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OBJECTIVES: To discuss studies conducted in Brazil relating to PrEP, from 2012 to 2022, based on a narrative review. METHODOLOGY: The databases of the Virtual Health Library/PAHO, portals from Scielo, Scopus, and PubMed, and the descriptors in English and Portuguese 'Pre-exposure to HIV' and 'Brazil' were used, as well as a list of planned/in-progress demonstrative studies. Inclusion criteria consists of articles with fieldwork in Brazil coupled with PrEP in the Brazilian scenario; and articles in English or Portuguese. Articles in which PrEP was not the central theme and the participating Brazilian population did not reside in Brazil were excluded. RESULTS: 107 papers have been reviewed, 80 articles met the inclusion criteria. The majority participating population was men who have sex with men. 61 studies preceded the implementation of PrEP in Brazil. Studies carried out after implementation (n = 19) deal primarily with the impact of the COVID-19 pandemic. CONCLUSIONS: There was an incipient number of studies on the injectable form of PrEP. Fewer studies included segments with greater difficulties in access, use, and adherence. Despite the issues that circumscribe this prevention technology, literature is consensual on the importance of Brazilian leadership for implementing PrEP. [ABSTRACT FROM AUTHOR]

This article approaches the emergence of social subjects – associativism – and the formation of horizontal circuits of solidarity, both of which were decisive processes for saving lives in favelas and suburbs in Rio de Janeiro during the Covid-19 pandemic. The impact of the pandemic has been enormous collective trauma that accentuated the collapse of health surveillance systems and generated a catastrophe and humanitarian crisis in the city. Solidarity and local collective cooperation processes had decisive effects as a new protagonism, generating synergy with health actions and social programmes. They contributed decisively to actions that made forms of immunological protection, food security, and access to basic care possible in adverse contexts with weak policies and severe limitations for social isolation. Highlighting the importance of collective health surveillance and assistance actions from local associations, this paper discusses public health actions in the favela territories that demonstrate how communities, universities, public officials, and public health networks can develop policies and projects to confront Covid-19 in the favelas. [ABSTRACT FROM AUTHOR]

How does the private sector structure the trajectory of a country's universal healthcare programme? Social scientists have long pointed to the importance of path dependence in shaping health reform. Yet, rarely have middle-income countries' experience with the private sector under Universal Health Coverage (UHC) been examined from comparative perspective. In this paper, we explore the changing landscape of the health sector in Brazil and Thailand before UHC reform and after. We find path-dependent processes at work that have pushed two countries that both adopted UHC reforms in divergent directions. In Brazil, a comparatively large and entrenched private sector that existed before reform has grown over time, and a sizable private health insurance industry has exerted powerful influence on health policy, weakening the public sector. In Thailand, constraints on private health insurance growth and sustained investment in public health infrastructure and governance have helped check the growth of private sector influence, although battles over health policy still remain contentious. The experiences of these countries offer lessons for policymakers seeking to achieve and maintain robust UHC programmes in other contexts. [ABSTRACT FROM AUTHOR]

Community health workers (CHWs) are framed as the link between communities and the formal health system. CHWs must establish trusting relationships with the community and with the broader health service. How to find the optimal balance between the various strands of work for CHWs, and how to formalise this, has been the focus of different studies. We performed an extensive documentary analysis of federal legislation in Brazil to understand the institutionalisation of the CHW workforce in Brazil over the last 3 decades. The paper offers three contributions to the literature: the development and application of an analytical framework to consider the institutionalisation process of CHWs; a historical analysis of the professional institutionalisation of CHW in Brazil; and the identification of the paradoxes that such institutionalisation faces: firstly, institutionalisation focused on improving CHW remuneration created difficulties in hiring and paying these professionals; when CHW are incorporated within state bureaucracy they start to lose their autonomy as community agents; and that the effectiveness of CHW programmes depends on the improvement of clinical services in the most deprived areas. [ABSTRACT FROM AUTHOR]

This paper examines the decline of the AIDS Programme in Brazil, the Latin American country most affected by the epidemic, with emphasis in the second decade of the twenty-first century. For many years, Brazil served as a model in Global Health due to a comprehensive preventive policy, a partnership between the government and health activists and the support of life-saving drugs as public goods rather than commodities. The regression of AIDS policies in Brazil interacted with developments in the United States as well as with multilateral agencies like UNAIDS that emphasised biomedicalisation in the response to the disease where broad human-rights programmes and alliance with activists were not priorities. International programmes like the 'Ending AIDS' campaign indirectly undermined the exceptional status AIDS enjoyed since the late 1980s. The backlash in Brazilian policies to fight AIDS was a result of the fragmentation of the left and the empowerment of radical conservative authoritarian and religious forces. The result was the breakdown of the long-held belief that successful anti-AIDS disease programmes could simultaneously help control the disease and build better healthcare systems and ultimately prompted the end of the special place AIDS' policy had in Brazil. [ABSTRACT FROM AUTHOR]

Drawing on ethnographic research conducted from 2011 to 2015 and the authors' long-term engagement in diverse aspects of HIV and human rights advocacy in Brazil, this paper explores key elements of the Brazilian sex workers' movement response to HIV and the broader political factors that profoundly influenced its trajectory. We argue that the movement has constantly challenged representations of prostitution by affirming sex workers' roles as political actors, not just peer educators, in fighting the HIV epidemic and highlight their development of a sex positive and pleasure centred response that fought stigma on multiple fronts. Moments of tension such as the censorship of an HIV prevention campaign and implementation of 'test and treat' projects are analysed, as are the complex questions that Brazil's 2016 political and economic crisis evokes in terms of how to develop and sustain responses to HIV driven by communities but with material commitment from the State. We conclude with what we see to be the unique, central components of Brazilian sex workers' approach to HIV prevention and what lessons can be learned from it for broader collective health movements in Latin America and beyond. [ABSTRACT FROM AUTHOR]

The global health community is increasingly advocating for the local production of pharmaceuticals in developing countries as a way to promote technology transfer, capacity building and improve access to medicines. However, efforts to advance drug manufacturing in these countries revive an old dilemma of fostering technological development versus granting access to social services, such as healthcare. This paper explores the case of Brazil, a country that has developed large-scale health-inspired industrial policies, but is, yet, little understood. Brazil’s experience suggests that progressive healthcare bureaucrats can create innovative practices for technology and knowledge transfers. It also demonstrates that highly competitive pharmaceutical firms can collaborate with each other, if a government provides them the right incentives. Reforming regulatory policies is crucial for guaranteeing high-quality products in developing countries, but governments must play a crucial role in supporting local firms to adapt to these regulations. These findings send a strong message to global health policymakers and practitioners on the conditions to create a suitable environment for local production of medical products. [ABSTRACT FROM PUBLISHER]

For more than 50 years, Cuba has been one of the most important playersin the field of international medical cooperation in the Global South.Between 2013 and 2016, Cuba maintained one of its largestcooperations with Brazil: nearly 11,400 Cuban physicians were sent towork within the framework of the Brazilian health programme ‘MoreDoctors-for-Brazil',which was implemented to improve Brazil'sprecarious public health sector. This paper inquires into the manifoldchallenges of horizontal connectivity in this medical South–Southcooperation. We will trace these back to deep-rooted contentions aboutthe epistemological approaches to medical practice and professionalrecognition within and between Cuban and Brazilian arenas of publichealth, which do not, however, conform to a simplistic socialism–capitalism dichotomy. Rather, this particular South–South cooperationreveals significant differences in how powerful the postcolonial legaciesof medical assistance remain in Global Health settings. This paperexplores how these legacies may impact on the moral and professionallegitimacy of the individuals involved in South–South partnership. Usingethnographic findings in newly established family clinics situated inurban poverty regions in Rio de Janeiro's North, we will also show howprolonged local interactions may create new spaces of horizontalencounters and connectivity in international medical cooperation. [ABSTRACT FROM AUTHOR]

Brazil's large-scale, successful HIV/AIDS treatment programme is considered by many to be a model for other developing countries aiming to improve access to AIDS treatment. Far less is known about Brazil's important role in changing global norms related to international pharmaceutical policy, particularly international human rights, health and trade policies governing access to essential medicines. Prompted by Brazil's interest in preserving its national AIDS treatment policies during World Trade Organisation trade disputes with the USA, these efforts to change global essential medicines norms have had important implications for other countries, particularly those scaling up AIDS treatment. This paper analyses Brazil's contributions to global essential medicines policy and explains the relevance of Brazil's contributions to global health policy today. [ABSTRACT FROM AUTHOR]

Brazil has a historical gap regarding information on violence against women. Herein we aimed to evaluate the association of socioeconomic and demographic characteristics with physical violence against women in Brazil, as well as the possible escalation of violence to severe patterns of violence. We analysed data from the 3rd Brazilian Household Survey on Substance Use, in 2015. The main outcomes were reporting any physical violence and being stabbed/shot in the last 12-months. Logistic regressions were fitted to assess the association between socioeconomic and demographic variables with the outcomes. We estimated 3.8 million women reported any physical violence (5.52%): 3.79% reported threats to beat/ push/kick, 1.87% threats with knife/gun, 2.49% were beaten/pushed/kicked, 0.63% were spanked/ choked, and 0.21% were stabbed/shot. The higher the severity of violence, the higher the number of types of violence experienced. The likelihood of reporting any violence was higher among women 18–24 years, without a stable partner, who were at an informal job or unemployed, and who live in urban areas. The sociodemographic characteristics associated with reporting any violence reinforce the importance of addressing gender inequalities. Evidence of escalation violence reinforces the need to protect and care for women who report any type of violence. [ABSTRACT FROM AUTHOR]

This article analyzes the efforts of the International Health Division of the Rockefeller Foundation (IHDRF) in its project initiative that resulted in the extermination of the African mosquito Anopheles gambiae from Brazil in 1940. This species, which originated in Dakar, Senegal, was identified in the Brazilian city of Natal in 1930, where insufficient local emergency sanitation actions enabled it to spread into the interior of the Brazilian northeast, causing an unprecedented malaria epidemic in the Americas in 1938, after years of silent spread. We will analyse the formation of Brazil's Malaria Service of the Northeast (MSNE), discussing its political and scientific controversies and how the transition from the idea of extermination to the idea of eradication was consolidated in the political process of creating this successful sanitation campaign. In addition, we will discuss how the integration and transnational development of medical entomology at the time was a fundamental factor in the cooperation and challenges among scientists involved in this campaign. The international cooperation of scientists, albeit oriented towards the project of eradication of this mosquito, organised different research agendas and gained new insights into the global dissemination of mosquito-borne diseases. [ABSTRACT FROM AUTHOR]

We examine how community health workers (CHWs), while working as links between doctors, nurses and vulnerable groups, participate in the social construction of citizens in the implementation of Brazil's primary healthcare policy. Drawing on interviews and a vignette experiment with CHWs in the city of São Paulo, we show that perceptions of CHWs about the vulnerability and agency of health system users impact upon their referrals to other levels of service. Judgments about the socioeconomic, cultural and moral conditions of families determine different referrals – on the one hand, to practices based on persuasion and respect for individual choices; on the other, to 'top-down' or forcible interventions. While implementing the same healthcare policy, CHWs construct users as (responsible) agents or (helpless) targets, thus determining different pathways in the health system and shaping the relationship between citizens and the state. Brazil's primary health policy, while seeking to tackle vulnerability, is also a site where social representations are reproduced that contribute to the denial of the agency of citizens deemed more vulnerable and to the definition of their bodies as sites for state intervention. [ABSTRACT FROM AUTHOR]

Addressing the politics of corporate political activity and policy interference in response to non-communicable diseases (NCDs) is a new area of scholarly research. The objective of this article is to explain how, in Mexico and Brazil, the ultra-processed foods and beverages industry succeeded in creating the political and social conditions conducive for their on-going regulatory policy influence and manipulation of scientific research. In addition to establishing partnerships within and outside of government, industry representatives have succeeded in hampering civic opposition by establishing allies within academia and society. Ministries of Health have simultaneously neglected to work closely with civil society, while legislative representatives have continued to benefit from industry campaign contributions. Findings from this article suggest that ultra-processed foods and beverages industries wield on-going regulatory policy influence in Mexico and Brazil, and that government is still not fully committed to working with civil society on these issues. [ABSTRACT FROM AUTHOR]

This study aimed to understand how the internal strategies of British American Tobacco (BAT) selling 'light' cigarettes to young people in Brazil may inform current global efforts to promote new tobacco and nicotine products. We reviewed industry documents in the Truth Tobacco Industry Documents (TTID) Library. In 1976, Philip Morris and BAT introduced 'low tar' or 'light' cigarettes in Brazil to maintain and attract new young smokers. At the time it was a novel tobacco product that implied lower health risks. While an initial push for 'light' cigarettes in Brazil did not materialise in the 1970s, BAT launched a new 'light' cigarette, Free, in 1984, with a marketing campaign consisting of symbols of personal freedom and choice to attract young people. In the mid-1990s, BAT used the success in Brazil to expand the lights segment throughout Latin America. BAT drove the lights segment through brand marketing and claims of a healthier alternative. As tobacco companies introduce and market new tobacco and nicotine products, mixing health and imagery messages, governments should recognise aggressive brand marketing messaging to attract new tobacco users and ensure that marketing regulations are enforced. [ABSTRACT FROM AUTHOR]

Few studies have investigated corporate political activity by unhealthy commodity industries in low- and middle-income countries, and the significance of social and political context has been largely neglected. This study aimed to explore the stalled development of marketing restriction policies in Brazil with an analysis of strategies used to undermine the Legal Framework for Early Childhood. Using a constructivist approach based on a typology of corporate political strategies, decision-making processes were assessed to understand interference by food companies in the Legal Framework, and how this was perceived by policy actors. Semi-structured interviews were conducted with public health advocates, academics and legislature officials. Three broad strategies that contributed to the stalling of marketing restrictions in the Legal Framework were identified: relational approaches to policy influence; collective participation in formal decision-making; and specific strategy choices (information and financial incentives). Key opportunities for policy influence through informal social networks in the 'backstage' of policy making are found to privilege commercial sector actors. Informal policy making may have a critical function in obstructing the development of health-focused regulation in Brazil. This highlights the need for a better understanding of non-codified and hidden corporate efforts to shape the policy environment. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic posed challenges for healthcare systems and political leaders across the globe. In this case study of Brazil, we argue that leadership failings at the highest level contributed to Brazil's relatively high and escalating death rates during 2020. Drawing on an analysis of a large amount of textual documentation drawn from media reports, we emphasise the role and consequences of President Jair Bolsonaro's political discourse and prioritisation of the economy. We focus on the first wave that swept across the globe between January and late June of 2020, arguing that Bolsonaro underplayed the seriousness of the epidemic, leveraged misinformation as a political strategy, promoted pseudoscience, and undermined the Ministry of Health. He also confronted subnational governments for adopting lockdown measures – a move that enabled him to blame regional governors for the short-term economic costs of COVID-19 related restrictions. We suggest that his denialist approach to climate change paved the way for his subsequent denialism of the seriousness of COVID-19 and for his undermining of social distancing, mask-wearing and other preventative responses supported by science. These sobering findings highlight the role that national leaders can play in undermining scientific approaches to both public health and the environment. [ABSTRACT FROM AUTHOR]

We address the limited understanding around the overlap between violence and HIV in Brazil. Data was from two clinic-based samples of HIV-positive (n = 1534) and HIV-negative women (n = 1589) in São Paulo and Porto Alegre. We conducted latent class analysis and identified violence typologies by type of violence, life course timing, frequency, and perpetrator, stratified by city and HIV-status. Overall, HIV-positive women experienced more lifetime physical and sexual violence than HIV-negative women. Twelve unique violence latent classes were identified. In São Paulo, HIV-positive women were likely to have endured physical violence several times (Conditional Probability [CP]: 0.80) by an intimate partner (CP: 0.85), and sexual violence several times (CP: 0.46) by an intimate partner (CP: 0.62). In Porto Alegre, HIV-positive women endured physical violence several times (CP: 0.80) by an intimate partner (CP: 0.70) during childhood/adolescence (CP: 0.48), and sexual violence several times (CP: 0.54) by an intimate partner (CP: 0.60). Findings inform interventions to educate around gender equity, violence, and the health effects of violence including HIV, integrate HIV and violence services, and improve the provision of bio-medical HIV prevention among HIV-negative women who experience violence. [ABSTRACT FROM AUTHOR]

Brazil's governance of the COVID-19 pandemic has been described as nothing short of tragic by several commentators. President Jair Bolsonaro's dangerous brew of neoliberal authoritarianism, science denialism and ableism has plunged this country into catastrophe. In this article we argue that this form (or lack) of public health governance can best be described as governance without (central) government. We begin with an overview of public health governance in the country before introducing the main theoretical concepts that guide our analysis, namely the notions of 'government by exception' and 'strategic ignorance'. Finally, we sketch the main features of this emerging form of (non)governance of COVID-19. We highlight the new forms of solidarity and mutual aid that have emerged in favelas and Indigenous communities, which have stepped in to fill the void left by a limited federal presence. The article concludes by reflecting on what this collapse of public health reveals about the limitations of democratic governance in the age of Bolsonaro. [ABSTRACT FROM AUTHOR]

The sexual exploitation of children and adolescents is a frequently underestimated health problem which includes transactional sex (TS), or the practice of sexual activity based on an expected return of benefits, favours and/or support in some form. This qualitative study focuses on age-disparate transactional sex (ATS) in urban favela communities of Rio de Janeiro between adult men (over 18) and girls and adolescents (G/A) (under 18), involving a minimum 5-year age disparity. We have employed social norms theory as a framework to identify the prevailing social norms contributing to or protecting children and adolescents from these relationships. Data collection utilised semi-structured interviews (n = 30) and ten focus groups with a total of 130 men/boys and women/girls selected through purposive sampling and varying in age from 15 to 65. Overall the findings identify factors, especially the essentialisation of gender, which promote the acceptability of ATS. When ATS surpassed the acceptability threshold, social norms discouraged direct interference. Concluding remarks point to possible strategies for reducing the occurrence of ATS. These must include girls, boys, women and men with community involvement in the deconstruction of social norms involving gender, age and economic consumption. [ABSTRACT FROM AUTHOR]

Few studies evaluate knowledge and willingness to use pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in middle-income countries. Brazil added PrEP to public drug formularies in December 2017, but little is known about local knowledge and attitudes about PrEP among MSM outside metropolitan areas in Southern Brazil. The cross-sectional HIV Surveillance Survey Project in Brazil estimates HIV and STD prevalence among MSM in 12 state capitals. Among 32 participants at the Salvador, Bahia study site, we used qualitative interviews to assess knowledge, willingness, and barriers to PrEP use among MSM; few MSM had previous knowledge of PrEP and were willing to use PrEP. Clinical, behavioural, social, and structural factors influencing participants' knowledge and willingness to take PrEP included concerns about efficacy and side effects, access to culturally congruent services for MSM, and stigma. Some participants reported that learning about PrEP online positively influenced their willingness to use PrEP. Participants' opinions about PrEP's contribution to risk compensation varied. Interventions to provide culturally congruent care and destigmatise PrEP for MSM at high risk for HIV acquisition, particularly those conducted collaboratively with Brazil's civil society movement, may enhance the public health effort to expand access to PrEP in Brazil. [ABSTRACT FROM AUTHOR]

Pre-exposure prophylaxis (PrEP) is an important biomedical intervention that may help reduce the risk of HIV transmission among transwomen. To date, little research is available to inform interventions to increase uptake and adherence to PrEP among transwomen, especially in places outside the U.S. We conducted a qualitative study in 2015 with 34 adult transwomen in Rio de Janeiro, Brazil and assessed awareness, interest, barriers and facilitators to PrEP uptake and adherence for transwomen. Almost one third of participants had heard of PrEP, and most were interested and thought it would be beneficial for transwomen in their community. Barriers to PrEP included fear of being HIV positive resulting in low HIV testing and concerns about the ability to adhere to a daily PrEP regimen. The most prominent barrier to uptake was past experiences of transgender-identity related discrimination in the universal health care system that reduced willingness to seek PrEP or health care in general. Participants recommended technological solutions to PrEP health education information that could address uptake and adherence. This study informs efforts to increase PrEP use among transwomen in Brazil. [ABSTRACT FROM AUTHOR]

Brazil’s response to the HIV/AIDS epidemic was characterised by an innovative alliance of governmental and non-governmental actors inspired by a strong progressive tradition in public health. Brazil eventually moved to decentralise HIV/AIDS programmes to its states and cities, a policy endorsed and supported financially by the World Bank as consistent with the mix of public and private elements central to the country’s HIV/AIDS strategy. However, decentralisation has not provided the results anticipated. Through interviews with key informants, government officials and patient advocates as well as observation of treatment sites, we outline how the shift of administration and resources to state and municipal bodies operated in practice. The Bank promoted decentralisation as an uncontroversial technical matter, and its programmatic guidelines implied that the nonprofit sector would be strengthened by it. However, instead of bringing HIV/AIDS policy closer to the grassroots, decentralisation has undermined the country’s early work and opened the door to a rejuvenated epidemic by empowering unsympathetic local elites, marginalising the human rights focus, and removing federal oversight. Its experience holds crucial lessons for developing countries facing similar conditions. [ABSTRACT FROM AUTHOR]

In 31 August 2016, Brazilian president Dilma Rousseff was impeached and replaced by her vice president Michel Temer. Herein, we examine how the conservative agenda of Mr Temer and his supporters is influencing key decisions in the human rights and public health arena in Brazil. The government’s austerity agenda includes severe cuts in critical areas such as health, education and science, jeopardising well-known strategies such as the Brazilian Public Health System (SUS) and nationwide cash transfer program, ‘Bolsa Familia’ - both benefited millions and were the largest of their kind in the world. Mr Temer’s decisions show not only severe cuts in critical areas but also a political agenda that clearly demonstrates a broad shift away from the progressivism and social agenda presented and supported by its predecessors. Most vulnerable groups such as the LGBTQ community, women, people who use drugs and disenfranchised communities have been severely affected. Mr Temer’s administration is putting Brazil far from its once nationwide goal to foster free and universal health care access and social equity for all its citizens. The near future for Brazil is unknown, but both national and international communities anticipate severe problems within the national human rights arena, if nothing changes. Abbreviations: CCT: Conditional Cash Transfer; LGBTQ: Lesbian, Gay, Bisexual, Transgender and Queer (and/or Questioning); SUS: Brazilian Public Health System [ABSTRACT FROM AUTHOR]

During the 1990s, Brazil and Russia diverged in their policy response to AIDS. This is puzzling considering that both nations were globally integrated emerging economies transitioning to democracy. This article examines to what extent international pressures and partnerships with multilateral donors motivated these governments to increase and sustain federal spending and policy reforms. Contrary to this literature, the cases of Brazil and Russia suggest that these external factors were not important in achieving these outcomes. Furthermore, it is argued that Brazil's policy response was eventually stronger than Russia's and that it had more to do with domestic political and social factors: specifically, AIDS officials’ efforts to cultivate a strong partnership with NGOs, the absence of officials’ moral discriminatory outlook towards the AIDS community, and the government's interest in using policy reform as a means to bolster its international reputation in health. [ABSTRACT FROM PUBLISHER]

Understanding partnership dynamics is a crucial step in the process of HIV serostatus disclosure to partners. This study examines the relational characteristics associated with HIV serostatus disclosure and the role of disclosure on sexual behaviours within steady partnerships among people living with HIV (PLHIV) in Rio de Janeiro, Brazil. The overall study surveyed 900 participants from six large public health facilities to investigate psychosocial and structural factors associated with sexual health and well-being. This analysis focuses on 489 individuals reporting being in steady partnerships, 86% of whom reported HIV serostatus disclosure to steady partners. After adjusting for demographic variables, attitudes towards disclosure, having an HIV-positive partner, living with partner and longer relationships were significantly associated with reported disclosure in multivariable logistic regression. Living with partner was negatively associated with partner concurrency. However, having an HIV-positive partner, sex under the influence of drugs or alcohol and experiencing physical aggression by a steady partner were negatively associated with consistent condom use. Interventions supporting PLHIV to safely and voluntarily disclose to partners may be an effective prevention approach between steady partners; however, partner violence and substance use should be addressed in future work. [ABSTRACT FROM PUBLISHER]

Studies have demonstrated that an early HIV diagnosis is a critical first step towards continued engagement in care. We examined HIV testing experiences in Salvador, Brazil, to understand how a focus on quality services can inform service provision more generally in the post–2015 global health agenda. Seventeen semi-structured interviews were conducted with HIV-positive pregnant women in Salvador, a large urban centre of north-east Brazil. Interviews were transcribed, translated and coded for analysis. Deductive codes confirmed factors identified in the literature review. Inductive codes highlighted new factors emerging from the initial coding. ‘Quality’ was defined according to global and national guidelines as HIV testing with informed and voluntary consent, counselling and confidentiality (3Cs). No pregnant woman experienced all elements of the 3Cs. Three women did not experience any informed and voluntary consent, counselling or confidentiality. Few women provided consent overall and none received pre-test counselling. Post-test counselling and confidentiality of services were more consistently provided. This study suggests that testing in Salvador – the third-largest city in the country – is not of the quality called for by global and national guidelines, despite the fact that HIV testing is being routinely provided for HIV-positive pregnant women in Brazil. Going forward, additional clarity around the 3Cs is necessary to improve how the quality, not just the quantity, of HIV services is measured. [ABSTRACT FROM PUBLISHER]

Since Brazil's adoption of universal health care in 1988, the country's health care system has consisted of a mix of private providers and free public providers. We test whether income-based disparities in medical visits and medications remain in Brazil despite universal coverage using a nationally representative sample of over 48,000 households. Additional income is associated with less public sector utilisation and more private sector utilisation, both using simple correlations and regressions controlling for household characteristics and local area fixed effects. Importantly, the increase in private care use is greater than the drop in public care use. Also, income and unmet medical needs are negatively associated. These results suggest that access limitations remain for low-income households despite the availability of free public care. [ABSTRACT FROM AUTHOR]

This analysis focuses on the evangelical Protestant responses to drug use and HIV prevention, treatment and care in the urban periphery of Rio de Janeiro. We question how religious institutions, and the positions of pastors, create or reduce various elements of societal illness and vulnerability. We aim to show that the views of pastors may symbolise a form of social regulation that may have a meaningful social impact on drug use and HIV and AIDS. The interviews of 23 evangelical religious leaders were collected. Two case studies of evangelical drug rehabilitation centres (DRC) are derived from five qualitative interviews. Evangelical DRC generally reflects pastors' discourses of reintegration into social networks including marriage, family and employment. We found important differences in the discourses and practices in private versus state-funded rehabilitation centres that may reveal ways social and programmatic vulnerabilities may affect the efficacy of public health interventions. [ABSTRACT FROM AUTHOR]