Countries that deal with AIDS belatedly or half-heartedly pay a price—both in lost lives and added health care and social costs. Brazil avoided a large-scale AIDS epidemic by adopting visionary policies and making bold investments early on. Brazil’s approach is now generating a global reassessment of the prospects for managing AIDS in developing countries.
As co-founder and subsequently director of the National AIDS Program in Brazil, and as president of its National AIDS Commission, Pedro Chequer helped to design policies that are being studied worldwide. Since March 2001, he has served as an advisor to the UNAIDS regional program for South America, specializing in Southern Cone countries. He holds a medical degree from the University of Rio de Janeiro and has completed additional studies in Brazilian and U.S. universities.
Chequer recently spoke to IDBAmérica about Brazil’s experience with AIDS.
IDBAmérica: Brazil’s AIDS strategy is now viewed as a model of success. How did it happen?
Chequer: Brazil took crucial steps when the scope of the epidemic was still unknown. In 1986, the decision was made to create an AIDS division with its own administration. Next, a national commission was formed with the participation of ministries involved in the issue, NGOs, universities, researchers, intellectuals, and social specialists.
In the beginning, the key to the program was the alliances forged with society and the high technical level of the medical officials involved, which lent credibility to the strategy. Today, the program continues to invite technicians from specialized fields—such as women, children, homosexuality, and data analysis—who provide a critical and innovative vision of the process.
IDBAmérica: What kind of cooperation did the program receive?
Chequer: One of our first objectives was to decentralize operations by seeking to create solid partnerships with states and municipalities.
The media helped to sensitize, inform, and educate Brazilians about AIDS. We made sure we informed the media about the technical and human aspects of the disease and its treatment. Brazil has invested a lot in communication, running national campaigns that have amounted to a true media blitz on all television stations, radio networks, and print media outlets.
Cooperation agreements with the political opposition have ensured the approval of laws and budgets and have provided continuity to the program despite changes in governments.
In general, the level of approval and awareness among citizens is very high. There is evidence that condom use and other prevention practices are widespread.
IDBAmérica: What role has the Church played in this process?
Chequer: In the beginning, the Church wanted to control information, but this met with strong resistance from the Ministry of Health and from the AIDS Program. Abstinence, fidelity and marriage were just not for everyone; condoms were the most sensible option for many. Since 1997, we have been dealing with the chairman of the Bishops Conference and the Church is now our great ally.
IDBAmérica: Brazil is currently manufacturing some of the patented drugs and is promoting partnerships with other countries for this purpose. Could this reduce incentives for pharmaceutical companies to invest in future treatments or cures?
Chequer: The pharmaceutical companies make so much money in the first world that they do not need to do business in the third world to make a return on their research investment. Our goal is to offer universal treatment to our AIDS patients at an affordable cost.
IDBAmérica: Another pillar of the Brazilian strategy is an extensive network of diagnostic and treatment services. Was this the product of the campaign against AIDS?
Chequer: Brazil has invested a lot of resources in training specialized personnel. Today we have excellent human resources, and our diagnostic and treatment centers throughout the whole country are linked by computer. Patients receive care and treatment at centers that are close to their residence, wherever they may live.
IDBAmérica: Brazil spends $300 million annually in antiretrovirals alone. Maintaining such an extensive network of services and personnel entails an enormous investment. Were doubts ever expressed about such an intensive use of resources?
Chequer: The 1998 financial crisis put universal access to treatment in jeopardy. We still didn’t have any results and we couldn’t defend the program with data. The health minister wanted to cut our spending. What saved us was our direct line to the president.
Now we can use figures to demonstrate the outstanding results of the program in reducing morbidity and mortality and the spectacular savings in hospitalization and care costs. The AIDS program is one of the country’s exportable items.
IDBAmérica: In what sense is the Brazilian model “exportable”?
Chequer: No process is 100 percent reproducible. In some countries it is crucial to organize civil society, and the IDB is helping us a great deal in this regard. Sensitizing the mass media is also important. Silence is the biggest danger. In Brazil the people and the media support the campaign. Something similar to this must be achieved throughout Latin America and the Caribbean.