Look at Brazil now: A case study in the plight of middle income countries

By Juliet Glassroth June 23, 2016

In the January 2001 article “Look at Brazil,” the New York Times lauded the country for defying the critics and showing that AIDS could be treated in developing countries, stating “ the debate about whether poor countries can treat AIDS is over. The question is how.” The article went on to describe how the mobilization of gay men and the support of an informed leader led to the nation’s decision to defy pharmaceutical companies and produce generic drugs on their own.

Importantly, Brazil also provides universal access to health care and began providing free access to antiretrovirals (ARVs) in 1996.  In the 1990s Brazil enjoyed the support of European and American foundations, and secured a loan agreement with the World Bank that generated $950M in resources to address HIV/AIDS through equal shares invested by the Bank and the Brazilian government.  In short, Brazil (with support from donor nations) was doing everything right, and creating an example for other developing regions to follow… but in the mid-2000s, Brazil achieved middle-income country status and everything began to change.

Fast forward to the present:  while globally HIV infection rates have dropped an average of over 35%, in Brazil, infections increased by 11% between 2005 and 2013, and have soared by 53% in youth 15-19.  The divestment of bilateral, multilateral and even private resources from Brazil -compounded by a shrinking economy – have left a void in funding for HIV prevention services.

Before they departed Brazil, some US and European foundations helped to set up Brazilian foundations to deal with various social justice concerns; however, none of these had an HIV focus.  In response, the Brazilian Health Ministry provided seed funding to establish Fundo PositHIVo in 2014. This is the first private social fund fostered by the federal government.

To date, four Brazilian companies and Gilead Sciences have joined the effort to establish this new foundation with a focus on:

  • Institutional strengthening and/or mobilization of resources ;
  • Prevention of STDs, HIV/ AIDS and  viral hepatitis (VH);
  • Education and respect for human rights of populations most vulnerable to STDs, HIV/AIDS and VH; and,
  • Acting on networks for advocacy and social monitoring of STD, HIV/AIDS and VH

In its first year of grantmaking, Fundo PositHIVo has made already made grants to:

  • The Youth Network and Adolescents Living with HIV/ AIDS
  • The National Movement of PositHIVe Citizens
  • Group of Women Prostitutes of the State of Pará (GEMPAC).

Middle-income countries are home to roughly 70% of HIV infected people, yet they are not eligible for critical funding to help treat those infected and prevent new infections.  The plight of middle-income countries provides a massive challenge for philanthropy, but the emergence of organizations like Fundo PositHIVo are proof that Brazil can still provide an example for others to follow. Fundo PositHIVo will be launching their first RFP for civil society organizations this summer on the issue of HIV prevention, with a focus on youth.