Brazilian policy of universal access to AIDS treatment: sustainability challenges and perspectives

INTRODUCTION: The Brazilian AIDS Programme success is recognized worldwide, due to its integrated approach of prevention, respect for human rights and to free of charge universal access to state of the art antiretrovirals. CURRENT SITUATION: As of 2006, 180, 000 people living with AIDS are on HAART with 17 drugs available, receiving medical and laboratory care through the public health system. Costs for ART drugs reached US 400 million in 2006 and will increase steeply if the current trends are maintained: uptake of approximately 20, 000 new patients/year and the need for more expensive, patent-protected second and third line drugs. DISCUSSION: We discuss the strengths and weaknesses of the programme, budgetary pressures, the need for more intense preventive efforts, for boosting local production of new drugs, for more investment in research and development and the issue of voluntary and compulsory licensing. There are many hurdles in pursuing long-term sustainability, which depends on country driven initiatives and international collaboration and participation. CONCLUSION: We conclude that the Brazilian experience demonstrated the capability of a developing country to treat people with equity, independently of race, gender or economic power and that this equality "seed" has already spread to other countries. Internally this experience must be used to tackle other endemic diseases, such as leprosy, malaria, dengue and leishmania. The Brazilian political will has been proven but, once again, there will be the need for concerted action by civil society, researchers, health professionals, people living with HIV/AIDS and the government to convince the world that health needs should not be treated as commercial issues, and that progress in research and development must be shared throughout the world if we expect to survive as a civilization.