Brazil- AIDS & STD Control III - Result Story

Brazil- AIDS & STD Control III ( 2003-2007)

Project ID: P080400

Objective

The development objectives of the Brazil STD & AIDS Control III Project were to reduce the incidence of STDs and HIV and improve the quality of life for people living with HIV/AIDS by strengthening the effectiveness and efficiency of the national response and ensuring its sustainability in the medium and long-term. These objectives would be reached by: (a) expanding the coverage and quality of interventions; (b) decentralizing the financing and management of program activities to states and municipalities in accordance with current national health policy; (c) strengthening program management by establishing an effective M&E capacity and instituting the use of management tools, including performance-based management, focusing on more cost effective interventions and improving their targeting; (d) introducing technological innovation and upgrading existing technology in treatment and prevention; and (e) reducing discrimination and stigma associated with HIV/AIDS.

Main Beneficiaries

 

The project was designed to benefit the Brazilian population as a whole, with a special focus on highly vulnerable groups. These groups included men who have sex with men (MSM), sex workers (SWs), pregnant women and their infants, people living with HIV (PLHIV) and emerging populations newly affected by HIV. NGOs and CSOs working on HIV/AIDS prevention and care would benefit from training and funding. The number of such organizations supported by the project was smaller than in the prior project, but those selected were better targeted in terms of integration with Brazil’s National AIDS Program (Programa Nacional – PN) and their focus on primary health care. HIV/AIDS units in states and municipalities were also designated as main beneficiaries of the Project, since decentralization of activities was a main focus.

Results

Achievement of the project objectives was satisfactory. Below you will find the main project achievement:

• AIDS mortality declined by 72% between 2001 and 2006.
• AIDS mortality decreased from 6.3 per 100,000 in 2003 to 5.1 in 2007.
• Morbidity decreased 77% in the decade 1997-2007.
• Hospitalizations decreased from 80.8% of AIDS patients, who had at least one hospitalization per year in 1997 to 18.6% in 2007.
• Estimated prevalence kept at 0.6% adult population (15-49 years).
• Prevalence of HIV among pregnant women has remained below 0.3% since 2004.
• Mother-to-child transmission decreased from 16% in 1998 to 6.8% in 2004.

• 97% of the population knows that HIV can be transmitted through sexual relations.
• About 97% of secondary schools conduct HIV/AIDS-related activities.
• Over 40% of adult population tested for HIV at least once.
• 79% people aged 14+ report use of condom in the last sexual encounter with a casual partner.
• 70% sex workers report using a condom with last client.
• Free provision of 1 billion condoms.
• 67% of pregnant women were tested, over 75% in the South, Southeast and Center-West regions.
• Over 51% of estimated infected pregnant women, and over 81% of those identified as infected, were provided with AZT for PMTCT.
• Notification of congenital syphilis increased 20%.

• Survival of PLHIV on ART almost doubled from 58 to 108 months in the period 1996-2007.
• Over 180,000 patients (100% of those identified that qualify) are treated with ARV according to a national treatment protocol.
• Initial average CD4 in patients not on ART increased from 387 to 432 in 2002-2006.
• ART and treatment of OIs is provided by the national health service free of charge.
• Savings due to ART estimated at R$ 1.1 billion in a decade (1997-2007).

• The DF, 26 states and 445 municipalities cover about 90% of notified AIDS cases in the country, and 62% of the entire population.
• 75% of the states achieved at least 75% of their HIV/AIDS targets in 2007.
• About R$ 510 million (US$305 million) transferred to states and municipalities under results based Agreements.
• Close coordination with national health surveillance, and Family Health and Basic Attention Programs allows for extension of coverage to new risk groups: women, poorer people in the interior.
• All states have launched public competitions to finance subprojects carried out by NGOs.
• About 1,500 NGOs and CSOs work in the PN, about 600 financed by the project.

Surveillance and M&E

• Complex seroprevalence surveys that will provide crucial information about HIV infection rates among highly vulnerable groups (MSM, SW, IDU) and general population are being carried out.
• MONITORAIDS is well established as a PN management tool.

Research and Development

• Carried out 141 research and development (R&D) subprojects out of 489 submitted under the project.
• Diagnostic kits for HIV 1 and 2 produced and distributed.
• HIV Vaccine Strategic Plan and Strategic Plan for Technological development of pharmaceutical drugs approved.
• HIV/AIDS and STDs R&D Information System developed.
• Network for technological development of vaccines and microbicides established.
• International HIV/AIDS and STD Network for Technological Cooperation established.

Lessons Learned

• Confronting the sensitive issues that surround HIV/AIDS is critical for program success. Issues such as having multiple sex partners, homosexuality and drug use were brought out into the open by government activities that directly targeted vulnerable groups like MSM, sex workers and drug users.
• Strong, sustained political will is a necessary (but not sufficient) requirement for a successful HIV program.
• Civil society and non-governmental organizations play a critical role in HIV programs.
• A multi-sector approach can increase the reach and effectiveness of program activities.
• Strategies to prevent and treat HIV/AIDS and STD need to be integrated and coordinated, without one overcoming the other, and should fulfill the needs of different groups, especially PLHIV and highly vulnerable groups.
• Treatment saves lives (and money) but its other effects must be managed carefully. Treatment does carry the risk of drug resistance, however, so treatment regimens must be closely managed and monitored.
• HIV/AIDS is a complex epidemic which demands a robust response that will rely heavily on existing institutions. An HIV/AIDS program requires high-functioning logistics, sophisticated testing facilities, reliable and robust information systems, communications and media that reach the entire country, effective M&E and experienced data analysis. Less developed countries may not be able to replicate the success of Brazil’s program until such peripheral programs or inputs are developed and/or expanded.
• Weak institutional capacity can affect project outcomes.
• Integration of HIV/AIDS activities with other health actors and institutions increases impact and sustainability.
• Decentralized management of resources is essential in the fight against the epidemic, allowing for differentiated interventions, with appropriate responses to different epidemiological profiles and contexts of vulnerability throughout diverse regions.
• Decentralization measures often progress unevenly, depending on variable capacity among state or municipal-level actors.
• High staff turnover hinders performance.
• Strengthening governance is essential for progress in epidemic control, as an integral part of increased management capacity of the federal, state and municipal level of the national health service.