A public policy approach to local models of HIV/AIDS control in Brazil.
OBJECTIVE
We investigated involvement and cooperation patterns of local Brazilian AIDS program actors and the consequences of these patterns for program implementation and sustainability.


METHODS
We performed a public policy analysis (documentary analysis, direct observation, semistructured interviews of health service and nongovernmental organization [NGO] actors) in 5 towns in 2 states, São Paulo and Pará.


RESULTS
Patterns suggested 3 models. In model 1, local government, NGOs, and primary health care services were involved in AIDS programs with satisfactory response to new epidemiological trends but a risk that HIV/AIDS would become low priority. In model 2, mainly because of NGO activism, HIV/AIDS remained an exceptional issue, with limited responses to new epidemiological trends and program sustainability undermined by political instability. In model 3, involvement of public agencies and NGOs was limited, with inadequate response to epidemiological trends and poor mobilization threatening program sustainability.


CONCLUSIONS
Within a common national AIDS policy framework, the degree of involvement and cooperation between public and NGO actors deeply impacts population coverage and program sustainability. Specific processes are required to maintain actor mobilization without isolating AIDS programs.
Paris Hospital and Institut National de la Santé et la Recherche Médicale UMRS, France. guillaume.leloup@u707.jussieu.fr
Guillaume
G
Le Loup
Andreia
A
de Assis
Maria-Helena
MH
Costa-Couto
Jean-Claude
JC
Thoenig
Sonia
S
Fleury
Kenneth
K
de Camargo
Bernard
B
Larouzé
D001938:Brazil / Q000453:epidemiology; D003695:Delivery of Health Care / Q000458:organization & administration; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control*; D006291:Health Policy; D006801:Humans; D017146:Models, Organizational; D009313:National Health Programs / Q000191:economics / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration; D019472:Universal Health Insurance / Q000191:economics / Q000458:organization & administration