The HIV/AIDS epidemic in Brazil: three decades

Abstract

The Brazilian government's policy to respond to AIDS with the universal, free supply of antiretroviral drugs and medications for opportunistic diseases through the public health system was heavily questioned, especially when the policy was first implemented in the 1990s. The program's success is now acknowledged internationally, due not only to this key component, but also to interaction with other government ministries, in constant dialogue with social movements and the scientific community. Universal access to antiretroviral therapy (ART) has led to a significant reduction in morbidity and mortality. However, the program still faces many difficulties in maintaining long-term sustainability. In addition to budget issues, care for persons living with HIV/AIDS poses major challenges. Prevention efforts also need to be intensified. Thirty years since the first AIDS cases in Brazil, young people are now living with a disease for which there is specific treatment, without having experienced the high AIDS case fatality at the beginning of the epidemic. And with the increase in survival, quality of life for persons living with HIV/AIDS has become increasingly relevant. This Supplement, sponsored by the Department of STD, AIDS, and Viral Hepatitis, under the Ministry of Health, includes articles on issues related to the HIV/AIDS epidemic since the consolidation of universal access to ART in Brazil. Two articles discuss the major strides in increasing survival among both adults and children. Despite undeniable success, the results of a case-control study presented here show that many of the factors associated with AIDS deaths could be prevented. As for aspects related to quality of life, the article with findings from a study on patients undergoing ART shows that a major proportion of these patients enjoy good selfrated health, although their concerns about the future and symptoms of depression are still problems that need to be overcome. Another article proposes three different ways of measuring adherence to ART that are appropriate for monitoring by health services and allow early identification of patients at risk of treatment failure. From the epidemiological point of view, the two studies with results from behavioral surveillance studies suggest problems in the adoption of safe sex practices. The first, featuring information collected in a household survey, reveals women's increased vulnerability in various areas. Meanwhile, the study on military conscripts shows a decrease in regular condom use. A study whose main objective was to evaluate the Ministry of Health's strategies to stimulate the municipal response to the HIV/AIDS epidemic shows that these strategies have in fact contributed to the strides achieved. On methodological issues, two articles present appropriate probabilistic sampling techniques for most-at-risk populations and discuss their application in Brazil. Another article provides a review of serological methods for estimating HIV incidence, based on data from cross-sectional studies. Currently, the ...

Incidence and Clinical Description of Lymphomas in Children and Adolescents with Vertical Transmission of HIV in Rio de Janeiro, Brazil, in Pre- and Post-Combined Antiretroviral Therapy Eras: A Multicentric Hospital-Based Survival Analysis Study

“…Brazil is presumably considered a model for the world in terms of public response to the AIDS epidemic and has offered a free supply of ART and medications for opportunistic diseases through the public health system since the 1990s [ 25 , 37 ]. In 2015, Castilho et al first described the cancer epidemiology of a Brazilian HIV-infected adult cohort in comparison to the general Brazilian population and to a US HIV-infected adult cohort.…”

“…The number of HIV-infected children receiving cART has been increasing since 1996. In Brazil, mono-and-dual antiretroviral therapy was initially provided in the early 1990s, and cART has been available since 1996, thus becoming the first developing country to provide free and universal access to cART [ 25 , 26 , 27 ]. This resulted in a substantial decrease in AIDS and mortality in HIV-infected children worldwide, as well as an increase in the survival of infected patients.…”

Assessment of postural sway in people living with HIV/AIDS

“…The advent of highly active antiretroviral therapy (HAART) has led to an increase in the life expectancy of people living with HIV/AIDS (PLHA) 1,2 . This has meant that PLHA are more exposed to the chronic effects of continued use of medication and infection [3][4][5] .…”

High HIV infection prevalence in a group of men who have sex with men

“…Despite the introduction of antiretroviral therapy since the 1990s in Brazil, 1 , 2 the Acquired Immune Deficiency Syndrome (AIDS) remains one of the most serious public health problems. 3 , 4 , 5 Brazilian studies have shown that a large proportion of individuals diagnosed with Human Immunodeficiency Virus (HIV) still started treatment late. 6 , 7 , 8 Szwarcwald et al showed that the delay between infection and date of first CD4 count was 4.3 years.…”