AIDS, Access to Medicines, and the Different Roles of the Brazilian and South African Governments in Global Health Governance

The present article illustrates how the main actors in global health governance (GHG) - governments, nongovernmental organizations (NGOs), intergovernmental organizations (IOs), and transnational pharmaceutical companies (TNPCs) - have been interacting and, as a result, modifying the global health architecture in general and AIDS treatment in particular. Using the concept of 'power types' (Keohane/Martin) and 'interfaces' (Norman Long), the authors examine the conflicts among major GHG actors that have arisen surrounding the limited access to medicines for fighting HIV/AIDS basically as a result of the Agreement on Trade Related Intellectual Property Rights (TRIPS), in force since 1995. They then analyze the efforts of Brazil and South Africa to obtain fast and low-cost access to antiretroviral medication against AIDS. They conclude that while policy makers in the two countries have used different approaches to tackle the AIDS problem, they have been able, with the support of NGOs, to modify TRIPS and change some WTO rules at the global level along legal interfaces. At the national level the results of the fight against AIDS have been encouraging for Brazil, but not for South Africa, where authorities denied the challenge for a prolonged period of time. The authors see the different outcomes as a consequence of Brazil's ability to combine discoursive, legal, administrative, and resource-based interfaces.