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Wednesday, January 2, 2008

Brazil’s Action against AIDS: A Model of Humanizing Globalization

Javed M. Iqbal
CIPOD, School of International Studies,

JNU, New Delhi.

The last twenty-five years have witnessed the rapid spread of HIV AIDS across the world particularly in Africa, Asia and Latin America. Its velocity is so intense, as even the Government’s resources are exhausted and fall deficit in checking the spread of the disease. Adding to the woes HIV has eluded scientific community from developing vaccines for prevention or cure. This virus has affected four million people and around one million people fall prey to this deadly virus in current year itself. Its nature of transmission through intimate relations poses serious challenges to the prevailing myths and realities in existing human rights regime. It becomes obvious public health responses were inadequate to face the grim realities of the disease. Richard Altman has identified two dominant paradigms in HIV AIDS research, which is quite significant in the pattern of transmission and curative process. Firstly, the social research on AIDS emphasis on psychological focusing on risk, individual behaviour and how to change it (1). The strand of paradigm attempts to shift its focus towards its transmission, impact and governance to the socio-political changes. These two influential paradigms of Prof. Altman transcends HIV into not only domestic public health problem but also serious international economic and security crisis. This debate assumes greater significance in the age of globalization. The vast number of literatures on public health and globalization has showed us that the process of globalization inevitably creates inequity in distribution of resources and technology both within and between countries. The critics believed globalization inheritantly denies the access to the drugs, care and support to the needy. This paper does not adhere to this notion and we try to propose an alternative proposition to the globalization debate in the case of HIV and public health. The globalization skeptics neglect the crucial element of unprecendented opportunities resulting from the process. As a consequences, they ignore the techniques of adaptability and mechanism to regulate to reap the benefits of the globalization. This is the central argument of this paper, which states globalization does not inheritantly creates impediments to growth but it begs right mechanism in the system. This is explained through the case study of Brazil in the case of combating HIV pandemic. The first section deals with globalization and HIV AIDS and emerging trends in global cooperation. The second section emphasis on unique Brazilian model which we term it as “humanizing globalization” Finally we offer some concluding remarks which we suggest other developing countries can emulate the Brazilian model.

Globalization has become a buzzword in the academic literature encompassing social, economical, political and cultural aspect of life. In simple terms as Robertson points out it is the process of time space compression (Robertson, Roland). In an rapidly globalizing globe the terms space and time assumes different meanings. As Paul Kennedy has observed the interconnectedness of capital, production, ideas and cultures at an increasing phase (3). The role of MNCs and TNCs in moving the capital and production factories across the globe provides ample space for opportunities and growth. The widespread competition to explore new avenues and possibilities increases new fortunes and prospects in developing countries. It is widely believed that flow of capital and ideas in search of markets and cheap man power increases fragility of traditional State sovereign. In a way we argue that national boundaries dissipate and now world has become global village. During this process, it is inevitable that inequity may arise, but can be overcome by establishing regulating mechanisms and prudent policies as demonstrated by Brazil. In a way what we suggest the globalization is the process of short run pain and long run gain. We emphasis on need for the need of a globalization that is not only dealing with markets and profits, but also a globalization of access to global public goods for the benefit of all, for the benefit of the poor, for the least powerful. This face of positive globalization is aptly galvanized by Brazil in its action against AIDS pandemic. While many countries have struggled to curb the spread of HIV/AIDS and to care for those affected by it, Brazil’s response has been seen as a success story. This successful adventure will be elaborated in the second section of the paper.
Diseases and the National Boundaries

The modern nations have been working together on international health problems over a century. They have collaborated because they have realized that disease does not honour national boundaries. In this means of cooperation, the Nation-states have learned that their self-interests are best served by worldwide collective action to eradicate communicable disease and to promote positive health conditions (4). International health collaboration became necessary as the result of the increased volume range and intensity of trade and travel. The expansion of trade and travel increased the possibility of proliferating infectious diseases. The overcrowded living conditions, inadequate sewage systems, and unclean drinking water made international community vulnerable to unsafe from the threat of epidemics. As a result of globalization of diseases, the World Government realized that no longer they could protect their citizens without international cooperation (5). But great power interest in the infectious disease control waned due to there over commitment in real polity. This decline in disease diplomacy seems to be counterintuitive. The intensity and volume of trade and travel continues to grow crating unprecedented opportunity for pathogens to spread worldwide. Advances in Scientific research helped developed countries to reduce from the ravage of tuberculosis or cholera but on the other hand developing societies continues to toil from the spread of pathogens (6).
When the humanity of the world debating to find solution to communicable diseases the HIV AIDS has not arrived on horizon. The landmark Alma Ata Declaration in 1977 called for “Health for All by the Year 2000’ (HFA 2000) was more concerned about spread of communicable diseases. This historic declaration is one the milestone and invigorated the new movement in the global health policy (7). Infact it can be argued Alma Ata declaration is the benchmark in the field of global health cooperation. The arrival of HIV AIDS in the global scene shifted the focus from PHC strategies to combating HIV virus. At its arrival, HIV spread rapidly to Africa, Latin America and Asia. In 29 African countries within the first decade the life span has declined to forty years, its economic is at shambles. Thus, the intensity and spread of HIV can be best understood by the rapid increase of in process of globalization.

Globalization and Public Health Response

The globalization presents daunting challenges to public health. The Global Public Health (GPH) regime must respond to the positive to the opportunities liberalized markets and trade. It can be argued that GPH should adhere to global coherence while maintaining local diversity (8). This notion becomes even more encompassing in responding to HIV AIDS. We cannot deny about the substantial advances in public health methods and Practices. Some of the widespread contributions are smallpox eradication, large reduction in communicable diseases and rise and decline of several communicable diseases. However, HIV AIDS emerged as a major challenge to the public health. Hence, it is important to emphasis on global HIV prevention is most crucial issue in the global health discourse (9). It is widely criticized that the globalized public health policies are endangering the national public health systems and hence it is impotent to deal with the domestic health issues. We should not carried away by such claims because the reality is the emerging GPH trend has shown people around the globe are welcoming the cheaper drugs and vaccines. We found much easier in acceptability, accessibility, affordability and availability of new technology and patterns that half a century before (10).
HIV/AIDS and Global Cooperation
The profound changes have occurred in global health policies. The new problems such as AIDS pandemic have become major security threat to the international community. Rapid spread of communicable diseases in developing countries and emergence of new drugs regime have created tumultuous situation over many countries. New agencies and actors have become harbinger in the field of international health more notably the World Bank and International Monetary Fund (IMF). These economic institutions have engineered well archestrated technocratically sound health policies. Since AIDS has been portrayed as a global pandemic, it required global collaboration in combating the problem (11).
The first response from the international community came in 1986 when World Health Organization (WHO) established the Global Programme on AIDS (GPA) based in Geneva. GPA provided much needed impetus in HIV AIDS discourse because it advocated for empowerment and participation, technical support for developing countries and resources mobilisation of industrialised countries for multilateral response for epidemic. It also helped in building of networks such as Global People of Network of People living with AIDS (GNP) the International Council of AIDS Service Organization (ICASO) and the International Community of Women Living with HIV/AIDS (ICW) (12). This networks tried to establish links between international bodies and civil society in order to generate awareness and explore strengths and weaknesses among the HIV effected communities. The development activities proliferated in 1990s and too many UN agencies involved themselves in HIV prevention activities. This actors and agencies could not harmoniously work with GPA. Hence donors proposed to establish an UN agency exclusively for HIV/AIDS UNAIDS which began its operation in 1996. UNAIDS cooperates along with seven UN agencies such as UNDP, UNPF, UNDP, World Bank, WHO, UNICEF, UNESCO and UN International Drug Control Programme which all agencies engage in combating HIV/AIDS. UNAIDS primary objective is to act as main advocate for global action on HIV/AIDS. Apart from UN agencies, HIV has been the major agenda in various international deliberations in G-7, leaders of African Union, European Union etc. United Nations has convened a special session in 1987 in view to evolve mechanism to check the menace. Hence, it is clear that HIV AIDS is a global pandemic and requires global cooperation in the time of globalization at its peak. We are in an crucial phase of our discussion and one tends to ask globalization has brought well being and human welfare or mystery to the masses. We argue that globalization provides with opportunity and it is up to the country to act prudently to bear the fruit. We suggest Brazil is one such case where it took maximum advantage of this globalization through its well-devised constitutional obligations in dealing with HIV AIDS. The next section of the paper will elaborate this positive face of globalization.
In this globalized age, while many countries have struggled to control the spread of HIV and to provide care for those affected by it, Brazil has been succeeded in bringing down the number oh HIV/AIDS cases. According to UNAIDS 2006 report by the end of 2005, 620,000 Brazilians were living with HIV, half the number that estimates in the previous decade had predicted. The number of people dying from AIDS-related illnesses has also fallen by 50% and HIV-related hospitalizations have decreased by 70-80% since the late 1990s. Thus, these statistics reveals that Brazilian response can be concluded as a success story. Its successful response can be understood well by studying its health, AIDS history and Incidence and State responses.

Health Sector

Health indicators have shown progress in the last 30 years, with increased life expectancy and decreased mortality rates. By 2001, it had risen to 67.8 years (63.7 for men and 72.3 for women). Regional differences in health outcomes persist, however, with the lowest indicators in the Northeast and the highest in the South/Southeast. In 2000, 76 percent of the total population had sustained access to improved sanitation, and 87 percent had sustained access to an improved water source (13).

There is a strong domestic pharmaceutical industry, with 500 companies and 47,000 employees. Brazil manufactures its own supply of BCG, tetanus toxoid, yellow fever, human and canine rabies, and DPT/pertussis vaccine. The health sector accounts for 8 percent of workforce. Nationwide, there is one physician per 757 inhabitants, and one nurse per 2,330 inhabitants. Health professionals are irregularly distributed, however with a disproportionately high concentration in industrial areas and in state capitals (14).

The 1988 constitution guarantees every Brazilian citizen access to a comprehensive national system of health care regardless of whether the individual can afford other forms of health insurance (15). To realize this promise, the federal government created the SUS (Sistema Único de Saúde, or Unified Health System) in 1990. SUS, funded by social security contributions, is responsible for universal health promotion and care, including policy formulation, epidemiology, public health promotion, and disease treatment. Seventy-five percent of the population receives its medical care through the SUS, while 20 percent has private insurance. Seventy-five percent of outpatient clinics are run by the SUS, in contrast to inpatient hospitals, 80 percent of which are privately owned (though publicly funded through SUS reimbursement) (16).

AIDS History and Incidence
The country’s first AIDS case was recorded in 1982 in the state of Sao Paulo. Miners who travel between southern Venezuela and Brazil are believed to have introduced HIV/AIDS in areas close to the Venezuela border through sex with local women (either via sex work or via rape). Indigenous women of certain ethnic groups are at the same or greater risk as the spouses of miners, because of rape and prostitution. Many different social and economic arrangements exist between indigenous women and migrants to their areas. Having temporary wives is one such arrangement. Among some indigenous peoples, such as the Yanomani, women who engage in sexual intercourse with outsiders face little social reprobation, and as such, HIV transmission has increased (17).
In December 2001, 52 cases of AIDS were reported over the period 1988-2001. Since then, additional cases have been identified in other regions. AIDS cases among the indigenous population tend to be concentrated in young adults living in the cities and mid-size municipalities of the Center-West and North: 68 percent are ages 20-34, with 65.2 percent of cases male and 79.2 percent female (18).
In 2002, UNAIDS and the Brazilian Ministry of Health (MoH) estimated that there were 610,000 Brazilians living with HIV/AIDS at the end of 2001, with adult prevalence at 0.7 percent. This estimate is subject to considerable variation, however, as HIV infection, unlike AIDS, is not a reportable condition in Brazil. In July 2005, UNAIDS released revised country-level data, estimating that there were 660,000 Brazilians living with HIV/AIDS at the end of 2003, with adult prevalence at 0.7 percent (19). According to UNAIDS, the HIV/AIDS epidemic in Brazil appears to be stabilizing. Since 1999, all regions but the South have experienced a decrease in incidence of newly reported AIDS cases. The incidence of AIDS has remained stable over the last five years at around 20,000 new cases per year through 2001, the most recent year with complete reporting. HIV prevalence also appears to be stabilizing across all sentinel surveillance studies conducted in the last four years (20).

As per the report of UNAIDS presented in the recently concluded International AIDS Conference in Toronto, out of total 186,112,784 population of Brazil (July 2005 est.), approximately 620,000 number of people are living with HIV/AIDS by the end of 2005. The report also says that 14,000 deaths are reported due to AIDS during 2005, which is far more lesser than the previously recorded cases in Brazil. Further, the report estimates that by the end of 2005, only 0.5% of adults (ages 15-49) were living with HIV/AIDS. The number of women (ages 15-49) living with HIV/AIDS by the end of 2005 as per the study of UNAIDS is merely 220,000 (21).
Brazilian State Response
Brazil’s response to the HIV/AIDS epidemic emerged in the mid-1980s when the process of economic liberalization was at its peak. The process of transition to democratization provided space for Brazil to shift its emphasis to health issues. This critical transition also coincided with the emergence of new disease HIV/AIDS in their soil. It was at just this time that Brazilian newspapers began describing a ‘new disease’ and the first AIDS cases were reported in the country (22).

Early responses to the epidemic came from NGOs advocating for the rights of populations initially affected by the epidemic, particularly gay men. Since then the organizations of the civil society, mainly those organizations of people dealing with HIV/AIDS, have been key partners of the Brazilian Government in order to contribute to the accomplishment of policies of assistance, prevention and human rights (23).

At the state level, in 1983 the first governmental AIDS program the São Paulo State AIDS Programme was set up in São Paulo. Brazil established an AIDS bureaucracy in 1985, when a National AIDS Program (NAP) was created within the Ministry of Health. The NAP assumed significant authority in the formulation of policy by 1988 and although it was largely dismantled from 1990-1992, there was substantial continuity in its policies and even its personnel (24).

In 1988, the inter-ministerial National Commission to Control AIDS was established. The Commission reported to the Ministry of Health but included representatives from Ministries of Education, Labor, and Justice, the principal association of lawyers in Brazil, various universities, and four NGOs (25).

The Brazilian government negotiated the first in a series of three loans with the World Bank in 1993, that targeted funding for AIDS gave the NAP substantial autonomy within the Ministry, including the ability to hire its own staff on a contractual basis with more flexibility than civil service rules generally allowed. Since 1992, the NAP has been responsible for and has formulated AIDS policies regarding prevention and treatment on behalf of the government. A government audit showed that 476 staff and consultants were under contract with the NAP in 2002 (26).

This period also saw greater trade and integration of markets and has to some extend produce net benefits of poverty reduction and economic developments worldwide. At the mean time the whole process raises question whether the post 1990 economic liberalization process is ensuring improvement in health sector or is simply deteriorating the whole system. However, the Brazilian case has proved the world that one can also make good use of the economic liberalization process. A case in point is the Brazilian government’s successful response to AIDS epidemic in the country which is now seen as a model by the rest of the world.

AIDS is the first epidemic of the age of globalization, and responding to the AIDS crisis constitutes a major challenge for all societies. Brazil is seen as a regional and global leader in the fight against HIV/AIDS and the government has generously allocated resources to the cause, at the national, state, and local levels. The Brazilian states’ response to the new millennium pandemic stands as both a model and an inspiration. The government launched number of programmes, include guaranteed human rights for PLWHAs, testing and treatment facilities, education initiatives, and disposable syringe and condom promotion programs. These programs have all proved successful.

One of the most important lessons from Brazil is its defense of human rights as a paradigm of health. In 1988, Brazil enacted a federal constitution which recognized the right to healthcare. Under this principle, Brazilian citizens with HIV have the right to treatment, just like those with tuberculosis. The principle further ensures that all Brazilian citizens receive health services for free, including people with HIV, people who have an HIV-related opportunistic disease, and people already in the AIDS stage. As a result, in the history of the response to the HIV pandemic, Brazil is best known for its pioneering decision in 1996 to offer free combination antiretroviral therapy to all citizens with AIDS. Today, in Brazil, access to treatment has progressed from being regarded as a legal right to being recognized as an absolute human right, by government at all levels (27).

Alongside free distribution, the ability of the Brazilian government to reduce the procurement costs of ARVs has been crucial to the success of the national HIV program. This has been made possible by the local production, by public health labs in Rio de Janeiro, of seven of the ARVs currently available in Brazil. For drugs that are not manufactured locally, Brazil has sought to negotiate the best possible prices with international drug companies, using the ability to break patents and produce drugs domestically as leverage to overcome resistance (28).

Current goals of the federal government’s AIDS program include the continued roll-out of the treatment program, continued reduction in the costs of drug and supply acquisition, continued access to treatment of opportunistic infections, and continued decentralization of the program through involvement of state and local governments and civil society, as well as an improvement in monitoring and evaluation of the program’s accomplishments and shortcomings. This exists alongside efforts to improve the funding of the national health care system in general.

Another indicator of the success is people’s adherence to treatment. Following the prescribed treatment is both vitally important and easily forgotten; people are prone to stop treatment for medical problems as soon as they see the first sign of improvement. But in the case of antiretroviral therapies, a failure to follow the regime can be fatal, causing the virus level in the blood to increase drastically. Since these therapies require people to take several pills a day for life, adherence is often a challenge for models seeking successful treatment. In Brazil, the adherence rate has been reported about 60-70 per cent (29).

Brazil, however, is a predominantly European formed society, settled largely by the Portuguese. Italians, Germans and Spaniards. The European origins are the bases of Brazilian family life, which is a rigid, patriarchal structure that permeates all areas of Brazilian life (30).
The involvement of civil society, Catholic Church and the people living with HIV/AIDS by the state in the fight against also provides an interesting lesson for the rest of the world. This partnership have ensured that stigma and discrimination have been reduced, human rights have been taken into account, moral and religious views have not impeded prevention campaigns and the government has acted swiftly.
The Brazilian government has vigorously promoted the use of condoms through media campaigns, adverts and other prevention initiatives. The NAP develops a number of different strategies to increase the spread of condom use. These include, the manufacture and distribution of generic condoms; the reduction of taxes on condoms; and agreements to be drawn up with manufacturing companies, distributors and retailers in order to reduce the profit margins on condom sale. Besides the male condom, the Brazilian NAP also distributes female condoms. In 2002, the authorities acquired 4 million units and the distribution is aimed at women’s health programs, drug users or partners of drug users, sex workers and HIV positive women (31).
In 2005, a study of Brazilian adults revealed that 35% used a condom during the previous year, compared with 24% in 1998. The increase in condom use has not only occurred among the general population, but also among HIV-positive people (32).
Globally, stigma has widely been recognized as a contributing factor to the spread of HIV. Fear of discrimination stops people going for HIV tests, causes denial in communities and can prevent HIV-positive people from admitting their status or from accessing medication. Brazil is a rare example of a country that has managed to minimize this problem. The government has shown vigorous commitment to protecting the rights of marginalized groups who may be affected by HIV and AIDS, such as sex workers, gay men, and drug users. It has also been generous with funding to groups of people living with HIV and AIDS, as well as events such as gay pride marches, which encourage people to respect sexual diversity (33).
Encouraging people to access testing is also an important part of Brazil’s successful HIV prevention, as HIV-positive people who are aware of their status are less likely to pass infection on to other people. People who test positive can also be directed to support and treatment, and given advice for the future. HIV testing in Brazil either takes place through public health facilities such as hospitals or through centres that provide voluntary counseling and testing. Since the mid-1990s, the availability of ARVs has given people more incentive to get tested and has led to testing becoming more popular and more widely available. Between 1997 and 2002, both the number of VCT centres and the number of HIV tests carried out through the public sector doubled (34).
The Brazilian government has used media campaigns to promote universal HIV testing. The central message of these campaigns is that everyone in the country should know their status. One major initiative, known by its slogan ‘Fique Sabendo’ (‘Be in the Know’), enlisted the help of models and other celebrities to promote testing (35).
Humanizing globalization
Although AIDS has always been termed as a ‘disease of globalization’. At the same time, globalization also creates unprecedented opportunities to advance human welfare, even for those marginalized and impoverished by many of its economic structures and political institutions. This was precisely the globalization advocated by Brazil as, “globalization of access to global public goods for the benefit of all, for the benefit of the poor, for the least powerful."
Brazil's global leadership in the fight against AIDS demonstrates this promise of globalization. Based on its constitutional recognition of the right to health and its own battle with AIDS, the nation has ultimately managed to galvanize human cooperation and solidarity across borders and institutions.
The country played a leading role in creating the UN Global AIDS, Tuberculosis, and Malaria Fund. UNAIDS has recognized Brazil's influence in global and regional policies and its pioneering treatment with generic drugs as important factors in the increased global access to treatment that has occurred in recent years. The new paradigm adopted during the UN General Assembly's Special Session on HIV/AIDS, which includes an integrated prevention and treatment focus, was based on the Brazilian experience. Brazil's effective lobbying with the international community has played a pivotal role in the following series of declarations and actions (36):

Ø The approval of Resolution 33/2001 by the United Nations Commission on Human Rights during its 57th session, establishing access to AIDS drugs as a basic human right.

Ø The approval of Brazil's May 2001 proposal to the World Health Organization on the need to have drugs at accessible prices available to all people living with HIV.

Ø The commitment signed at the UN General Assembly Special Session on HIV/AIDS in June 2001, which reiterates the need for a holistic approach including prevention, care, treatment, and the protection of human rights.

Ø The establishment of the UN Global AIDS, Tuberculosis, and Malaria Fund, which guarantees equal participation in resource administration to rich and poor countries and thus constitutes a unique case among international funds. The Global AIDS Fund will also finance projects that include distribution of antiretroviral drugs.

Ø The declaration of the WTO's Fourth Inter-Ministerial Conference, held in Doha, Qatar, in November 2001. This declaration, promoted by Brazil and other countries, defends the preeminence of public health above intellectual property rights.

Besides, effective leadership, setting up of National Welfare system, HIV prevention in prisons, protection of AIDS orphans etc. forms the bases of Brazil’s successful response to HIV/AIDS.
In this paper, we had made an attempt to bring into lime light the positive phase of globalization that Brazil has galvanized in its action against HIV/AIDS. Brazilian government has made aggressive efforts to minimize the impact of the epidemic. Even at the International fora Brazil
Brazil’s bold and effective program to combat the HIV/AIDS crisis also goes global because of its certain uniqueness in general approach towards AIDS. The most important feature of Brazilian success story is that NAP has become a source of national pride for Brazilians. This gives the impression that to control HIV we must first admit that the problem belongs to all of us. Besides, a sense of national community, explicit discourse around sex and encouraging a culture where people living with HIV/AIDS are not looked upon forms the basis of Brazilian success in combating AIDS.
There is also a debate among several scholarships regarding the replicability of Brazilian model in rest of the world.
had succeeded in the approval of number of Conventions and Declarations which were proved fruitful for other countries. Brazilian initiatives support the view that we will be able to harness our common energy toward our shared goal of combating the spread of this dangerous virus. AIDS specialist like Christine Pimenta raises question on the possibility of emulating Brazilian model. She argues that the country’s response to HIV/AIDS has been effective, but it is particular to Brazil only (Valentine 2003). But we are not wholely adhere to this argument, instead we believe that if any country can generate the much needed political commitment and social impetus would be conducive for replication. However to ascertain the facts of its implication in other severely affected states needs further research and exploration.


1. Altman, Dennis (August 1999), Globalization, Political Economy and HIV/AIDS, Theory and Society, Vol.28, No.4, pp. 559.

2. Robertson

3. Kennedy, Paul (May 1996), Forecast Global Gales Ahead, New Statesman and Society,No. 31, p.28

4. Fidler, David (Jan-Feb 2001),The Return of Micro Bio-Polity, Foreign Policy, No. 122,pp. 82.

5. Charles, Allen, E. (February 1950), World Health and World Politics, International Organization,Vol.4, NO.1, pp. 31.

6. Ibid, 32.

7. WHO (1977), Alma Ata Declaration:A international Conference on Primary Health Care USSR.

8. Fitzgerald, Niall (1944), Harnessing the potential of Globalization for Consumers and Citizens, International Affair, Vol.73, No.4, pp. 739.

9. Jonnathan, Fielding, E (March 17, 1999), Public Health in the Twentieth Century: Advances and Challenges, Annual Review of Public Health,Vol.20, Marc, pp.18-19.

10. Cahill, Lisa Sowle (Sep-Oct 2003), Biotech and Justice: Catching up the real World Order, Hasting Centre Report, Vol.33, No.5, pp.41.

11. Piot, Peter (June 23, 2000), Global AIDS epidemic: Time to Turn the Tide, Science, New Series, Vol.288, No.5474, pp.2177.

12. Altman, Dennis (August 1999), Globalization, Political Economy and HIV/AIDS, Theory and Society, Vol.28, No.4, pp.566.

13. UNDP (2004), Human Development Report 2004: New York, (

14. Ibid

15. UNAIDS (2003), Progress Report on the Global Response to the HIV/AIDS Epidemic, 2003: Geneva, ( Epidemic Global;.

16. Brazilian MoH (2001), AIDS the Brazilian experience, cited in Pembrey (2006), AIDS in Brazil, (

17. Pembrey (2006), AIDS in Brazil, (

18. Bacon O., M.L. Pecoraro et al. (2004), HIV/AIDS in Brazil, AIDS Research Policy Centre, University of California.

19. UNAIDS (2005), Brazil Fact Sheet, 2005, (

20. USAID (2004), USAID Country Profile: Brazil,2004: Brasilia, (

21. UNAIDS (2006), 2006 Report on the Global AIDS epidemic, 2006: Geneva.

22. Meneses, L.(1983), A Praga gay no Brasil, cited in Bacon O., M.l Pecoraro et al., HIV/AIDS in Brazil, pp.52.

23. Brazilian MoH (2001), AIDS the Brazilian experience, cited in Pembrey (2006), AIDS in Brazil, (

24. USAID (2004), USAID Country Profile: Brazil,2004: Brasilia, (

25. Ibid

26. Mattos, R. et al. (2003), World Bank Strategies and the response to AIDS in Brazil, Divulgacao em Saude para Debate, Rio de Janeiro, pp.76-84.

27. Okie, S. (May 2006), Fighting HIV-Lessons from Brazil, The New England Journal of Medicine, (

28. Langevin, S., (2005), The Brazilian Model to Fight HIV/AIDS, The Globalist: Washington.

29. Ortells, P. (April 2003), Brazil: A Model Response to AIDS, Cooperation South: 64.

30. Valentine, S., (2003), HIV-AIDS-Lessons from Brazil, Centre for the Study of AIDS, (

31. Okie, S. (May 2006), Fighting HIV-Lessons from Brazil, The New England Journal of Medicine, (

32. Ibid

33. Berkman A. et al. (July 2005), A Critical Analysis of the Brazilian Response to AIDS: Lessons for controlling and mitigating the epidemic in developing countries, American Journal of Public Health (

34. Bacon O., M.L. Pecoraro et al. (2004), HIV/AIDS in Brazil, AIDS Research Policy Centre, University of California.

35. Ibid

36. Ortells, P. (April 2003), Brazil: A Model Response to AIDS, (