Brazil has pioneered the distribution of free AIDS treatment. But as costs soar, it is considering the issue of compulsory licences to bypass patents on some AIDS drugs.

About 125,000 Brazilians with AIDS take advantage of the nation's 1996 free-drugs policy, and mortality has dropped from 70% to 40%. But the country's generic drugs are becoming obsolete, forcing it to import costly, newer ones.

The Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement, which Brazil joined in 1996, prevents it from making generic copies of drugs developed since then. Patient demand for newer therapies means that 8 of the 15 approved drugs are now brand-name imports, and account for 70% of its AIDS treatment budget.

A meeting of Latin American politicians and scientists in Brasilia on 23–24 June will discuss how to assure the long-term viability of free antiretrovirals.

Brazil could invoke a compulsory licence, which would allow it to make generic versions of recent drugs. Under World Trade Organization rules adopted last year, this is legal in cases of 'national emergency'. But Brazil fears a trade dispute with the United States if it does this, says Michel Lotrowska, from the Rio de Janeiro office of Médecins Sans Frontières. Trade pressure against doing so is very strong, he says.

The threat of such licensing has lowered prices in the past, but it becomes less convincing as Brazil's production of generic drugs falls, and the expertise to make them is lost. So, Brazil will "need to think about compulsory licences", Lotrowska says.