China, India, South Africa, Brazil: How Will They Use Their Leadership to Advance the AIDS Response?
July 27, 2012
Research Assistant, Global Health Policy Center
On July 24, a special session during AIDS 2012 featured representatives from the China, India, Brazil, and South Africa; and Professor Jeff Sachs, Director of the Earth Institute. Dr. J. Stephen Morrison, Director of the CSIS Global Health Policy Center, moderated the discussion.
Country representatives included: Dr. Zunyou Wu, Director, National Center for AIDS/STD Control and Prevention at the Chinese Center for Disease Control and Prevention; Ms. Aradhana Johri, Additional Secretary, Departments of AIDS Control, India; Dr. Aaron Motsoaledi, South African Minister of Health; and Dr. Dirceu Greco, Director of the Department of STD, AIDS and Viral Hepatitis in the Brazilian Ministry of Health.
The BRICS – Brazil, Russia, India, China, and South Africa – represent over forty percent of the world’s population and “nearly a quarter of its economic output.” At the same time, as noted by Dr. Motsoaledi, the BRICS contain one-third of the world’s HIV+ individuals. Over the past decades, each nation grappled with national HIV/AIDS epidemics. The panelists discussed their nations’ responses to the epidemics – successes and lingering challenges – and their global contributions to combating the epidemic. The conversation illuminated a number of common themes regarding how each nation has responded to the epidemic, as well as similar challenges that the nations face as they look to achieve national ‘AIDS-Free Generations.’ Thanks to focused leadership, important national policy changes, sufficient financing, and building national health care infrastructure and human resource capacities, these nations have made substantial progress in turning the tide on their respective epidemics.
Different factors motivated each nation to begin HIV/AIDS programs. After transitioning to democracy, the governments of South Africa and Brazil each faced popular demand to respond to their HIV/AIDS epidemics. Brazil’s newly-established constitution codified a 'right to health' for its population, so care for HIV/AIDS patients was an outgrowth of the government’s positive obligation to its citizens. In 1996, once ARVs were available, the Brazilian government passed a law that guaranteed HIV+ citizens those medications. Brazil has successfully contained its HIV/AIDS epidemic – funding the response primarily with Brazilian taxpayer dollars. The objectives of the South African government and the nation’s civil society took longer to align, which impeded national efforts. Effective, focused leadership has helped South Africa attain remarkable gains over the past three years: record numbers have been tested and are undergoing treatment.
Public health threats motivated the Indian and Chinese responses to their epidemics. For India, the prospect of that the nation could contain the greatest number of HIV+ individuals in the world – and a realization of the potential economic consequences – motivated the government to act. India successfully scaled-up prevention and treatment efforts and increased government spending on HIV/AIDS programs over the past decades. As a result, 99.7% of India’s population is now HIV-free. For China, according to Dr. Wu, the 2003 SARS epidemic motivated the government to reprioritize its focus on the health of its population – including its HIV+ citizens. After implementing sensitive policies (e.g. condom promotion) and increasing the government’s financial commitment, substantially greater numbers of Chinese citizens have been tested and are receiving treatment – and the Chinese government now finances 80-90% of the HIV/AIDS budget.
Globally, India and Brazil have supported the response by manufacturing generic ARVs – helping bring down the price of drugs globally. Brazil has also shared technical knowledge with developing nations, including assisting Mozambique with constructing a pharmaceutical manufacturing plant. According to Dr. Wu, China has consistently raised the profile of health in its diplomacy with other developing nations and will share its scientific achievements. Ms. Johri proposed that a formal South-South platform be established to institutionalize HIV/AIDS cooperation among the BRICS. Professor Sachs suggested that these nations transform from recipients to donors by contributing to the Global Fund to Fight AIDS, Tuberculosis, and Malaria.
Challenges remain: ensuring programs’ financial sustainability as policymakers confront competing priorities; and combatting stigma and discrimination – especially directed against most-at-risk populations. Overall, the picture is positive and these nations can serve as models of success for other developing countries.