Summary: This study assesses the potential demand by the public sector for a preventive HIV/AIDS vaccine in Brazil and the costs of alternative strategies for a vaccination program. Brazil has a mature AIDS epidemic: the percent of the population living with HIV or AIDS (about 0.6 percent of adults) is not as high as in other severely affected developing countries, but infection rates in specific risk groups in the population are very high and HIV has spread beyond these groups into the general population of low-risk individuals. Preventive HIV/AIDS vaccines are still in the testing stage. The characteristics of the first vaccines developed, in terms of their efficacy, duration of effectiveness, ease of administration, and price, are still unknown. But the potential benefits of such a vaccine in Brazil would be high. The study reviews the cost and impact of HIV/AIDS in Brazil, in terms of disease and economic burden, as a proxy for the benefits of an HIV/AIDS vaccine. The epidemiology of AIDS and Brazil's experience with immunization coverage with other vaccines are used to assess the number of vaccines, delivery strategies, and possible costs of an HIV/AIDS immunization program in Brazil, assuming the availability of a 100 percent effective AIDS vaccine that lasts a lifetime under different pricing and dosing assumptions. A low-cost, highly effective vaccine would likely be affordable to an upper-middle-income country like Brazil and yield large benefits from a policy of universal, publicly subsidized immunization. But if prices are higher and the impact less favorable, the costs and effects would have to be compared with other AIDS prevention programs or other health interventions. Both political and economic considerations will likely figure into public policy on HIV/AIDS vaccination, when such a vaccine is developed.
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