education on sex and AIDS in Brazilian schools starts at 12. Packs of condoms appear in Rio hotels alongside the peanuts. "We deal with sex, drugs and rock and roll (at the clinic) all the time," says Kalichman wryly. "If we couldn't deal with differences it would be tragic." A transsexual named Greta, with long hennaed hair, who works as an on-stage impersonator of Ann-Margret, pops up from a line of waiting patients to talk about how free AIDS drugs for the last two years have given her back her life. Which leads to Brazilian principle three: cheap medicine to treat AIDS patients. Brazil has distributed the AIDS cocktail free to any needy person since 1997. This is possible because Brazil produces cheap, generic versions of several antiretroviral drugs -- and because Brazil is a rich poor country. But even if global drug prices drop, Brazil could not deliver the drugs if it didn't already have a good public-health network. "If a country has a public-health system . . . it can copy Brazil," says Dr. Mylva Rossi of the Sao Paulo clinic. So here's the catch. In poorest Africa the health system is sketchy and the Brazilian model may be out of reach. But it could work in Latin America, in India, in urban South Africa. And Brazilian specialists are ready to consult with poorer African nations on how to distribute cheaper AIDS drugs in a more limited way. Meanwhile, hard-hit African nations can adopt Brazil's first two principles of top-down, bottom-up leadership to push prevention and develop a health network. Without such leadership, no amount of cheap drugs will do any good.