HIV in Brazil
Ana Paula Pfitscher
Cavalheiro
Infectious Disease Resident at
Hospital de Clínicas de Porto
Alegre
HIV in Brazil
• Population:192 million
– 85% urban
– Life expectancy: 66.7 y
– 1/3 poor (family income < 160 €/m)
• 1988 Constitution: “Health is a right for all and a
obligation of the state”
– 1985: Civil society + Government -> the National AIDS
Program
• 80s: Spread information about STD-AIDS
• 1991: AZT free access
• 1996: HAART free access
• Present: HAART, CD4/VL, genotyping in cases of viral
failure, drugs for treatment of HAART side effects
HIV in Brazil
• HIV
– Estimated prevalence: 630,000 people (<1% of
adult population)
• Half of predicted in the early 90s by the World Bank
• AIDS
– Prevalence: 0.6% of total population
• + 25-49y
– Increasing between women, heterosexuals,
socially excluded and older than 50 y
– 190,580 on HAART treatment
• By 2002 ARVs had prevented ~358,000 HIV-related
hospitalisations, resulting in a saving of more than US$1.1
billion
Source of HIV acquisition
HIV in Brazil
• HIV test is free of charge and can be done in primary care
units, hospitals or and STD/AIDS counseling testing centers
– 38% of sexually active population has already been tested at least
once
– Mean first CD4 (without HAART): 316
• 35% less than 200
• Pregnant women are usually tested for STDs and HIV as part
of their regular follow-up
– But in 2007 only 62% had been tested for HIV before labour
– Recommendation not to breastfeed
• Provision of infant formula to all children born from HIV + mothers
– Reduction of vertical transmission
• 581 in 2004 and 320 in 2006
Brazilian Guideline
• When start treatment:
• Symptomatics
• Asymptomatics
– CD4 > 500: no ART
– CD4 350-500: ART if
• Nephropaty, HCV or
HBV coinfection, VL
>100.000, > 55y,
high risk of CVD, any
cancer
– CD4 <350: ART
• AZT, 3TC, TNF,
ddI, ABC
• EFZ, NVP
• ATV, LOP/r,
SQV, /r, DRV ,
IDV
• T20
• Raltegravir
• Etravirine
HIV in Brazil
• Key points of National AIDS Program
• Prevention:
– promote frank talk about safe sex
– focus on condom promotion
• Brazil is the world’s largest condom
importer buying 1.2 billion in 2009
• state-run factory produces 100 million
condoms a year
– focus on preventing HIV among sex workers
• Treatment:
– ARV drugs are provided free to everybody who
needs;
– aggressive efforts to minimise the cost of
ARVs
Show that you´ve
grown up and know
what you want. In
this Carnival use
condom.
Living with AIDS is possible,
living with prejudice is not.
Thank you!
Sources: aids.gov.br, avert.org
datasus.gov.br, ioc.fiocruz.br
Condoms
after 50:
Try it!