HIV This Week

Okie S. Fighting HIV — Lessons from Brazil. N Engl J Med 2006;354:1977-81

Okie x-rays Brazil’s experience in providing access to HIV prevention, treatment, care and support to those in need of these services. The government-funded treatment programme, which has improved the health system and extended the survival of tens of thousands of Brazilians, has saved the country an estimated US$2.2 billion in hospital costs between 1996 and 2004, and inspired similar efforts elsewhere — including PEPFAR. In addition, Brazil’s persistent and aggressive efforts to prevent new HIV infections have probably played an equal or greater role in slowing the spread of the virus and containing the country’s epidemic. At the beginning of the 1990s, the epidemics in Brazil and South Africa, both middle income countries, were at a similar stage, with a prevalence of HIV infection of about 1.5 percent among adults of reproductive age. But by 1995, the year before Brazil’s treatment program was established, the HIV epidemic in South Africa had begun to explode; with a prevalence already greater than 10 percent, whereas the infection rate in Brazil had declined by half.