Origins and Limitations of State-Based Advocacy: Brazil’s AIDS Treatment Program and Global Power Dynamics

Brazil has occupied a central role in the access to medicines movement, especially with respect to drugs used to treat those with the human immunodeficiency virus (HIV) that causes the acquired immune deficiency syndrome (AIDS). Contrary to previous literature centered on the role of the domestic pharmaceutical industry, politicians seeking electoral gains, and civil society activists, I argue that the state, especially the National AIDS Program, led the struggle in contesting a corporate-driven international intellectual property regime. After reviewing the origins of Brazil’s treatment policies and patent reforms, I trace the actions and relationships between the state, civil society, transnational corporations (TNCs), and local industry in three instances when Brazilian officials used compulsory licenses to reduce the price of medicines. Coalition-building and “naming and shaming” tactics contributed to Brazil’s success, while changing pharmaceutical capabilities limited more aggressive actions.