Contenu du sommaire

AIDS treatment access, drug markets, and citizenship in Brazil today This article addresses the politics and economics underlying Brazil's universal AIDS treatment policy and probes its social and medical reach in urban poor contexts where AIDS is spreading most rapidly. I argue that a combination of patient activism, pharmaceutical industry interests, and state reform has led to an incremental change in the concept of public health, now understood less as prevention and medical attention and more as access to medicines and community-outsourced care. AIDS therapies have indeed become universally available (the state is actually present through the dispensation of drugs), yet it is up to individuals and communities to take on the roles of medical and political institutions locally. Against the backdrop of limited infrastructures and through multiple circuits of care, the individual subjectivity of some AIDS patients is refigured as a will to live.

Aids, public health and drug policy : autonomy or dependency ? Brazilian policy on Aids stands as a “ model” whose originality stems from the production of generic drugs for facilitating all patients' access to treatments and therapies. This model, elaborated within state bureaucracies, has been inspired by the “ sanitary” movement which emerged in 1970' s, with an aim at promoting health as a fundamental human right that must be guaranteed by the state. Brazilian policy on Aids has also been highlighted for the transformations it has brought about in the relations between national industry and large multinational pharmaceutical firms. Drawing upon in-depth interviews with various actors who have played strategic roles within Brazilian health system and economic bureaucracy from 1960' s onwards, we will display the multiple interactions between public health policy, war on Aids, and drug policy. We will notably examine the complex configurations within which the issue of autonomy versus dependence of Brazilian pharmaceutical industry has been raised.

Eulogy for copying : reverse engineering of anti-retrovirals for HIV/ Aids in Brazilian pharmaceutical laboratories The Brazilian programme for combating the Aids epidemic, based on universal access to treatment and on the local production of generic drugs, closely combines public health policy and pharmaceutical companies' industrial policies. Using the window opened by the non-patentable status of pharmaceutical products in that country before 1996, Brazilian pharmaceutical laboratories in both the public and private sectors reverse engineered anti-retrovirals (ARV) that were patented elsewhere but could legally be copied for the domestic market. Whereas the leading international laboratories generally consider the copying of drugs to be a “ waste of resources”, the reverse engineering of molecules as complex as ARVs has led to the creation of local knowledge by Brazilian chemists. It has also enhanced the research and development (R& D) capabilities of the pharmaceutical laboratories engaged in this economy. Based on the questions and methods of sociology of science and innovation, the article examines the production, circulation and conditions of duplication of knowledge in laboratories. It sets the work of reproducing knowledge and technology in the context of intellectual property rights on drugs.

Vaccination policies in Brazil : science, public health and social control This article opposes the history of smallpox vaccination in Brazil with the one of vaccination against yellow fever. First attempts to impose small pox vaccination were closely linked with efforts of forced “ sanitizing” popular neighborhoods of Rio de Janeiro. These efforts met popular resistance that culminated with the “ vaccination rebellion” of 1904. The overall success of Cruz's sanitary campaign (1903-1907) led to enhancement of prestige of public health in Brazil, but public health measures rooted in control over populations continued to induce reactions of reject and resistance. The vaccination campaign against yellow fever that started in 1938, did not led, however, such reactions. This campaign was welcomed by local populations, and it popularity was not harmed by a series of vaccination accidents. The radical change of attitudes towards vaccination between 1904 and 1938 may be explained by the displacement of goals of vaccination from protection of spaces to protection of individuals at risk.