In the 1980s, Brazil was experiencing an AIDS epidemic comparable to that of South Africa, with reported cases increasing at an alarming rate. Brazil started to address the issue as early as the 1990s. Broad awareness led to mobilisation—individual citizens, government officials, community and church groups, and healthcare workers joined forces to tackle the problem.

Dialogue and debate constituted the first phase, leading to different lines of inquiry and, with them, different ways of framing the issue and different solutions. The problem of affordability became how to drive down the costs. In the end, it meant staring down the pharmaceutical companies through the World Trade Organisation to produce generic versions of antiretroviral drugs and giving them free to those infected with HIV and suffering from AIDS. The problem of medical capacity was turned on its head by enrolling 600 NGOs, churches and food distribution centres to support existing hospitals and clinics. The problem of reaching those affected was addressed by enrolling the contribution of individuals and groups in the communities.

By 2002, the HIV infection rate in Brazil was 0.6 percent and stable. In contrast, it was 25 percent and climbing in South Africa.

Update, 2014

Monitoring results and timely adjustments are essential to sustain the effectiveness of public policies over time. In 2013, Brazil added a new dimension to its strategy for combating HIV/AIDS.  The strategy aimed to ensure that all people with HIV have access to ARVs regardless of the virus’ progress.  Previously, Brazil had only administered anti-retroviral therapy (ARVs) to patients when their CD4 count dropped to 500 or below. The CD4 count is a measure of immune system deterioration caused by HIV.

In Brazil, 720,000 people live with HIV. The new approach reduces the risk of spreading the disease through early detection by testing people at risk, such as: the gay community, crack addicts, sex workers, people with TB, and homeless people. The tests are conducted at the community level.

In conjunction with the early detection plan, Brazil launched the world’s largest “pre-exposure prophylaxis” plan that provides ARVs for people who are at risk, but not infected by the virus.  In 2013, Brazil also passed a law criminalising discrimination based on HIV status. It is the first of this kind in the world. Brazil is once again of the forefront in combatting HIV.

Begun, James, Brenda Zimmerman, and Kevin Dooley. “Health Care Organizations as Complex Adaptive Systems.” In Advances in Health Care Organization Theory, edited by S.M. Mick and M. Wyttenbach, 253-88. San Francisco:Jossey-Bass, 2003.

Fonseca, Maria Goretti P., and Francisco I. Bastos. “Twenty-five Years of the AIDS Epidemic in Brazil: Principal Epidemiological Findings, 1980-2005.” Cadernos de Saude Publica 27, sup. 3 (2007): S333-S344.

Westley, Frances, Brenda Zimmerman and Michael Patton. Getting to Maybe: How the World is Changed. Toronto: Random House, 2006.

World Bank. Controlling AIDS: Public Priorities in a Global Epidemic. New York: Oxford University Press, 1997.