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Targets and results - Latin America and Caribbean
Brazil
Cuba
Haiti
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Of all developing and transitional regions, Latin America and the
Caribbean has by far the most comprehensive ARV treatment coverage,
with 62% of those in need receiving drugs. More than a third of
those being treated live in Brazil, which is a world leader in
providing ARVs free to its population, achieved mainly through
in-country production of cheap generic ARVs. Progress in other
countries varies widely.
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In 1988, Brazil began to offer drugs to treat
opportunistic infections. Then, in 1991, Zidovudine began to be
offered. In November 1996, the government agreed to start providing
free ARVs. The government does purchase some drugs from abroad, but
the programme is based upon the domestic producers being able to
supply cheap generic copies of branded ARVs. The government has said
that the logistics of their programme are threatened by the high
prices of bought-in ARVs, but they persist in the plan because
deaths have been reduced, and quality of life has greatly improved
for those living with HIV. It was estimated in 2003 that 660,000
people were living with HIV, 60% of whom were unaware of their
infection.
In 1997, an estimated 35,900 people were receiving
treatment. This increased to 55,600 in 1998; 105,000 in 2001; and
140,000 in June 2004. At the end of 2004, between 154,000 and
160,000 people were receiving treatment, of an estimated 179,000 in
need. Spending on ARVS has followed the same pattern, increasing
from US$34 million in 1996 to US$232 million in 200112. In January
2004, it was announced that the government had reached a deal with
pharmaceutical companies to reduce the price of AIDS anti-retroviral
drugs by around a third. Health Minister Humberto Costa said the
deal would save the government about US$100 million during the year.
The price cuts brought the total annual cost of Brazil's AIDS
treatment programme to its lowest level since 1999 - US$180m - while
cutting the average cost per patient to a new low of US$1,20013. The
government proudly stated that they had halved the number of
AIDS-related deaths since 1996, when the distribution of free drugs
began.
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Cuba set up its National Commission on AIDS in 1983,
three years before its first case was diagnosed. It has since had a
'strong-arm' approach to dealing with HIV, quarantining those
diagnosed, having strict partner tracing programmes, as well as
having compulsory 8 week education programmes for those diagnosed
and providing ARVs for all pregnant women. Just a handful of
children have ever been born HIV+ on the island. Cuba consequently
has one of the lowest prevalence rates in the world, at 0.1%. At the
end of 2003, there were 3,300 people living with HIV.
No ARVs were available in Cuba up until 2001 because
of the US trade embargo. However, in 2001, Cuban laboratories began
making generic ARVs and now Cuba is one of only a few developing
countries producing their own supplies of the drugs to all people
living with HIV who need treatment14. Latest available data records
1,500-2,000 people receiving ARVs in Cuba, which is more than the
number thought by UNAIDS/WHO to be in immediate need. The island's
mortality rate from AIDS has now dropped to as low as 7% of patients
with AIDS. Because of it success in providing ARVs for its own
population, Cuba is now looking to export generic drugs to other
developing countries.
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It is estimated that 280,000 people are living with
HIV in Haiti, which gives the country a prevalence rate of 5.6%. The
yearly total health budget is US$15 million, so the government could
not have provided ARV treatment unassisted. Treatment began in 1998
in rural Haiti through a US organisation called Partners in Health.
The Global Health Fund, USAID and the Bush Presidential Emergency
Relief Fund all later pledged money for Haiti.
The Global Fund was the first international donor to
provide money for ARV purchasing. In conjunction with the Haitian
Ministry of Public Health, money has been used to provide HIV
prevention and treatment throughout the country; in Port au Prince
at GHESKIO centres and in central Haiti by Partners in Health's HIV
Equity Initiative. Providing a comprehensive treatment programme has
necessitated revitalising the public health infrastructure, and this
has subsequently improved basic healthcare for all.15, 16, 17
At the end of 2004, an estimated 3,000-4,000 people were using ARVs,
out of 42,500 in need. It seems certain that the government failed
to meet their target of 5,000–10,000 people on treatment by the end
of 2004.
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