rodrigo zilli haanwinckel ministry of health of brazil health surveillance secretariat department of...

Rodrigo Zilli Haanwinckel

Ministry of Health of BrazilHealth Surveillance Secretariat

Department of STD, AIDS and Hepatitis

Prevention of vertical transmission of HIV in Brazil

3

• Population – 190 million

• 27 States

• Municipalities - 5,561

• Area: 8,5 million sq km

Brazil

SUS - National Health System

• Federal law # 8080 (1988) - National Health System (SUS) established – “health as a citizen’s right and the government’s duty” - free and universal access to health care

• 100% of Brazilian people have the right to access the National Health System, including the prisoners.

Prevalence : 0.61%

(pop. 15 to 49 years old)

fem: 0.42%

male: 0.80%

HIV: General Data. Brazil,

Estimate nr of PLHA620,000

Detection of Pregnant Women with HIV/aids (cases and incidence rate/100,000 live births), by year. Brazil, 2005-2009(1)

FONTE: MS/ SVS/ Departamento de DST, Aids e Hepatites Virais

NOTA: (1) Casos notificados no Sinan até 30/06/2010

(2) Utilizados nascidos vivos no ano de 2008

Dados preliminares para os últimos 5 anos

2005 2006 2007 2008 2009

n rate n rate n rate n rate n rate

6091 2,0 6100 2,1 6532 2,3 5903 2,0 6104 2,1

Reported Cases of MCT of HIV in children less than five years-old.

Year Cases

2004 678

2005 683

2006 564

2007 483

2008

2009

533

468

Incidence rate of AIDS (by 100,000 inhabitants) in

children less than 5 years-old by Brazilian region and

year of diagnosis. Brazil, 1997 to 2009.

FONTE: MS/SVS/Departamento de DST Aids e Hepatites Virais.POPULAÇÃO: MS/SE/DATASUS em <www.datasus.gov.br> no menu informações em saúde > Demográfica e socioeconômicas, acessado em 20/10/2009.NOTA: (1) Casos notificados no SINAN e registrados no SISCEL/SICLOM até 30/06/2009 e SIM de 2000 a 2008. Dados preliminares para os últimos cinco anos.

0,0

2,0

4,0

6,0

8,0

10,0

12,0

14,0

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Year of diagnosis

Inc

ide

nc

e r

ate

Brazil North Northeast Southeast South Midwest

*Brazilian local production (10 out of 21)

Year of introduction in parenthesis

RITONAVIR (1996)*

SAQUINAVIR (1996)*

INDINAVIR (1997)*

NELFINAVIR (1998)

AMPRENAVIR (2001)

LOPINAVIR/r (2002)

ATAZANAVIR (2004)

DARUNAVIR (2008)

TIPRANAVIR (2010)

ZIDOVUDINE (1993)*

ESTAVUDINE (1997)*

DIDANOSINE (1998)*

LAMIVUDINE (1999)*

ABACAVIR (2001)

DIDANOSINE EC (2005)

TENOFOVIR (2003)-2011*

NEVIRAPINE (2001)*

EFAVIRENZ (1999)-2007*

ETRAVIRINE (2011)

NTRI

ENFUVIRTIDE (2005)

PI

FUSION INHIBITOR

NNTRI

RALTEGRAVIR (2009)

INTEGRASE INHIBITOR

Antiretroviral drugs universally available in Brazil

Brazilian Penitentiary System

Scenario (Dec/2011): Incarcerated population: 471,254

441,907 (94%) – Men 29,347 (6%) – Women

• 1,779 penal facilities – 4 federal prisons

0tan26a566026

0tan27a566027

0tan5a56605

0tan9a56609

0tan24a566024

Number of Reported Pregnant Women In Prision. Brazil, 2010 (n= 423)

NORTHNORTHEASTSOUTHEASTSOUTHMIDWEST

HIV, HPV and Syphilis prevalence in São Paulo’s feminine prison – 1997/1998 – Public Health Review - 2001

F. Lopes;M. Latorre;A. Pignarati;C. Buchalla

Population: female prisoners;City: São Paulo, SPSamples: 262HIV: 14,5%; HPV: 16,3%; Syphilis: 5,7%

Behaviour associated to HIV and HCV infection in female prisoners in a penitentiary of São Paulo, Brazil – Public Health Review - 2007

L. Strazza;E. Massad;R.Azevedo;H.Carvalho;

Population: female prisonersCity: São Paulo, SPSamples: 290 (299)HIV: 13,9%; HCV: 16,2%

Prevalence of HIV/AIDS in female in prision:

Increasing vulnerability context

Confining Conditions• Overcrowding• Inadequate facilities• Difficulties in accessing prevention and hygiene

materials (condoms, lubricants, toothbrushes, shavers)• Violence• Poor health care• Limited access to information

Practices that increase vulnerability• Drug Use• Unprotected sex• Sharing of tattoo and piercing equipment

The Brazilian Response to HIV & AIDS

Is focused on principles of protection and human rights;

Universal access; Is structured by the Policy of Attention to

Incarcerated Individuals; Is based on integral attention and access to

prevention materials (condoms, ART and testing);

Multisectoral actions.

HIV & AIDS in the Penitentiary System National Actions

• National Plan for Health in the Penitentiary System, 2003

• Regional Consultation for Latin America and the Caribbean on HIV & AIDS in Prison Settings, 2008

• National Consultation on HIV & AIDS in Prison Settings, 2009

• Technical Cooperation Project – Ministry of Health, Penitentiary System Authority and UNODC: HIV & AIDS prevention and assistance - Strengthening health care in the penitentiary system.

• National Plan for Health in the Penitentiary System - Revision

National Plan for Health in the Penitentiary System

Purpose:

Organize the access of inmates to public health services

Targeted population:

100% of Brazilian inmates

18 Brazilian states qualified and developing

Health Network Prevention:

Prevention commodities (condoms and harm reduction kits)

Breast milk substitute for exposed children Medication to inhibit breast milk production Hepatitis B vaccination

Diagnosis: Testing (HIV, STD, TB, hepatitis B and C) Follow-up procedures: viral load, CD4, genotype

Treatment: ART Treatment for opportunistic infections; STD treatment

Operational Plan for The Reduction of MCT of HIV

and Syphilis

Goals:• Reducing HIV MCT rate to less than

1%

• Eradicating congenital syphilis (<1 case/1,000) nationwide.

Main achievement:• From 1997 to 2009: 49% reduction in

the incidence rate of AIDS cases in children under 5 years old.

Challenges

Organization of the health care network Access to prevention materials Access to diagnosis and specialized

care to women in prision Monitoring of the PMCT in this

population Human rights as a key issue to reduce

vulnerabilities

THANK YOU!

rodrigo.zilli@aids.gov.br

FAÇA O TESTE DE AIDS,SÍFILIS E HEPATITE