Forty years have passed since the beginning of Brazil’s AIDS policy, and the country has just over four years to achieve the Ministry of Health’s plan to eliminate HIV transmission as a public health problem.
The goal of significantly reducing new AIDS infections and deaths, which is more well-intentioned than feasible, faces enormous challenges. It is estimated that about 100,000 people in Brazil are living with HIV without knowing it, revealing flaws in the testing strategy. The volume of rapid tests has increased, but they have generally done little good for those who cannot access a diagnosis.
Among those who already know they are infected with HIV, there are at least 160,000 people who do not receive antiretroviral therapy and, as a result, lose their quality of life and can transmit the virus. In about 40,000 patients seen at SUS, treatment fails, HIV remains active in the body, the immune system is weakened and the risk of other diseases increases.
Advanced AIDS, a preventable condition resulting from late diagnosis or discontinuation of treatment, kills an average of 28 people every day in Brazil.
SUS offers pre-exposure prophylaxis, a daily pill that protects against infection during risky sexual intercourse. However, the number of new PrEP users each year is smaller than the number of new recorded HIV infections, approximately 46,000 cases annually.
Innovative technologies such as annual injections or monthly pills to prevent or treat HIV may soon be validated. But there is no clarity on what measures the federal government will adopt to integrate them into the unified system.
An example of the slowness is the drug lenacapavir, which is injected every six months, and which is already used prophylactically by citizens of many countries and recommended by the World Health Organization since last July. Since there is no agreement between the Ministry of Health and the manufacturer, it remains difficult to reach Gilead for price reductions or voluntary licensing in Brazil.
We should remember a remarkable chapter in the country’s AIDS history: national production of low-cost generic anti-HIV drugs, made possible by the drug’s patent break in 2007, was crucial to ensuring universal treatment in the United States.
The scenario now is different. A clear example of this is the case of dolutegravir — used by the majority of patients and responsible for a large portion of the Ministry of Health’s budget for purchasing antiretrovirals.
It is surprising to note that the generic laboratory Farmanguinhos sells dolutegravir to the United States at a price ten times higher than the international average for its generic version.
Excluding spending on medicines required by law, federal transfers to states and municipalities for AIDS control remained stagnant at around R$ 300 million annually, which is inconsistent with the size of the population to be reached and the ambition to eliminate HIV transmission.
Today, the SUS arsenal is incomplete; Funding is insufficient; Access to prevention, testing and treatment remains unequal.
The epidemic in Brazil remains concentrated among men who have sex with men, sex workers, transgender people, users of alcohol and other drugs, homeless people, and persons deprived of liberty. Furthermore, it disproportionately affects Black, low-income, young, and Indigenous people.
The difference between receiving treatment and contracting the disease, and between living with HIV and dying from AIDS in Brazil is no longer a problem of science alone, but has become a question above all of politics.
Not giving in to reactionary forces, promoting equality and inclusion and protecting vulnerable lives are essential steps for the country to see the end of AIDS.
Trends/Discussions
Articles published with a byline do not reflect the opinion of the newspaper. Its publication aims to stimulate debate on Brazilian and global problems and reflects different trends in contemporary thought.