Marseille 2007
| Abstract #406 - PATTERNS OF COOPERATION AND CONTROL OF HIV/AIDS EPIDEMICS IN POOR POPULATION: LESSONS FROM BRAZIL | ||||
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Session: 29.3: Lessons learned for tomorrow's strategies (Parallel) on Tuesday @ 11.00-12.30 in Auditorium/Overflow Chaired by Lisa Power, Yves Souteyrand Authors: Presenting Author: Mr Guillaume Le Loup - INSERM, France |
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| Additional Authors: Mrs Andreia de Assis, Mrs Maria-Helena Costa-Couto, Prof Jean-Claude Thoenig, Prof Sonia Fleury, Dr Kenneth Camargo Jr, Dr Bernard Larouz, | ||||
| Aim: Confronted with the pauperization of the HIV epidemics and with the rising cost of ARV, the brazilian STD/AIDS program considers as priority the cooperation with actors of the public health system (Sistema Universal de Saude, SUS), particularly with primary health care (PHC), and with non-governmental organizations (NGOs). The aim of the study is to analyse this cooperation and its consequences for the control of the HIV epidemics. | ||||
| Method / Issue: Documentary analysis, direct observation and semi-structured interviews of local actors in the public health services and some NGOs were realized according to the methods of the strategic and systemic analysis during 2005 and 2006, in 5 brazilian cities: Belm, Ananindeua, Santarem (State of Par), Guarulhos, Ribeiro Preto (State of So Paulo). | ||||
| Results / Comments: The STD/AIDS program locally has a limited cooperation with other actors of the public health system, particularly PHC, regarding formulation and implementation of the HIV/AIDS control policy. But the STD/AIDS program has very strong links with actors outside the SUS: NGOs, the media, international institutions. It determines, at the local level, the economy of the HIV/AIDS policy: a priority for treatment and care over prevention and diagnosis in the poor populations and in specific vulnerable groups, and an indirect selection of the target groups who benefit from this policy. Two different local cooperation patterns were observed: 1. In the context of high stigmatization and strong mobilization of NGOs/AIDS, the cooperation is quite limited between DST/AIDS programs and other actors of the SUS, particularly PHC. The involvement of PHC professionals in HIV prevention is weak. In the poor general populations, prevention is locally limited to providing information and distributing of condoms, in response to demands; HIV volontary testing and care for STD, which are important risk factors of HIV infection, are frequently neglected. 2. In the context of low stigmatization and more limited political mobilization of NGOs/AIDS, the participation of PHC in the HIV prevention is stronger. It relies on close and informal links with HIV/AIDS programs, delegation of HIV testing and counselling to PHC, and on a strong participation of community leaders and health professionals. The prevention in the poor population includes a set of tools: HIV voluntary testing, health education, large distribution of condoms and care for STD. | ||||
| Discussion: These patterns of cooperation and their consequences for the control of the epidemics can be primarly explained by: (1) the political and functional cost/benefit balance for public health services of their involvement in HIV control and territorial embeddedness of PHC; (2) the priority given to STD/AIDS program to overcome financial constraints and instability of local health programs; (3) the type of the NGOs (AIDS specific versus NGOs with wide range of activities and population groups) and their main activity (political activism versus provision of services). Our study raises some questions about the ambivalent effect of cooperation with PHC and with NGOs in the control of the HIV epidemics. | ||||
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