Ministry of Health Health Surveillance Secretariat NATIONAL STD/AIDS PROGRAMME
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Transcript of Ministry of Health Health Surveillance Secretariat NATIONAL STD/AIDS PROGRAMME
Ministry of Health
Health Surveillance Secretariat
NATIONAL STD/AIDS PROGRAMME
National Response to HIV and AIDS in Brazil
• Population - 169.799.170 (2000)• GNP per capita: US$ 2569 (2002)
• ACCUMULATED AIDS CASES (2003): 310,310
• AIDS INCIDENCE RATE (2002): 12.8/100,000
• ESTIMATED N. OF PEOPLE LIVING WITH HIV (2003): 600,000
• PREVALENCE: 0.65% (15 to 49 years of age)
• AIDS DEATHS (1980-2002): 149,559
• MORTALITY RATE: 6.3/100,000 (2002)
BRAZIL
11146,000 (on ARV)
146,000 (on ARV)
89,000 (without ARV)
89,000 (without ARV)
365,000(majority don’t know they are HIV+)
235,000 (being monitored)
Brazil600,000 PLHA
BRAZILTrends of the epidemic
• Stabilization
• Heterosexualisation
• Feminisation
• Pauperisation
• Interiorisation
InteriorisationMunicipalities with at least one AIDS case Brazil, 1980 - 2004.
1980-1987
1988-1994
1995-2004
Fonte: PN DST e AIDS – SVS - MS.
Pauperisation% Aids cases over age 19 X schoolingBrazil, 1985 - 2002.
85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 020%
20%
40%
60%
80%
100%
3º Grau 2º Grau 1º Grau Analfabeto
Annual mortality rate by sex. Brazil, 1984 – 2002.
Source: Brazilian STD/AIDS Program
0
2
4
6
8
10
12
14
16
84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02
year of death
per
10
0,0
00 i
nh
ab
.
men women Brazil
Characteristics of the Brazilian Response• Early government response - since 1983
• Strong participation of civil society in all decision levels
• Multi-sectoral mobilization
• Specificity of Brazilian culture
• Balanced approach between prevention and treatment
Human rights perspective in all the strategies and actions
Source: IPEA/2001
295,0
394,8
595,5
445,9359,9
243,2
44,6
41,0
44,2
57,2
41,4
30,7
1997 1998 1999 2000 2001 2002
Year
0
100
200
300
400
500
600
700
(US$) Million
Federal
WB
Distribution of Public Resources in external
source WB* and Government source.
Health Promotion and Prevention
• Promotion of human rights
• Implementation of major national media campaigns
• Prevention actions for general population and specific groups
Early diagnosis of HIV infection
• STD diagnosis and treatment
Health Promotionand Prevention
Access to condoms 700 million / year
1317
2013
3839
80126
148
260 Progressive increase of Public Distribution (20x)
Steady growth of Market sales (3x)
152186
227267
325373
430497
548
700Growth trend of condom use (4.6 x)
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
139 169 207 254 287 334 350 371 400 440
Condom use (in millions of units)
Sources: DKT and PN-DST/AIDSMarketed Public Distribution
Adoption of Safer Sex practices (1998 - 2003)
Source: (1) CEBRAP/MS/PN-DST-AIDS/SVS
(2) MS - IBOPE
Use of condom in last sexual intercourse
With occasional partners (%) With regular partners (%)
64
79,5
1998
2003
0 20 40 60 80 100
21
20,2
1998
2003
0 20 40 60 80 100
(1) (1)
(2)(2)
69% of the population is sexually active
70
150
130
120
50
Number of Institutions which distribute Female Condoms, per Macro-Region2000-2003
Distribution of 4 million condoms / year
Priority Population:
Seropositive women
Sex workers
IDUs and their partners
Women victims of domestic sexual violence
5241,5
1999 2001
21,4
11,4
reduction of needle sharing
HIV BEHAVIOR
6046,2
1999 2001
HCV
HARM REDUCTION
Support to 125 projects with 65,000 ID users - estimated 20% coverage
Today 1.8 million people are tested per year
30% of the sexually active population have
taken the test.
300 and 400 thousand HIV+ are not aware of
their status.
Diagnosis is made 4/5 years after infection.
Access to HIV diagnosisGoal is to test 4.5 million a year
Impact of prevention interventions – vulnerable populations
Drop in HIV infection rates
• Sex workers – From 17% in 1992 to 6.1% in
2000
• MSM - from 10.8% in 1999 to 4.7% in 2001
• IDU - from 21% of AIDS cases 1994 to 11.4%
in 2000
Mother to Child Transmission, Brazil, 1997 to 2003
3.420
2.512
1.364
5.149
5.969 5.983
6.661
0
1.000
2.000
3.000
4.000
5.000
6.000
7.000
1997 1998 1999 2000 2001 2002 2003* Ano
N. of pregnant women
* Preliminary data
Estimated 17thousand pregnant women infected per year
Rate of Mother to Child Transmission (%) per year of birth - Brazil, 1997-2002
Tess, 1998; Succi, 2003 (preliminary data)
16
9.7
7.8
3.7
0
2
4
6
8
10
12
14
16
1998 2000 2001 2002
Health Care
HIV/AIDS services
Accredited hospitals: 375
Day hospitals: 79
Home care: 54
Outpatient services: 381
Source: UDAT/PN-DST-AIDS. March/2002
2
11
1122
1
1
2
21
531
1
11
5 31 1
4 32
1
2 1193 1 4
11
221
3111
1113
2 1 1 1
4 4
633 133210 5
5015186158174924
11 1 7 114 410
321 9 9
1
6 1 8
Access to Treatment 889 services for PLHA
Laboratories: Viral Load, CD4+ count and Genotyping
PLHA on ARV useBrasil, 1997 a Jun/2004
0
20000
40000
60000
80000
100000
120000
140000
160000
jan/
97
abr/
97
jul/9
7
out/9
7
jan/
98
abr/
98
jul/9
8
out/9
8
jan/
99
abr/
99
jul/9
9
out/9
9
jan/
00
abr/
00
jul/0
0
out/0
0
jan/
01
abr/
01
jul/0
1
out/0
1
jan/
02
abr/
02
jul/0
2
out/0
2
jan/
03
abr/
03
jul/0
3
out/0
3
jan/
04
abr/
04
146.000
Dados preliminares
ZIDOVUDINE (ZDV)* DIDANOSINE (ddI)* LAMIVUDINE (3TC)* STAVUDINE (d4T)* ABACAVIR INDINAVIR* TENOFOVIR
16 ARVs distributed
RITONAVIR* SAQUINAVIR NELFINAVIR AMPRENAVIR NEVIRAPINE* EFAVIRENZ LOPINAVIR / r ATAZANAVIR
(*) Brazilian state production available
•Universal and free of charge access to ARV - federal law Nov.1996
MEDIAN SURVIVAL AFTER AIDS
DIAGNOSIS IN BRAZIL
MEDIAN SURVIVAL AFTER AIDS
DIAGNOSIS IN BRAZIL
Source: Chequer et al, 1992; Marins et al. 2002
58
18
50
10
20
30
40
50
60
70
1989 1995 1996
Mo
nth
s o
f su
rviv
al
Introduction of Potent ARV Therapy in Brazil
LPV.r NFV EFZ 12 other ARVs
Exp
end
itu
res
(in
mill
ion
s o
f R
$)
121
131
106
215
2003
21%
23%
19%
573
37%
Access to treatment3 imported drugs take up 63% of the budget - 2003
LPV.r+ EFZ+ NFV
63%
12 other ARVs
37%
ARV drug expenditures avoided trough negotiation (In millions of US$), for 2004 - Brazil (Jan/2004)
9,4560483,7440258
7,539552
12,32544
63,65448
3
Efavirenz Nelfinavir Lopinavir/ritonavirTenofovir Atazanavir Outras negociações
Total US$ 99,7
Fonte: PN-DST/AIDS
Expenditures (In millions of US$) with ARV Drugs and Average Number of Patients under treatment - Brazil (1997-2004*)
*Data subject to alterations
224
305
336
303
232
179 181169
35,9
55,673
87,5104
119,3132,9
148,512
0
50
100
150
200
250
300
350
400
1997 1998 1999 2000 2001 2002 2003 2004*Ano
Gastos (Em milhões de US$) Média de pacientes/1000
527
SE
M R
ED
UÇ
ÃO
SOURCE: PN-DST/AIDS
** Average dollar of the year used for conversion to R$
MoH / 2003
3810
48604540
4240
3320
2223 2035
1996 1997 1998 1999 2000 2001 2002
Average cost (US$) of ARV per Patient/year -1996 - 2003*
1630
2003
* Preliminares datas
Impact of the Brazilian ARV Policy (1996-2002)
reduction of mortality 40%
90,000 deaths prevented
reduction of morbidity 70%
reduction of hospitalizations 80%
358,000 hospitalizations prevented - average of
hospitalizations / patient per year reduced from
1,65 in 1996 to 0,28 in 2003.
Impact of ARV Therapy Policy (1996-2002)
Cost Savings - US$ 2.2 billion
US$ 1.23 billion in hospitals and treatment opportunistic infections
US$ 960 million reduction in drug prices
“Life sleeps in the crude earth,
dreams beauty in the flowers,
wakes with power in the animals
and in man has consciousness
of infinite possibilities”
Yogananda