Brazil Health Official On Progress of HIV Prevention

Public Health officials from around the world met this week at a United Nations conference about the HIV/AIDS global crisis. Dr. Mariangela Simao, the director of Brazil's program against HIV-AIDS, is a featured guest. She discusses the conference and a new report about improved access to medications used to treat HIV.

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CHERYL CORLEY, host:

There was a top-level meeting at the UN this week to review efforts to prevent and treat HIV/AIDS. UN Secretary-General Ban Ki-moon told world leaders that two and a half million people became infected with HIV/AIDS last year, far outpacing the one million that started using important anti-retroviral drugs. The UN has both a Declaration of Commitment on HIV/AIDS and a corresponding political declaration in place. And one of its goals is to provide universal access to treatment by 2010. That's been a huge problem in some parts of the world for AIDS victims. But there's been significant progress in Brazil.

Here to talk more about this is Mariangela Simao, who heads Brazil's national program against HIV/AIDS. Welcome to the program.

Dr. MARIANGELA SIMAO (Director, Brazil's program against HIV/AIDS): Thank you, Cheryl.

CORLEY: Well, Brazil has largely fought HIV/AIDS by producing anti-viral drugs at a reduced cost, making it accessible to most people in the country. But that's really a controversial move because Brazil doesn't have permission to do so by companies with patents on those drugs. So tell us how this program has been working.

Dr. SIMAO: Yeah, I think first we have to make it very clear that the Brazilian production of ARV drugs is permitted by international regulations, as the drugs that are being produced locally were not under patent when Brazilian patent law was approved at the Congress. ..TEXT: CORLEY: So you're saying it's doing this legally, then.

Dr. SIMAO: Yes, sure. We have seventeen drugs that are available for Brazilian patients. Eight of these drugs are produced in Brazil, and not one of them was protected by patent. But, Cheryl, I think you raise the point because last year Brazil made use of the flexibilities that are allowed in international regulations and legislations and agreements, like the Doha Declaration on TRIPS and Public Health. And Brazil issued a compulsory license for one ARV, which was Efavirenz from Merck.

And by doing so - and that was all done strictly in accordance to the national regulations and to the Brazilian legislation - and by doing so, we were able to like save more than thirty million dollars in just one year. And with that money, what did we do?

We introduced a new drug that is used - what's called now, a third line drug, that's used for patients who have already failed all types of treatment for AIDS. So what we are really doing is looking for sustainability, long-term sustainability. And we are not willing to pay more than we should for drugs that are available in the market for a long time.

CORLEY: Well, another difference between Brazil and many other countries fighting this disease is your use of non-governmental organizations. And how are your NGOs doing this?

Dr. SIMAO: You have to understand that when the epidemic started in Brazil, it was at a time that there was a real democratization of the country, and we were establishing a national health system, a public health and so on. And saying that in the constitution, that providing health care and right to health was a citizen's right and that the state had to provide it.

And at the time, the NGO movement in Brazil, especially those groups that were most affected by the epidemic in the beginning of the '80s and the beginning of the '90s, came out really strong with the government, pressing the government to provide like treatment, care and support for people affected by AIDS.

And so we right now - Brazil - I think we can say that we have a balanced situation with NGOs. The government finances many of the prevention activities that are executed by NGOs. And we have a formal decision-making forum where NGOs are part of them now, where we decide on the national policy and decide on what the priorities are for the country as a whole.

So when we talk about the Brazilian experience, we don't say the government of Brazil or we don't say that - we say the Brazilian response, because the Brazilian response was made up by the government, by the civil society organizations, by the university and researchers that work with us and fight against AIDS.

CORLEY: Have pharmaceutical companies been complaining about Brazil's manufacturing at all?

Dr. SIMAO: Actually, you see, I like to use the example of Merck. Merck was the owner of the patent of Efavirenz, the medicine that we issued a compulsory license. Merck, after the last year when Brazil issued this compulsory license - in the beginning of this year, Merck has already registered a new drug in Brazil. So we do have a commercial relation with the pharmaceutical industry.

Brazil is a big market. We have 180,000 people in treatment now, which is one of the highest numbers in the developing world. And we have very good coverage. And only the Ministry of Health buys ARVs. So it's in the best interest of us, the patients and of the pharmaceutical industries that we reach the best deals for everybody. And for us, paying the best prices, as we are a good buyer. We buy large quantities. We pay on the dot. So I would say we do have a good working relationship with the pharmaceutical industry.

But we fight every year to lower down the prices of ARVs. As we understand, we have a duty to provide for patients the best treatment available. But we have to work with our budget, and we have to think about long-term sustainability.

CORLEY: It's interesting that you mention Merck. I understand your president has authorized Brazil to break the patent on an AIDS drug made by Merck and to import a generic version from India instead. So are those the types of things that you will be continuing to do?

Dr. SIMAO: If necessary, because the Brazilian way is always to negotiate prices. What happened with Merck was that Brazil was paying one dollar fifty-nine cents per tablet. And we wanted to pay the price that Thailand was paying at the time, which was seventy cents. We ended up coming to Merck. Merck offered us three cents of discount. The company offered us to sell it for one fifty-six dollars. And we are buying it for thirty-nine cents from a generic version made in India, but from two different generic labels. So we are always trying to lower down the price.

I think that's our goal, to ensure that universal access in Brazil is sustainable on the long term. Because right now, like I said, we have 180,000 people with treatment, and it's free treatment. And we have, every year, around 15, 17,000 new patients entering treatment. So we have to think in the long term.

CORLEY: If you're just joining us, you're listening to Tell Me More. I'm Cheryl Corley and we're speaking with Mariangela Simao, who heads Brazil's program against HIV/AIDS. And she attended the world meeting on AIDS sponsored by the UN.

I wanted to take you back to the decision to go ahead and get the generic drugs from India. Merck said it was profoundly disappointed, calling the decision a quote "misappropriation of intellectual property that would stifle research." And I was wondering if you had any fear of that at all?

Dr. SIMAO: Not at all. The studies, when they come to our country, they are already advanced phases of studies, you know. Actually, Merck cannot say we didn't try to negotiate because I think we had like 14 meetings with Merck. And Merck always wanting that we wouldn't give Brazil any price different or lower or at least closer to what they're practicing to the other countries. And we used Thailand as an example at the time because Thailand is very similar to Brazil.

And also, nowadays I use Merck as an example that we did not put companies away. They don't want to come to Brazil, as Merck has already registered with our FDA, the regulatory agency in Brazil. Has already registered a new ARV, you know, and we are all analyzing it to see whether we're going to introduce it in the now guidelines or not.

SO if Merck thought that Brazil was unreliable, Merck wouldn't register a new drug in Brazil. So what we do have is a commercial relation. Merck already offered to sell.

CORLEY: You're not just keeping the fight local. You're taking it to other countries, and the president of Zambia, for instance, has complimented Brazil for donating Portuguese-language material on HIV/AIDS. And it was later distributed in Zambia, a former colony, of course, of Portugal. Tell us about this.

Dr. SIMAO: We have a community of Portuguese-speaking countries: Portugal, Brazil, Guinea-Bissau, Sao Tome and Principe(ph), Cape Verde, Mozambique, Angola and East Timor. And we share a language, which is - even with the local differences, it's very, very important that we have a common way of communicating.

We had a meeting in Rio last month with UN aides and the Brazilian government and with representatives from the Ministry of Health and the Ministry of the Women's Affair in all these countries to discuss how to deal with the AIDS epidemic and gender imbalance, gender at the social-economic, social-cultural impacts of gender imbalance and AIDS in our countries.

I'm just saying that as an example of how we can work collaboratively as a network and help each other. Also, because we do with some of these countries, we provide treatment with ARVs produced in Brazil. For example, in Guinea-Bissau we provide like 1,100 treatments for people who live with AIDS in Guinea-Bissau with Brazilian-produced drugs. And that's a kind of solidarity type of cooperation, you know, because Brazil's not a rich country but we share our doctors and the doctors from Guinea-Bissau, they come to Brazil and they're trained in Brazilian health centers, and they go back and we help them and we help each other. And I think that is quite appropriate for the Portuguese-speaking countries to work together with such issues that affect all of us.

CORLEY: Mariangela Simao is the director of Brazil's national AIDS program. She joined us from New York where she attended the joint UN program on HIV/AIDS. Thank you so much.

Ms. SUMAR: Thank you, Cheryl.

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