The Politics and History of AIDS Treatment in Brazil (eBook)

Dr. Amy Nunn is a postdoctoral research fellow in the Division of Infectious Diseases at Brown Medical School where she conducts research on HIV testing, HIV risk behaviors, and how to best link people living with HIV/AIDS to treatment and care services. A social scientist by training, Dr. Nunn has worked in several countries where she conducted domestic and international research on a variety of health policy topics including HIV/AIDS, patient safety, access to reproductive health services, and family planning. Her current HIV/AIDS research is financed by the National Institutes of Health and the Brown University Center for AIDS Research. She has received research grants from Harvard University, the US Department of Defense, and the US Department of Education. Dr. Nunn holds masters and doctoral degrees from the Harvard School of Public Health and is a Fulbright Scholar.

Introduction 19
Ezio’s Story 19
AIDS in Brazil 20
The AIDS Crisis and Democratization in Brazil 28
Brazil 28
Building Democracy in Post-Authoritarian Brazil 32
The State and Public Health 35
AIDS in Brazil 37
Brazil’s AIDS Program 39
Democratization and Institutional Precursors to AIDS Treatment in Brazil 47
Sanitarista Health Reform Objectives 47
Reformers Working Within the State 49
Brazil’s First Public and Civil Society Partnerships for AIDS 50
The Evolution of Sanitarista Strategiesin Postauthoritarian Brazil 52
AIDS Activism in Rio de Janeiro State 54
The 1988 Constitution and the Right to Health 56
Development of Brazil’s First AIDS Treatment Institutions in a New Democracy 61
Social Movements Infiltrate the State 61
Early Federal AIDS Programs 62
The Genesis of the AIDS Movement 65
Committing to Treat AIDS 70
National AIDS Program Partnerships with the AIDS Movement 77
Mounting Pressure for AIDS Treatment and Brazil’s First World Bank Loans for AIDS 80
Legislative Reforms and AIDS Treatment in the 1990s 91
Public/Private Partnerships to Develop AZT 92
Public Production of AZT 94
Industrial Property Law 9.279 96
Fernando Henrique Cardoso’s 1994 Presidential Victory 96
Brazil and the World Trade Organization 98
Law 9.279’s Implications for AIDS Treatment 100
Political Action and Chronic Shortages in Drug Supplies for AIDS Treatment 101
Sarney’s Law: Law 9.313 103
Cumulative Impacts of the Industrial Property Law and Sarney’s Law 107
Development of Brazil’s Contemporary AIDS Treatment Institutions 111
Sanitarista Leadership in the National AIDS Program Bureaucracy 111
World Bank AIDS II Loans 116
AIDS II and the AIDS Movement 118
The Evolving Political Context of the Late 1990s 120
The 1998 Drug Policy Reforms 124
A Decisive Step: José Serra and the Domestic Production of ARVs 125
Brazil’s Contributions to Global Essential Medicines Institutions 135
Growing Political Momentun for Affordable Access to Medicines 135
The Global AIDS Treatment Movement 136
Global Launch of Generic ARVs 137
The Global Fund to Fight AIDS, Tuberculosis, and Malaria 139
José Serra’s Essential Medicines Strategy 139
Brazil’s Efforts to Change Global Essential Medicines Institutions in 2000 142
Brazil’s Contributions to Global Essential Medicines Institutions in 2001 143
Intellectual Property and Human Rights Resolution 147
US Drops WTO Dispute 150
The UN General Assembly Special Session on HIV/AIDS 151
World Trade Organization 152
Price Declines for ARVs in Brazil 155
The Symbiotic Relationship between José Serra and the AIDS Movement 156
Brazil’s Contributions to Essential Medicines Institutions from 2002 to 2006 158
Brazil’s Enduring Legacies 159
Conclusion 164
Building Brazil’s AIDS Treatment Institutions 165
Costs and Compulsory Licenses 167
Looking Ahead 171
Global Impact 173
Implications for Other Countries 174
Study Strengths and Limitations 178
The Brazilian Model 180