UNGASS-HIV/AIDS: a review of the Brazilian response, 2001-2005

FOREWORD

UNGASS-HIV/AIDS: a review of the Brazilian response, 2001-2005

Alexandre Grangeiro^I; Dulce Ferraz^I; Regina Barbosa^I; Dráurio Barreira^I; Maria Amélia de S M Veras^II; Wilza Villela^III; José Carlos Veloso^IV; Alessandra Nilo^V

^IInstituto de Saúde. Secretaria de Estado da Saúde. São Paulo, SP, Brasil

^IIFaculdade de Ciências Médicas da Santa Casa de São Paulo. São Paulo, SP, Brasil

^IIIUniversidade Federal de Medicina. São Paulo, SP, Brasil

^VIGrupo de Apoio e Prevenção à Aids. São Paulo, SP, Brasil

^VGestos Soropositividade, Comunicação e Gênero. Recife, PE, Brasil

^{Correspondence}

Recognizing the HIV/AIDS pandemic as an unprecedented worldwide emergency and one of the greatest challenges to life and the enjoyment of human rights, the United nations called on member states to reflect on this matter. In June 2001, around 20 years after the first AIDS cases were recorded, the United Nations General Assembly Special Session on HIV and AIDS (UNGASS HIV/AIDS) was held in New York. The Session culminated in the drafting of the Declaration of Commitment on HIV and AIDS:⁴ a document that reflected the consensus between 189 countries, including Brazil, and stated some essential principles for an effective response to the epidemic. The Declaration recognized that economic, racial, ethnic, generational and gender inequalities, among others, were factors that boosted vulnerability and, whether acting separately or in synergy, favored HIV infection and the onset and evolution of AIDS.

The Declaration of Commitment on HIV and AIDS has become transformed into a tool for reaffirming the urgency and necessity of promoting the solidarity that the epidemic demands. It aims towards better management of the actions and resources destined for controlling HIV and AIDS⁵ and towards social control over public HIV/AIDS policies.

The document emphasizes the importance of promoting actions that combat discrimination against people with HIV; that reduce the vulnerability of the segments of the population that are most exposed to becoming infected and ill; and that support AIDS orphans. It adopts the paradigm that governments have a responsibility to ensure access to treatment and prevention as indissociable actions, and recognizes that results cannot be achieved solely by governments. Thus, it reaffirms the importance of involving civil society at all stages of constructing the response, thereby reinforcing the principle that people living with HIV/AIDS should participate in the process.

The Declaration is divided into 11 chapters: leadership; prevention; care, support and treatment; human rights; reduction of vulnerability; orphans and children who are vulnerable to HIV/AIDS; reduction of the social and economic impact; investigation and development; regions affected by conflicts and natural catastrophes; financial resources; and monitoring and assessment. Each chapter includes commitments and targets to be achieved at the national, continental and global levels, using the years 2003, 2005 and 2010 as reference points.

In 2003, as foreseen, the first assessment of the progress towards fulfilling the targets and commitments taken on was made. Out of the 189 signatory countries, 103 submitted national monitoring reports to the United Nations.⁵ Most of the reports presented a variety of limitations regarding the quality of the information and the participation of civil society in drawing them up. According to the United Nations itself, these limitations made it difficult to analyze the progress in controlling the HIV/AIDS epidemic achieved around the world over this period, and to come to valid conclusions. One example of this is that fewer than 20% of the countries presented data that were broken down according to sex, age and geographical regions.

In June 2005, with the objective of assessing the targets set for that year, the United Nations held a preparatory meeting for the second progress review on the targets and commitments.⁶ This second review is scheduled for June 2006, and is also known as UNGASS+5. The conclusions from this preparatory meeting revealed challenges that were even greater that those on which the adoption of the Declaration of Commitment in 2001 were based. In 2005 alone, almost five million new cases occurred; the Joint United Nations Program on HIV/AIDS (UNAIDS) registered 3.1 million deaths and around 40 million people living with HIV/AIDS all around the world,³ of whom the great majority were in poor and developing countries. Even though these results were preliminary, they showed that, generally, governments were still not basing their actions on the recognition of human rights, or mobilizing at the speed and with the technical quality needed to face up to the epidemic.

In 2006, during UNGASS+5, the obstacles and opportunities for implementing the Declaration will be reviewed, on the basis of the reports from each country and the various consultations that have been made regarding the attainment of universal access to support, treatment and prevention. The meeting will also have the objective of renewing the global political commitment towards facing up to the epidemic. It will involve different sectors of the international community: governments, civil society, private sector and people living with HIV/AIDS. A session of hearings for civil society will be held, with the expectation that this occasion will enable an exchange of views and opinions between representatives from civil society and the member states.

In Brazil, civil society has had active participation in this process since 2001, and formed part of the Brazilian government's official delegation to UNGASS HIV/AIDS. In 2003, the deadline set for handing over the first national reports to the United Nations, there were initiatives from the government and from civil society aimed at following up how the commitments and targets in the Declaration were being put into effect. At that time, the Ministry of Health sent a report to the United Nations that was subsequently discussed nationally. During this same period, the non-governmental organization (NGO) Gestos (from Pernambuco) and the São Paulo NGO/AIDS Forum held the First Brazilian UNGASS Forum, which became a formal space for civil society to discuss and follow up the Declaration in Brazil. To date, there have been three national UNGASS forums, two state forums and one regional forum, held with support from the National STD/AIDS Program and from UNAIDS.

To monitor the targets established for 2005, two strategies were voiced by Brazilian civil society. The first, organized within the sphere of the UNGASS forums, consisted of conducting the case study "Monitoring UNGASS – the View from Civil Society regarding Access and Treatment", which had support from the United Nations Population Fund (UNFPA) and UNAIDS/Brazil. The topics analyzed in the study were: the capacity to produce antiretroviral drugs; civil society's activities; strengthening for the situation of seropositive women; and respect for the human rights of the populations that were most excluded from comprehensive healthcare. The results indicated the need for effective use of legal instruments to ensure sustainable universal access to antiretroviral drugs, such as utilization of compulsory licensing and review of the patents law itself; the existence of problems relating to the logistics of drug acquisition, supply and distribution; and the need to improve the quality of comprehensive care for people living with HIV and AIDS. The document emphasized the importance of the participation by civil society in constructing the responses to overcome these problems.¹

The second strategy, coordinated by the São Paulo Institute of Health, Gestos and the AIDS Support and Prevention Group of São Paulo (GAPA/SP), with support from the Ford Foundation and the National STD/AIDS Program, consisted of bring together non-governmental organizations and researchers in universities, institutes and other knowledge-producing entities in the country. The objective was to deepen the analyses on the Brazilian response towards meeting the commitments expressed in the Declaration, utilizing the extensive set of information on the epidemic that has been produced in Brazil as the reference point.

For this, researchers in different fields of activity were invited to conduct analyses on the indicators available for each chapter of the document. The studies produced were presented and debated during the Monitoring and Assessment Seminar on Target and Commitment Fulfillment relating to the United Nations Declaration of Commitment on HIV and AIDS, which was held in São Paulo on November 21 and 22, 2005, with participation by activists within the movement for combating AIDS, public administrators and researchers. A synthesis from these studies² was sent to the Ministry of Health, and these analyses of the National STD/AIDS Program, together with the case study conducted by civil society, constituted the Brazilian government's official report to the United Nations.

The articles presented here are the product from this extensive process of debate. Together, they show that the targets put forward by the Declaration of Commitment have mostly been taken on by Brazil and that some of them had already been met as early as 2001, when they were agreed on. They therefore point towards what seems to be Brazil's greatest challenge in the context of UNGASS HIV/AIDS: the revision and adaptation of the targets to national realities in such a way that they can be effectively transformed into an instrument to guide the national response.

The supplement starts with an analysis of the trends within the epidemic in Brazil, in a paper by Dourado et al that is complemented with regard to the specific characteristics of mother-to-child HIV transmission in the paper by Brito et al. In both these articles, the contrast in the dynamics of the epidemic before and after the advent of highly active antiretroviral therapy (HAART) stands out. Completing this section analyzing the recent trends in the Brazilian epidemic, França Júnior et al analyze the question of AIDS orphans and children who are vulnerable to the epidemic.

In two interrelated articles, Bastos & Hacker review and analyze the main findings from Brazilian research over the course of two decades of activities in a very wide variety of fields of knowledge, and at its interface with innovation and technological development.

The economic dimension of the Brazilian response, the sustainability of some of its fundamental policies and the challenges posed within a context of budget restrictions, growing demand for resources and protection for intellectual property in the form of patents on new drugs and medications are analyzed in the articles by Grangeiro et al and Teixeira. These questions are taken up again in the paper by Portela & Lotrowska, in the specific dimension of assistance for people living with AIDS.

The paper by Oliveira deals with the topic of the overlapping dimensions of gender and social inequalities within the contexts of the HIV/AIDS epidemic and respect for and promotion of human rights. These questions are reflected in the paper by Villela & Veloso, within the wide-ranging perspective of the participation of civil society in the Brazilian response to the epidemic.

The need for continual monitoring of the indicators put forward by UNGASS has led to the need to construct speedy interactive systems for accessing up-to-date data. This question, which is mentioned in the abovementioned text by Villela & Veloso, is taken up again in detail by Barbosa Junior et al.

The question of leadership in the response to the HIV/AIDS epidemic within the national and worldwide contexts is dealt with by Bermúdez & Seffner. The paper by Paiva et al takes up these questions again within the sphere of prevention and vulnerability reduction initiatives implemented by different public entities and by civil society, as a central part of the Brazilian response to the epidemic.

Thus, through disseminating these analyses, the intention is to expand the knowledge of the commitments agreed on in the United Nations Declaration of Commitment on HIV and AIDS. This has the aim of refining the debate on the achievements attained by the country over the course of three decades of the epidemic, and eliciting reflections from civil society regarding the challenges in combating AIDS that have been identified as the main ones for the Brazilian response. Within a context in which Brazil continues to be internationally prominent because of its recognized model for responding to the HIV/AIDS epidemic, it is hoped that such reflections may bring in contributions that extrapolate the local debate and indicate the advances that Brazil needs, in the light of its proactive position within the international debate.

REFERENCES

1. Fórum UNGASS Brasil. Monitoramento da UNGASS. Olhar da Sociedade Civil sobre Acesso a Tratamento. Disponível em http://www.redegapa.org.br/biblioteca/Artigos/O_olhar_da_sociedade_civil_sobre _Acesso_ao_tratamento_Antiretroviral_no_Brasil.doc [acesso em 30 mar 2006]

2. Instituto de Saúde, Gestos, Grupo de Apoio à Prevenção da Aids (Gapa)-SP. Monitoramento do cumprimento das metas e compromissos previstos na Declaração sobre HIV e Aids das Nações Unidas adotadas pelo Brasil. Brasil; 2005. Disponível em http://www.isaude.sp.gov.br/relat_Ungass.pdf [acesso em 7 abr 2006]

3. Joint United Nation Programme on HIV/AIDS. Aids epidemics update 2005. Geneve; 2005. Disponível em http://www.unaids.org/epi/2005/doc/EPIupdate2005_pdf_en/epi-update2005_en.pdf. [acesso em 30 mar 2006]

4. United Nations. General Assembly. Declaration of commitment on HIV/AIDS. New York; 2001. Disponível em http://data.unaids.org/publications/irc-pub03/aidsdeclaration_en.pdf [acesso em 28 mar 2006]

5. United Nations. Progress Report on the Global Response to the HIV/AIDS Epidemic. 2003. Disponível em http://whqlibdoc.who.int/unaids/2003/9291732885.pdf [acesso em 23 mar 2006]

6. United Nations. Aids epidemic still outpacing response: report by UM Secretary-General calls on governments to expand accesses to HIV prevention and treatment. Jun 2005. Disponível em http://data.unaids.org/Media/Press-Releases03/PR_UNGASS_02Jun05_en.pdf?preview=true [acesso em 7 abr 2006]

Received: 26/4/2006.

Financed by Fundação Ford and Ministério da Saúde - Programa Nacional de DST e Aids.

1. Fórum UNGASS Brasil. Monitoramento da UNGASS. Olhar da Sociedade Civil sobre Acesso a Tratamento. Disponível em http://www.redegapa.org.br/biblioteca/Artigos/O_olhar_da_sociedade_civil_sobre _Acesso_ao_tratamento_Antiretroviral_no_Brasil.doc [acesso em 30 mar 2006]

Publication Dates

• Publication in this collection
  14 Sept 2006
• Date of issue
  Apr 2006