RIO DE JANEIRO, Brazil (WOMENSENEWS)–Eloan Pinheiro never shies away from a good fight.
Passionate and determined, she overcame her family’s financial difficulties and put herself through school. As a student activist in the 1960s, she protested her country’s military dictatorship. And as a tenacious chemist in the 1970s and 1980s, she sprinted her way up to management in Brazilian subsidiaries of major pharmaceutical companies, staking out her ground as a female pioneer in her field.
And in the 1990s Pinheiro faced her ultimate challenge: to help her country curb the spread of HIV/AIDS and produce domestic alternatives to the costly medicines patented by large foreign drug companies, such as her employer. She abandoned a high-paying job in a multinational pharmaceutical company and took over as director of Far-Manguinhos, Brazil’s largest government-owned laboratory.
"I’ve always clamored for justice," said the 56-year-old Rio de Janeiro chemist, a recognized leader in Brazil’s quest to contain the deadly epidemic and face up to pharmaceutical giants and international patent treaties.
By copying and manufacturing generic versions of AIDS drugs locally, Pinheiro has helped Brazil cut treatment costs by more than 70 percent, the government says.
"I think health is for everybody," Pinheiro said in an interview.
Brazil and other developing countries, she said, must "rescue their self-esteem" and foster local production instead of serving as factories for international companies who then ship profits abroad.
Brazil Must Not Become ‘Industrial Backyard for the World’
"A country like Brazil has to empower itself technologically," Pinheiro said. "I don’t want this country to be transformed into an industrial backyard for the world."
The United States recently dropped its complaint against Brazil with the World Trade Organization, opening the way to further domestic production. The United States had alleged that Brazil was violating international patent protections with its policy that calls for a compulsory licensing of patents, granting domestic production rights to Brazilian companies, if after three years, the drugs were not yet being manufactured by the foreign company in Brazil. The United States agreed that discussion, not legal grievance, was the best way to resolve the problem.
Similarly, 39 drug makers in April dropped a 1998 lawsuit against South Africa, recognizing a South African law allowing the government to selectively import low-cost pharmaceutical drugs. Major drug companies also reached important cost-cutting agreements with Senegal, Mali, Rwanda and Uganda, among others.
The Brazilian drug manufacturing initiative, coupled with widespread prevention campaigns, has reduced by half the number of AIDS deaths per annum. It has also put free medicine into the hands of 95,000 Brazilians infected with the virus, according to the ministry of health.
The ministry has recorded 203,000 cases of HIV/AIDS, but a UNAIDS report recently estimated that as many as 620,000 Brazilians are believed to be HIV-positive, one-third of whom are believed to be women.
Infection Rate Among Brazilian Women Is Rapidly Increasing
The number of women infected is rapidly increasing.
In the past five years, the number of AIDS cases grew nine times more among women than among men. In the 1980s, there were 25 men for each woman infected. By 2000, that ratio was up to 2 to 1. The ministry attributes the increase to an apparent lack of awareness and false sense of security among women, especially those who are married or are involved in serious relationships, which keeps them from seeking testing until the illness manifests itself in an advanced stage.
But the overall death rate has dropped: Between 1995 and 1999, 12.54 percent of people diagnosed with AIDS died, down from a death rate of 20.92 percent during the period 1991-1994 and 72.46 percent during the period 1987-1990, said Marcia Duarte Lage, a health ministry spokeswoman.
Together with five other government labs, Far-Manguinhos is producing 7 of the 12 drugs that can be used in AIDS-fighting drug combinations used to keep the disease in check. Far-Manguinhos supplies 40 percent of Brazil’s local production of generic AIDS drugs
HIV-AIDS Treatment, Drugs Are Free to All Brazilians
Many see Brazil as a model of sustainability and courage.
Anyone infected with the virus, rich or poor, can sign up for the government’s AIDS treatment program, which is free and includes regular doctors’ visits, exams and medications. Patients in the United States spend an average of $15,000 a year on such treatments
"There is a conscious commitment to saving lives," Pinheiro said.
Brazil has gained worldwide praise for its life-saving, cost-cutting strategies.
Pinheiro’s efforts are a drop in the pond against AIDS’ devastating record–21.8 million people dead from AIDS and 36.1 million others infected with HIV worldwide. But recent production of AIDS drugs–with and without a patent–demonstrate that Brazil’s perseverance has paid off.
Pressured by Brazil’s scientific advances in copying the drugs and a Brazilian patent law that protects the practice, U.S.-based pharmaceutical companies announced recently that they were reducing the prices of two drugs sold here: indinavir, from $1.3 to 47 cents a capsule, and efavirenz, from $2 to 84 cents a capsule.
Far-Manguinhos began selling its generic version of indinavir last year and began studying the chemical composition of efavirenz earlier this year, Pinheiro said.
Health Minister Jose Serra praised the pharmaceuticals’ price reductions, which will save the country $39 million, and called on other drug companies to do the same.
The ministry expects to reach an agreement with Swiss pharmaceutical giant Roche Group in the next few weeks. Brazil has threatened to issue a compulsory license for Roche’s Viracept, known generically as nelfinavir–which also is used to combat AIDS–if the company fails to cut its price by at least 40 percent, said Flavio Pontes, another ministry spokesperson.
Brazil spends $1.08 per pill to buy the drug from Roche. But Far-Manguinhos can make it for 60 cents.
Brazilians Now Spend Nearly Two-Thirds Less on AIDS Drugs
In 1996, the ministry spent the equivalent of $900 million on importing AIDS drugs. In 2000, recorded costs were down to $350 million as the number of people being treated increased, Pontes said.
"It shows that investing money in AIDS brings a very large financial return," Pontes said.
Although more women are being infected, more women also are being helped.
Heli Cordeiro knows it all too well. The 57-year-old office assistant said she contracted HIV from her husband of more than 30 years. Doctors suggested that she get tested after they attributed her husband’s sudden death to AIDS.
Cordeiro said she suspected her husband’s infidelity, but was never aware of her risk.
"I had only one man in my life," she said.
The free drugs she receives from a local health clinic have granted her a second lease on life, said Cordeiro who appears healthy and energetic, aside from a slightly pouched belly, which is one of the fat-redistribution side effects of the treatment.
She says she has adjusted to living with the virus and is not afraid of death. She speaks cheerfully of belly-dancing lessons she dreams of taking and of plans to visit Paris some day. Cordeiro has become a regular speaker to groups of women about the risks of trusting too much. She says that every woman is at risk and encourages women to be smarter and better informed.
She added that the Brazilian government’s approach–developing innovative ways to confront the need for medical care and medicines, treating all who have the disease regardless of their financial standing, and adding to the quality of life of those with AIDS–is part of her vision of how the world should work.
"I think the world will be better if we can achieve some social equality," Pinheiro added. "It’s my dream, my utopia."
Ana A. Lima is a free-lance writer and language teacher. She is Brazilian and worked as a news stringer for The Associated Press in Rio de Janeiro while teaching English and Portuguese classes. She is currently residing in Los Angeles, where she writes and teaches.
For more information:
FIOCRUZ (Oswaldo Cruz Foundation; includes Far-Manguinhos; English ver.):
Ministerio da Saude (Brazilian Ministry of Health; Portuguese only):
World Trade Organization:
Joint United Nations Programme on HIV/AIDS (UNAIDS):