15th International AIDS Conference Bangkok, Thailand - July 11-16, 2004

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. TuOrC1160)

Enriquez ME, Petersen M, Hacker M, Bastos FI
Stanford University, Stanford, United States

BACKGROUND: Brazil, as the first developing country to offer HAART through a government public health system in November 1996, presents a unique opportunity to assess the impact of universal access to HAART in a resource-limited setting. This study aims to analyze nationwide trends in AIDS incidence and mortality in Brazil during the period from 1984-2000, taking into account the striking regional and gender inequalities of a continent-sized country.

METHODS: National, regional, and gender-specific AIDS incidence and mortality rates, as well as deaths-to-cases ratios, were calculated using data from the Brazilian disease notification and mortality information databases for 1984-2000.

RESULTS: Declines in AIDS mortality in the post-HAART era occurred for both men and women and in all regions of Brazil. Incidence rates for both sexes declined after 1998, but at a slower rate than observed for mortality. Declines in incidence and mortality rates were more pronounced among men than women. Deaths-to-cases ratios, which had previously been substantially greater for women, equalized rapidly after 1996.

CONCLUSIONS: AIDS mortality rates in Brazil declined abruptly with universal access to HAART in 1996. Gender and geographic inequalities remain challenges, but the Brazilian HAART delivery system has resulted in clear reductions in AIDS mortality for both sexes and across regions and may be contributing to decreases in AIDS incidence. Brazil's experience demonstrates the feasibility of providing antiretroviral therapy to a large and economically heterogeneous population in the developing world.

040711
TuOrC1160

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