From Policy to Practice: Brazil's Pathway to Eliminating Vertical Transmission of HIV as a Public Health Milestone

INTRODUCTION: The elimination of vertical transmission of HIV is a global health priority endorsed by the Pan American Health Organization (PAHO) and the World Health Organization (WHO), aligned with the Sustainable Development Goals (SDGs). Brazil has made substantial progress towards this goal through sustained investment in universal health policies and a rights-based approach to healthcare. DISCUSSION: Brazil's national HIV response is anchored in the Unified Health System (Sistema Único de Saúde-SUS), a universal, decentralized and participatory health system that ensures access to prevention, diagnosis, treatment and monitoring. Tripartite governance-across federal, state and municipal levels-combined with strong community engagement, has enabled coordinated policy implementation at scale. This framework has supported high coverage of antenatal care (>98%), HIV testing (>95%) and antiretroviral therapy among pregnant women living with HIV (>95%) in recent years. Vertical transmission rates of HIV declined from 3.73% in 2015 to 1.78% in 2023, remaining below the elimination threshold. The annual rate of new paediatric HIV acquisitions also declined to low levels, being 5.99 per 100,000 live births in 2023, far below the PAHO/WHO targets. A certification for states and municipalities strategy further accelerated progress toward the elimination by strengthening accountability, improving data quality and engaging local health systems. CONCLUSIONS: Brazil's experience demonstrates that HIV vertical transmission elimination is feasible in large and unequal settings when supported by strong governance, integrated health systems and sustained political commitment. The certification of vertical transmission elimination of HIV by PAHO/WHO in 2025 represents a major milestone and offers valuable lessons for global health. Brazil remains committed to sustaining stainability of this certification and to advancing efforts for the elimination of other vertically transmitted infections, including syphilis, hepatitis B, Human T-cell lymphotropic virus (HTLV) and Chagas disease.