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The goal of the Brazil program was to reduce the incidence of
sexually transmitted HIV infection among targeted populations
in the states of Rio de Janeiro and São Paulo, the two geographic
areas reporting the largest number of AIDS cases. The Brazil program
focused on reaching individuals at risk of HIV infection, with
the consideration that 60 percent of the HIV/AIDS cases are sexually
transmitted. Initially, five target populations were selected:
male and female CSWs, men who have sex with men (MWM), men working
away from home (MAFH), STI patients and their partners, and adolescents.
AIDSCAP/Brazil identified three major strategies
to achieve this goal:
- Reduce sexually transmitted infection
(STI) prevalence by strengthening local capacity to provide
diagnosis, treatment and prevention. This includes, but is not
limited to, improving STI clinical services by training public
and private sector providers in syndromic management, expanding
services to new clinics, increasing utilization of new and existing
STI clinics through the creation of a referral system, upgrading
facilities, improving epidemiological surveillance and developing
educational materials to improve the counseling of STI patients.
- Reduce risky sexual behavior among the
target groups through behavior change communication (BCC) emphasizing
partner reduction, consistent condom use and appropriate and timely
treatment for suspected STIs.
- Decrease structural obstacles to risk
reduction by improving national policies related to HIV and improving
quality, accessibility and affordability of male and female condoms.
In order to enhance the major program areas
above, the Brazil program included four supporting strategies:
- Improve logistics management for condoms
and STI pharmaceuticals in the public and private sector by
ensuring adequate supplies, and improving logistics cycles and
management systems.
- Private sector leveraging to create
a model, integrated program to form the foundation for greater
private sector support for AIDS prevention. Small amounts of
project funds are expected to leverage industry and union resources
to provide AIDS prevention activities at the workplace.
- PVO/NGO/MOH support activities that
complement the overall program. In addition to PVOs' competitive
grants program and funds (to strengthen the capacity of NGOs
to implement HIV/AIDS activities), a mechanism has been established
to quickly respond to short-term technical assistance needs
from the MOH.
- Condom social marketing (CSM) to ensure
availability of condoms for all the program sub-projects by
intensifying the marketing in non-traditional outlets such as
bars, brothels, saunas and other meeting points in sub-project
areas.
Additional interventions provided overall
program support to the program in Brazil, and included:
- Support of an in-country capacity-building
component to provide effective and sustainable services to prevent
and control the spread of HIV/AIDS. AIDSCAP supported implementing
agencies as they enhanced their program designs and development
skills; improved management, coordination, monitoring and evaluation
capabilities; and institutionalized training as a mechanism
of human resource capacity building.
- Behavioral research grant programs strengthened
Brazilian institutions' research on sexual behaviors in populations
at risk, paying careful attention to the validity and reliability
of research on sexual behavior, a strengthened capacity to follow
a cohort of at-risk participants in order to link behaviors
to serostatus.
- Policy reform addressed activities in
each major program area, such as policies of condom importation,
taxation, and regulation. Restrictions on imported condoms made
it difficult for NGOs to provide affordable condoms and recover
costs.
- Program monitoring and evaluation included
the major interventions in the four targeted populations and
supporting program areas.
The key element of the Brazil program was
a comprehensive approach to AIDS prevention. All program components
worked to reduce risky behaviors and reduce the spread of STI among
specific targeted populations.
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