The panel combined three successful Governmental experiences in the response to the HIV Epidemic, Brazil, United States of America and Swaziland.
Brazil started early in the response to HIV from the establishment of the National AIDS Response in the wave of democratization of the country in 1985 (also year of the formal creation of the National Program) and the new Constitution in 1988 that guaranteed the universal right to health. The basic principles of the health system built by then were: universal access to health, equity, integrality and community participation. The National AIDS Response was built with that background and a special moment was in 1996 when the government decided to provide universal access to ARV for all in need, despite their social position or being the most affected sector of the population. That national decision at the time was opposed by many global institutions, such as the World Bank, which argued that Brazil could generate drug resistance and it was not rational for such investment in expensive treatment. History proved that the decision was right and cost-effective and was later one of the basis for Global proposals such as 3 x 5. Levels of resistance in Brazil were never different from US or European, and most of the time were better. Despite the advances, it was recognized that improvements are needed to confront social inequities, limitations in prevention and late initiation of treatment in 30% of the cases with CD4 less than 200.
The United States of America was very early involved in the control of the HIV epidemic in country through many institutions such the US CDC, Universities, Non-Governmental Organization, State and City Governments and the National Institute of Health among others. People were able to access life saving ARVs from many sources, despite not having a structured health system to deal with this. However, it was under the President Obama administration that a coordinated effort to confront and halt the epidemic was established with the launching, in 2010, of the National HIV/AIDS Strategy for the United States. The Strategy was based on evidence and planned according to consistent strategic information and the flexibility to shift resources and priorities based on monitoring and evaluation. It was also noted that despite a national strategy, there is the concurrence of multiple epidemics in different States, or even inside of one city. The main challenges are to intensify the work with different communities, particularly MARPS , and to make condoms widely accessible, HIV testing and provision of ARVs. New technologies are being applied to capture more people into prevention and treatment such as social media, mobile phone text, advertisements in sex web pages, among others. For the United States, sustainability is dependent on increase of efficiencies, better functioning of the health system and community participation.
Swaziland was particularly successful in controlling HIV from mother to child with the achievement of 96% coverage in PMTCT. Their programme from the beginning counted with the leadership of the Central Government using the three principles of UNAIDS: One agreed AIDS action framework; one national authority; one country agreed system of Monitoring and evaluation. The country has received international financial and technical support, but has had the commitment to really face the epidemic. Despite efforts and successes, general population prevalence is still 26%. Problem such as misinformation, regional lack of commitment among others were certainly important drivers of the epidemic. There are still problems to overcome such as the rights of the females and the stigma and discrimination against some MARPS such as MSM. The large use of the media, particularly radio and the partnership with community leaders have been effective in advancing the response.
The way forward
Political commitment, ownership, South-South collaboration and saving lives of new born.