restricted access 2. Brazil’s Response to HIV/AIDS and Obesity
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2 Brazil’s Response to HIV/AIDS and Obesity In the midst of its transition to democracy and introduction of ­ free market reforms, at the turn of the twenty-­ first ­ century, Brazil confronted the HIV/ AIDS and obesity epidemics. The government’s failure to respond immediately through effective prevention and treatment programs drew criticism and pressure from influential international institutions such as the UN and the WHO. Seeking to improve the government’s international reputation in health, Brazil’s po­ liti­ cal leaders immediately began to provide more po­ liti­ cal and financial support to the MOH for its prevention and treatment programs. To expedite this pro­ cess, the government also requested the help of international donors such as the World Bank, through both financial and technical assistance. ­ These efforts revealed the government’s positive geopo­ liti­ cal positioning, which was built upon the historical pre­ ce­ dent of the striving of Brazil’s governments since the early twentieth ­ century to enhance the nation’s international reputation in development and public health while pursuing international donor assistance and collaboration to eradicate disease. Eventually, Brazil would begin to provide foreign aid assistance to other nations grappling with HIV/AIDS, with the intent of furthering its international reputation in health. The government’s ability to achieve a centrist policy response to HIV/AIDS and obesity was facilitated by the presence of strong bureaucratic–­ civil societal partnerships, which predated the arrival of ­ these epidemics. Equipped with a reliable and informative working relationship with NGOs, bureaucrats strategically used this partnership to bolster the MOH’s legitimacy and influence within government, thus securing bureaucrats’ ability to obtain the ongoing funding and po­ liti­ cal support needed to implement their centrist policy response. Brazil’s Response to HIV/AIDS and Obesity   35 Responding to HIV/AIDS The HIV/AIDS epidemic first emerged in Brazil in 1982 in the city of São Paulo and subsequently spread to Rio de Janeiro and other major cities. The disease first emerged within the gay community, then intravenous drug users (IDUs) and heterosexual ­ couples. By the late 1980s, HIV/AIDS had begun to affect the lives of famous individuals, including intellectuals, artists, and politicians (Veja, 1985). In a context of heightened discrimination ­ toward the gay community (Mott, 2003), the virus’s emergence among famous individuals drew a considerable amount of media and po­ liti­ cal attention (Parker, 2003). Despite this greater media attention and the accompanying alarm and fear, the epidemic continued to spread throughout the nation, puzzling medical scientists and alarming politicians. In July 2009, CNN’s Sanjay Gupta reported that Brazil was the “envy of the world.” He was referring neither to the economy nor to Brazil’s vibrant culture and beautiful beaches. He was referring to the government’s impressive policy response to HIV/AIDS that led to a massive decline in infection and death rates. What many may not know is that several years before Gupta’s public commentary, Brazil’s government had joined its BRICS counter­ parts in being substantially delayed and lackluster in its policy response (Da Costa Marques, 2003; Galvão, 2000). Several years would go by before the president publicly acknowledged the epidemic (Da Costa Marques, 2003; Galvão, 2000). In addition , in pruning government spending, stabilizing markets, and encouraging decentralization throughout the 1980s, the government allocated ­ little of the federal bud­ get for AIDS prevention and treatment programs. And the national AIDS program (NAP) that was eventually created, in 1986, was poorly or­ ga­ nized and managed (Da Costa Marques, 2003). Many ­ were of the view that the NAP was a hollow shell, with ­ little funding and ­ little po­ liti­ cal support and poorly managed from within (Teixeira, 1997; Visão, 1985). It was as if the government created an institution to give the impression that it was fully committed to eradicating HIV/AIDS, when in real­ ity it was not. Even though the NAP began to provide information on prevention, the quality and effectiveness of the advice was deemed insufficient and questionable (Parker, 2003). Worse still, the minister of health at the time, Carlos Santana, publicly claimed that his ministry had more impor­ tant healthcare ­ matters to attend to, and se­ nior health officials questioned ­ whether HIV/AIDS actually posed a public health prob­ lem (Parker, 2003; Teodorescu and Teixeira, 2015). 36   Geopolitics in Health Despite the government’s commitment to healthcare decentralization as enshrined in the 1988 constitution, during the 1980s the state governments found themselves in need of...


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