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Sustaining a Rights-Based Response to HIV in Brazil

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Part of the Social Aspects of HIV book series (SHIV,volume 4)

Abstract

Brazil has been internationally recognized for its historically rights-based response to HIV, including the significant engagement and mobilization of vulnerable population groups. However, in recent years, concerns have grown that this approach has weakened and questions about its sustainability have been raised. Similar shifts in the international context evoke a broader reflection about how to develop and sustain responses to HIV driven by community needs and guaranteed through state responsibility. This chapter begins by exploring key elements of the historical response to HIV including a critical analysis of how vulnerable population groups were integrated into national prevention programs in Brazil. It goes on to examine the more recent sociopolitical and economic shifts that have contributed to a change in the structure of the Brazilian response to HIV and outline how certain groups have been impacted by these shifts through a case study focused on female sex work. The chapter focuses on how recent policy changes, including the prioritization and rollout of test and treat and associated biomedical prevention strategies, such as pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP), are being implemented. The authors conclude with a discussion of the complex questions raised by current attempts to sustain a rights-based approach amidst constitutional changes in the state’s financial and social commitments to health.

Keywords

  • HIV/AIDS
  • Brazil
  • Public Health Policy
  • Sex work

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  • DOI: 10.1007/978-3-319-63522-4_7
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Notes

  1. 1.

    Travesti is a gender subjectivity in Brazil (see Pelúcio 2009; Kulick 1998) that is distinct from the category of transvestite in English and references those who perform femininity in their daily livesand have not surgically altered their male sex.

  2. 2.

    Although the Ministry of Health had been increasingly investing in testing since the rapid test became available in Brazil in 2005, oral tests were not yet developed, so the possibility that tests would be done by sex workers on other sex workers was not discussed.

  3. 3.

    It is important to note that this understanding of ‘combination prevention’ is fundamentally different from that originally intended by those who developed the concept to refer to tailored and context specific responses to the epidemic that combine biomedical, behavioral and structural approaches (see Hankins and de Zalduondo 2010).

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Correspondence to Laura Murray .

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© 2018 Springer International Publishing AG

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Murray, L., Kerrigan, D., Paiva, V. (2018). Sustaining a Rights-Based Response to HIV in Brazil. In: Kerrigan, D., Barrington, C. (eds) Structural Dynamics of HIV. Social Aspects of HIV, vol 4. Springer, Cham. https://doi.org/10.1007/978-3-319-63522-4_7

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  • DOI: https://doi.org/10.1007/978-3-319-63522-4_7

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-319-63522-4

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