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The Politics and History of AIDS Treatment in Brazil
Amy Nunn, Center for AIDS Research, Brown University Medical School, Providence
In 1992, the World Bank warned that Brazil would face enormous challenges confronting the AIDS crisis, and forecast that Brazil would have 1.2 million people living with HIV by the year 2000. Today, AIDS prevalence in Brazil is approximately 660,000, and Brazil is home to the oldest and one of the largest public AIDS treatment programs in the developing world. Challenging the conventional wisdom that AIDS treatment was infeasible in developing countries, Brazil has halved AIDS-related deaths and dramatically reduced AIDS-related morbidity. Today, Brazil’s AIDS program is considered a global model.
The first book to narrate Brazil’s complex and inspiring history, The Politics and History of AIDS Treatment in Brazil traces development of Brazil’s AIDS treatment policies during the country’s tumultuous path to democracy as its government redefined access to health care as a basic right. Meticulously researched, and drawing on dozens of interviews with politicians, activists, people living with HIV/AIDS, pharmaceutical executives and health care providers, this profound volume explains the key role of Brazil in raising global AIDS consciousness. The Politics and History of AIDS Treatment in Brazil also explores the global implications of Brazil’s program and identifies the challenges ahead for addressing HIV/AIDS in the developing world.
In clear, accessible detail, The Politics and History of AIDS Treatment in Brazil examines:
- Brazil’s long history of AIDS treatment in the context of progressive social movements.
- The coalition-building between politicians, activists and government agencies in developing the country’s National AIDS Program.
- The role of the executive, legislative and judicial branches of government in promoting access to drugs for AIDS treatment in Brazil.
- The government’s controversial decisions to produce generic AIDS drugs and challenge multinational pharmaceutical corporations regarding AIDS drug prices.
- Brazil’s ongoing efforts to promote global access to AIDS treatment and the country’s contributions to international health, human rights, and trade law related to access to medicines.
- The impact of the Brazilian experience on global AIDS drug prices and global AIDS treatment policy.
The Politics and History of AIDS Treatment in Brazil contains invaluable lessons for readers across disciplines, particularly researchers and practitioners in health policy, global health, HIV/AIDS, political science, and Latin American studies.
“This is an exceptional academic work, one that deserves to be widely read, and that in my opinion will come to be considered the leading historical study on the social and policy response to the HIV/AIDS epidemic in Brazil – and one of the major policy studies on the response to the AIDS epidemic anywhere in the world.”
Richard Parker, Mailman School of Public Health, Columbia University
With foreword by former Brazilian President Fernando Cardoso.
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Amazon Average Rating 4.0/5.0
The Politics and History of AIDS Treatment in Brazil
Nunn provides a recap of the steps that led to Brazil’s successful implementation of universal treatment for people living with HIV. Like many successes in public health, it represented a fortunate alignment and convergence of various forces that occurred in a series of important but rather serendipitous moments. HIV in Brazil has received less ink than the well characterized epidemic in Thailand and the large African epidemics. It’s instructive that HIV in Brazil once made up a much larger proportion of the global epidemic. Her documentation of the internal politics of HIV, the international politicking on intellectual property and the role of the World Bank are all useful contributions to the literature. Several factors, though, knocked off a couple stars. The writing is often tedious and repetitive, and some key points beg for elaboration such as a brief review of how the epidemic evolved in different segments of the population and the role of specific NGOs in these populations. The NGO sector is treated as a bloc and there is little attention to the dynamics of these organizations (e.g., their reliance on charismatic leadership, their jockeying for position, and their relationships to other civil society players and to the political system). Only near the end of the book is there any comparison with other countries and even this is deficient. For example, Thailand, like Brazil, made an early commitment to AZT; however, the cost and limited efficacy of AZT led to a very cautious course with embracing more effective drugs, post-Vancouver.
The book looks like a Fulbright progress report or a policy dissertation that has been padded out to a book length. It will be most easily read and used by experienced HIV researchers and policy people who have at least cursory knowledge of HIV in Brazil, although gaps around description of the NGO sector may be problematic. People with less international knowledge or more recent entry into the field will find the book more challenging and frustrating because of its lack of context, despite the large number of reference citations.
Rating: 3 / 5
Brazils AIDS program is world-renowned for its policy of providing free and universal access to AIDS treatment, successful civil society partnerships and prevention programs. This book, grounded in extensive qualitative, quantitative and historical research, and is an exceptional work that explains how Brazil improved access to AIDS treatment at both domestic and international levels. Amy Nunn begins with an excellent overview of the AIDS epidemic and genesis of AIDS treatment in Brazil.
She then demonstrates how Brazil strategically used World Bank loans, public production of AIDS drugs, collaboration with international agencies, and strategic engagement with the media and global social movements to support its controversial, if highly successful, AIDS policies. This book is suitable for a wide audience and should be considered essential reading for anyone interested in AIDS policy and global health.
Elize Massard da Fonseca is a PhD Student in Social Policy – University of Edinburgh, United Kingdom.
Rating: 5 / 5
In developing countries, successful social policy initiatives are rare. Brazil, for instance, is notorious for having educational and health indicators that lag behind its economic development level. But as Amy Nunn analyzes in this very thoroughly researched book, Brazil did succeed in averting a looming health crisis by building up a rather successful program of AIDS treatment. The book skillfully traces the role of social movements and professional activists who found positions inside the Brazilian state in the course of the country’s lengthy democratization. Nunn also analyzes Brazil’s bargaining with multinational pharmaceutical companies. While not lighting any big theoretical fireworks, the book offers a highly informative, well-researched study of an interesting instance of “good government in the tropics.”
Rating: 4 / 5