Greco Dirceu B, Simão Mariangela
Internal Medicine Department, School of Medicine, Federal University of Minas Gerais, Avenida Alfredo Balena 190, CEP 30130-100 Belo Horizonte, MG, Brazil.
AIDS. 2007 Jul;21 Suppl 4:S37-45. doi: 10.1097/01.aids.0000279705.24428.a3.
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.
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.
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.
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.
巴西艾滋病防治项目取得的成功得到了全球认可，这得益于其预防、尊重人权以及免费普及先进抗逆转录病毒药物的综合方法。
截至2006年，18万艾滋病患者正在接受高效抗逆转录病毒治疗，有17种药物可供使用，通过公共卫生系统接受医疗和实验室护理。2006年抗逆转录病毒治疗药物的费用达到4亿美元，如果维持目前的趋势，费用将急剧增加：每年约有2万名新患者接受治疗，并且需要使用更昂贵的、受专利保护的二线和三线药物。
我们讨论了该项目的优势与劣势、预算压力、加大预防力度的必要性、促进新药本地生产的必要性、加大研发投资以及自愿和强制许可的问题。在追求长期可持续性方面存在许多障碍，这取决于国家主导的举措以及国际合作与参与。
我们得出的结论是，巴西的经验表明，一个发展中国家有能力公平地治疗患者，不论其种族、性别或经济实力如何，并且这种平等的“种子”已经传播到其他国家。在国内，这一经验必须用于应对其他地方病，如麻风病、疟疾、登革热和利什曼病。巴西的政治意愿已经得到证明，但同样，民间社会、研究人员、卫生专业人员、艾滋病毒/艾滋病患者和政府需要采取协调一致的行动，以使世界相信健康需求不应被视为商业问题，并且如果我们期望作为一种文明生存下去，研发成果必须在全世界共享。
