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AIDS treatment in Brazil: what kind of evidence do we need?

2009; Elsevier BV; Volume: 374; Issue: 9695 Linguagem: Inglês

10.1016/s0140-6736(09)61705-0

1474-547X

Artur Olhovetchi Kalichman, Simone Grilo Diniz,

HIV/AIDS Impact and Responses

Elizabeth Pisani's review (July 18, p 191)1Pisani E AIDS treatment in Brazil: success beyond measure?.Lancet. 2009; 374: 191-192Summary Full Text Full Text PDF Google Scholar of Amy Nunn's book2Nunn A The Politics and History of AIDS Treatment in Brazil. Springer, Berlin2009Crossref Scopus (82) Google Scholar is informative and provocative, but reflects a common misunderstanding of the context of the Brazilian AIDS response. First, the artificial dichotomy between prevention and treatment is contrary to the Brazilian health system (SUS) principle of integralidade (comprehensiveness). Treatment is in itself a form of secondary prevention of complications, and reduces HIV transmission. Prevention was always at the top of the agenda, and key strategies such as promoting condom use among adolescents and men who have sex with men, empowerment of sex workers, and harm reduction for injection-drug users received as much resistance from conservative sectors, domestically and internationally, as treatment itself.The second misunderstanding is the artificial dichotomy between strengthening of health systems and programmatic, focused, public-health-oriented actions. The Brazilian HIV programme would never have succeeded without the SUS principle of universality, based on constitutional rights, for both prevention and treatment. Mortality and incidence decreased:3Brasil, Ministério da SaúdeBoletim epidemiológico: Aids e DST Ano V. No 1 (in Portuguese).http://www.aids.gov.br/data/Pages/LUMIS9A49113DPTBRIE.htmGoogle Scholar from this rights-based perspective, that is the necessary evidence. Synergistically, the AIDS response itself has been instrumental to SUS development.The Brazilian AIDS programme is a success story, with much room for improvement, in treatment and prevention, particularly in regional equity. The SUS public health structure and information systems are extraordinary sources of data from which to produce the observational and experimental evidence needed for its monitoring and improvement. The expansion of SUS research capacity to produce such evidence should do justice to the complexity of evaluating public health interventions—integrating, instead of creating artificial dichotomies between, evidence-based and rights-based perspectives.We declare we have no conflicts of interest. Elizabeth Pisani's review (July 18, p 191)1Pisani E AIDS treatment in Brazil: success beyond measure?.Lancet. 2009; 374: 191-192Summary Full Text Full Text PDF Google Scholar of Amy Nunn's book2Nunn A The Politics and History of AIDS Treatment in Brazil. Springer, Berlin2009Crossref Scopus (82) Google Scholar is informative and provocative, but reflects a common misunderstanding of the context of the Brazilian AIDS response. First, the artificial dichotomy between prevention and treatment is contrary to the Brazilian health system (SUS) principle of integralidade (comprehensiveness). Treatment is in itself a form of secondary prevention of complications, and reduces HIV transmission. Prevention was always at the top of the agenda, and key strategies such as promoting condom use among adolescents and men who have sex with men, empowerment of sex workers, and harm reduction for injection-drug users received as much resistance from conservative sectors, domestically and internationally, as treatment itself. The second misunderstanding is the artificial dichotomy between strengthening of health systems and programmatic, focused, public-health-oriented actions. The Brazilian HIV programme would never have succeeded without the SUS principle of universality, based on constitutional rights, for both prevention and treatment. Mortality and incidence decreased:3Brasil, Ministério da SaúdeBoletim epidemiológico: Aids e DST Ano V. No 1 (in Portuguese).http://www.aids.gov.br/data/Pages/LUMIS9A49113DPTBRIE.htmGoogle Scholar from this rights-based perspective, that is the necessary evidence. Synergistically, the AIDS response itself has been instrumental to SUS development. The Brazilian AIDS programme is a success story, with much room for improvement, in treatment and prevention, particularly in regional equity. The SUS public health structure and information systems are extraordinary sources of data from which to produce the observational and experimental evidence needed for its monitoring and improvement. The expansion of SUS research capacity to produce such evidence should do justice to the complexity of evaluating public health interventions—integrating, instead of creating artificial dichotomies between, evidence-based and rights-based perspectives. We declare we have no conflicts of interest.