The HIV/AIDS epidemic commenced in Brazil, the fifth largest country in the world, in the early 1980s during a time of profound social and political change. As the military dictatorship, which had taken power in 1964, gradually lost support, a political process known as abertura,“opening”, began. During the late 1970 s, there was a gradual recovery of political rights and by the early 1980s Brazil held its first post-dictatorship democratic elections. During this time, new political and community leaders, as well as non-government organizations (NGOs), lobbied for public health, social security and medical care reforms. In 1988, Brazil adopted a new Constitution which guaranteed universal and equitable provision of health care to all Brazilians. As HIV/AIDS became a growing public health problem, both the social will and a public framework to fight the epidemic were developing; advocacy by the public health sector and by social activists played a fundamental role in shaping the nation’s early response to the epidemic.

In the mid 1980s/early 1990s, people living with HIV/AIDS (PLWHA) sued local and federal governments for failing to uphold the constitutional right to health in the context of HIV/AIDS. They first sued for the right to treatment of opportunistic infections, and later for antiretroviral drugs (ARVs) such as Zidovudine (AZT). These court cases and social mobilization paved the way for a 1996 Law, Law 9.313, which established free and universal access to ARVs. A tremendous amount of social mobilization by civil society groups held the government accountable for its commitments to providing health services to treat PLWHA and clearly stood in contrast to other illnesses. Brazil’s early inclusion of highly active antiretroviral therapy (HAART) in the Brazilian HIV/AIDS program played a major role in its success in combating the AIDS epidemic over the years, and has distinguished Brazil from most other developing countries that did not offer treatment to PLWHA until much later. However, major achievements in terms of comprehensive management and care of PLWHA took place in a context of deep social inequality. Brazil has one of the world’s most inequitable wealth distributions (BMoH–IDB, 2005). In 2005, 46.9% of the national income was controlled by the wealthiest 10% of the population, while only 0.7% was controlled by the poorest 10%(UNDP, 2005). As a consequence, Brazil’s Human Development Index (HDI) ranking is relatively low given its per capita Gross Domestic Product. Indeed, almost a quarter of Brazilians earn less than USD 2 a day (UNAIDS, 2006)(See Table 29.1). Wealth, health and income disparities also vary widely by geographic region as do degrees of urbanization, economic development (Szwarcwald et al., 2002), and access to health care infrastructure (Almeida et al., 2000). Socioeconomic disparities, geographic diversity, and the size of the country have all complicated the Brazilian response to HIV/AIDS. While universal access to HAART was quickly implemented in major metropolitan areas with well-functioning health systems, drug logistics and patient monitoring systems remain fragmentary in more remote Brazil, where health infrastructure development requires significant time and financial investment (Bastos et al., 2001). Despite these challenges, the history of the Brazilian HIV/AIDS epidemic has been characterized by collaboration between the Brazilian Ministry of Health (BMoH), NGOs, and international organizations. While dispensing and