Politics and Policy of HIV/AIDS

Panel I: Undergraduate and Graduate Student Research on HIV/AIDS in Brazil
Panelists:
David Martin, Harvard College 07
Amy Nunn, ScD, Harvard School of Public Health, dissertation: “The Politics of Life and Death: A Historical Institutional Analysis of Antiretroviral Drug Policy in Brazil”; Corporate Relations Manager, Global Business Coalition on AIDS, Tuberculosis and Malaria
Sophia Zamudio-Haas, M.S. Candidate in Population and International Health, Harvard School of Public Health.
Moderator: Lorena Barberia, Program Associate, Brazil Office, David Rockefeller Center for Latin American Studies

Amy Nunn:

• Global context of the epidemic. In the world, only about 1.6 Million of 7 million needing HAART receive it
• Brazil was the first country to implement HAART and has the most people on it. ABout 175,000 right now.
• What social and political processes best explain the development of Brazil’s AIDS treatment institutions?
• -case study approach, 86 people in 91 interviews; 5000+ news articles, cong records, etc.; descriptive historical data. Using a historical institutionalist approach.
• 1990: Brazil’s first federal commitment to provididng drugs for AIDS treatment.
• 1996: Law 9.313 establishes foree and unversal access to drugs and treatment (Sarney’s Law)
• 1997: AIDS treatment costs rise dramatically b/c of the scale up and the new regime of respecting intellectual property laws
• Inst’ns: 1998-scale-up of ARV prod’n. 2000–Brazil’s tradition of threatening to issue compulsory license to reduce the price of patented ARVs. 2001-06: Brazil’s contributions to international health, human rights and trade institutions related to essential medicines (introduction of a number of resolutions in international fora)
• Outcomes: USTR files but later drops trade complaint; Multinat’l pharma companies drop ARV prices; Brazil negotiates ARV prices and price negotiation traditions endure
• Brazil’s costs have gone up, but it has saved about $1B through it’s pricing negotiations
• Brazil’s actions have affected the global treatment
• – Showed that resource-poor settings could have treatment
• – dramatic increases in AIDS and global health spending
• – Flexibility on intellectual prop rights and public health issues
• -1.6M on ARV today
• -never would have happened if Brazil hadn’t taken its actions
• Key Findings:
• -Brazil’s strategies were born in Brazil and the result of local initiative
• -Democ and regime change have provided instituional openings for social movements
• -Middle-income countries can and do have an enormous impact on global policies and regimes

David Martin, Undergrad H&S Harvard

• Brazilian response has three factors
• -Social mob’n via civil society mechs
• AIDS policy via int’nal mechs
• Technological developments in HIV treatment
• Response successful becuase
• -AIDS elicited a quick response
• -adaptability of AIDS policy to changing face of the epidemic
• -intro of new, effective treatment options
• AIDS and democratization
• -umbrella mov’t for previously voiceless
• -reveled the public health crisi and the social fractures within Brazilian society
• Civil soceity–what’s its role?
• -Augments the quality of the treatment program: provided some social infrastructure in geographic areas not covered and helped with the negative social manifestations of the disease(stigma, emotional support, reintegrate into society, poverty)
• Talked about an NGO in Recife as an illustration of the interaction of civil society institutions with government. Specifically, “Gestos, Soropositividade, Comunicacao, e Genero”
• Tech and Civil Society
• -Response to HIV became subject to international influence (TRIPS, compulsory licensing, etc.)
• -Increasing reliance on ARV meant a decreasing role of civil society
• Medicalization of AIDS (neglect of the social problems that stem from having AIDS)
• -ARVs only address teh physical aspects, neglecting the social dimensions of HIV, which is what the civil-society groups did.
• Sustainability of Brazilian Response?
• -Precarious balance between the social and physiological mechs of epidemic control
• -society demobilizing as HIV has become a chronic, managed disease
• -not clear what the financial sustainability of ARVs is.

Sophia Zamudio-Haas

• Presentation of the volunteer work she did for a year in Rio.

One question that the first two panelists raised that I don’t think were adequately answered was whether Brazil’s HIV policies dramatically changed global practices regarding HIV. From what I know of the global regimes, this isn’t a far-fetched notion, but I did not see any systematic evidence to support this sort of causal claim. It’s a fairly strong causal statement, and I didn’t see evidence or methods that supported the reach of that claim. In talking with Amy, she said that she’s been surprised that more people don’t know about the international dimension. Her proof is in the historical documentation that she was able to do on Brazil’s action in multilateral fora. I’m going to try to get a copy of the dissertation.

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