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AIDS in Brazil at Harvard, Panel 2

Panel II: A Comparative Look at the Brazilian Response to AIDS

Varun Gauri, Senior Economist. Development Research Group, World Bank
João Biehl, Associate Professor of Anthropology, Princeton University; author of Will to Live: AIDS Therapies and the Politics of Survival (Princeton Univ. Press, forthcoming).
Cristina d’Almeida, National Agency for Research on AIDS, France
Moderator: Eduardo Gómez, Politics and Governance Group, Harvard School of Public Health; dissertation: “Contested Epidemics: Institution, Global Politics and Response in the United States and Brazil

Varun Guari, “Institutions and Identities: Explaining Gov’t Responses to HIV/AIDS in Brazil and South Africa”

  • Summary of his research with Evan Lieberman
  • Came out as a paper in Studies in Comparative International Development (Fall 2006). Also coming out as a chapter in “Public Health and Human Rights”
  • Ethnic boundaries and fractionalization are among the most salient characteristics in explaining response levels.

João Biehl

  • Most social science explanations explain HIV policies as a result of social movements. he wants to identify some of the other political and social mechanisms, obtained by broad ethnographic field research.
  • AIDS policy as a marker of success of Cardozo’s model of the inter-permeability of the state and civil society. “Governmentality in action.”
  • A new political economy of pharmaceuticals is one of the social and political explanations that must get attention. Trade in pharmaceuticals has increased markedly since Brazil accepted international norms on intellectual property.
  • Once a government designates a disease as the “country’s disease”, a market takes shape. Thus, the preferences of the pharmaceutical industry become integral to public health policy. As drugs lose their efficacy, government will shift its preferences to new drugs developed by the pharma companies.
  • PEPFAR, e.g., favors large-scale pharmaceutical intervention, but does not address health care delivery, prophylaxis, and education with the same vigor.
  • Since the HIV policy is seen as the success of the previous government, the new government is seeking its own policy, and in Brazil, the preference has always been for electoral expediency over policy continuity.
  • Some 80 percent of expenditures are for ARVs/drugs. This is the movement to drug monopoly.
  • Sustainability of the policy has to be constantly renegotiated in the marketplace.
  • The political grounds of existence become individualized and (poor) AIDS patients rarely become activists. And the patients find themselves often not having a unit of belonging, like a family.

Cristina d’Almeida, “Comparative Look at the Brazilian Response to AIDS” (crisdalmeida at gmail dot com, calmeida at seg dot univ-paris13 dot fr)

  • Networks, the new trend on South-South Coop
  • -Overcome IP and trade barriers
  • -Local capacity/capacitation strengthening
  • -national autonomy strengthening
  • Descriptions of two networks: the Lacos Sul-Sul network (policy sharing), and the Technological Cooperation Network on HIV/AIDS (technical/technology experience sharing)
  • Milestones of the two networks (chronologies of the meetings and some of the inter-meeting activities)
  • Summary of the main achievements of the Lacos Sul-Sul network, summarized by country. Mostly the provision of HAART, health expert training, prevention education, and surveillance/data improvement.
  • Achievements of the Technological Cooperation Network: ID the state of the Art in member countries, est. technological coop, elaborate joint guidelines for quality control of ARV manufacturing
  • Challenges?
  • -Lacos Sul-Sul: budget constraints, and diversity of the problem in member countries
  • -Tech Coop Network: budget constraints, contrasting national HIV policy and industrial policy, differences in national drug procurement and price negotiation systems

Questions followed.

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