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Brazilian Ministry of Health Health Surveillance Secretariat STD, AIDS and Viral Hepatitis Department

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Brazilian Ministry of Health Health Surveillance Secretariat STD, AIDS and Viral Hepatitis Department Brazilian Ministry of Health Health Surveillance Secretariat STD, AIDS and Viral Hepatitis Department Targets and Commitments made by Member‐States at the United Nations General Assembly Special Session on HIV/AIDS UNGASS – HIV/AIDS Brazilian Response 2008‐2009 Country Progress Report Brazil, March 2010 The Federative Republic of Brazil Ministry of Health Health Surveillance Secretariat STD, AIDS and Viral Hepatitis Department Technical Index of the Brazilian Progress Report: Institutional authorship of this document is attributed to the National STD and AIDS Commission ‐ CNAIDS General Coordination: Mariângela Batista Galvão Simão (Director of the STD, AIDS and Viral Hepatites Department); Eduardo Luiz Barbosa (Joint Director of the STD, AIDS and Viral Hepatites Department) Organization: Ângela Pires Pinto (STD, AIDS and Viral Hepatites Department) Report writer: Fernando Seffner (Consultant) Working group designated by CNAIDS for data gathering and producing this report: Mariângela Simão (Director of the STD, AIDS and Viral Hepatitis Department and Coordinator of the Working Group); Ana Maria de Oliveira (Federal Medical Council); Euclides Ayres Castilho São Paulo University); Felipe Krause Dornelles (Ministry of Foreign Affairs); Jacqueline Côrtes (Joint United Nations Programmme on HIV/AIDS ‐ UNAIDS); Jaime Marcelo Pereira (AIDS NGO Forum – Southeast Region); Jair Brandão Filho (UNGASS Forum/Gestos ‐ Seropositivity, Communication and Gender); José Carlos Veloso (UNGASS Forum/GAPA/SP); Maria Clara Gianna (STD/AIDS Actions Management Commission‐ COGE); Mariza Gonçalves Morgado (Oswaldo Cruz Foundation ‐ FIOCRUZ); Nélio José de Carvalho (National Network of People Living with HIV/AIDS); Ximena Pámela Diaz Bermudez (Pan American Health Organization PAHO/WHO). Ministry of Health team involved in data gathering and desk review of this document: Alessandro Ricardo Cunha, Ana Roberta Pascom, Ana Paula Prado Silveira, Andressa Bolzan, Ângela Pires Pinto, Barbara Graner, Caio Gonçalves, Carlos Passarelli, Cristina Possas, Dario Noleto, Dulce Ferraz, Eduardo Luiz Barbosa, Emília Ramos do Valle, Érika Fazito, Flávia Moreno, Gerson Fernando Pereira, Gilvam de Almeida, Gilvane Casimiro da Silva, Gustav Liliequist, Ivo Brito, Josué Ferreira, Juliana Vallini, Juliana Machado Givisiez, Karim Sakita, Lilian Amaral Inocêncio, Marcelo Araújo de Freitas, Marcelo Barbosa, Maria do Socorro de Oliveira, Maria Etelvina Barros, Mariângela Simão, Mauritânia Pereira, Mirtha Sudbrack, Mônica Bulhões, Nádia Paranaíba, Rachel Baccarini, Rogério Scapini, Romina do Socorro M. de Oliveira, Rosângela Ribeiro, Rubens Duda, Ruy Burgos, Samia de Albuquerque, Sérgio D’Ávila, Thaisa Lima, Valdir Pinto. Editing, revision, diagramming: Communication Unit (STD, AIDS and Viral Hepatitis Department) Angela Gasperin Martinazzo, Alexsandro de Brito Almeida, Dario Noleto, Myllene Müller Nunes. English version: Martin Charles Nicholl Spanish version: Javier Martínez 2 Acknowledgements We wish to thank: The members of the STD and AIDS Commission – CNAIDS who contributed to the discussions of the report at their regular meetings in 2009 and 2010; The institutions that make up the UNGASS/Brazil Forum for disseminating the UNGASS commitments and for the debates that were eheld in th various regions of the country; Participants in the meeting to validate NCPI Part A (Government), especially the members of the STD/AIDS Actions Management Commission ‐ COGE (vide appendix II). Participants in the meeting to validate NCPI Part B, referring to Civil Society, notably the members of the Commission for Articulation with Social Movements – CAMS (vide appendix II). Participants in the meeting to validate NCPI Part B, referring to the United Nations Agencies, especially the UNAIDS WG (vide appendix II). To all health staff, managers, members of social movements and NGOs and others that took part in the Public Consultation via Internet; To those who took part in the meeting to validate the final document: Alessandro Ricardo Cunha (STD, AIDS and Viral Hepatitis Department), Ana Maria de Oliveira (Federal Medical Council), Ana Roberta Pati Pascom (STD, AIDS and Viral Hepatitis Department), Ângela Pires Pinto (STD, AIDS and Viral Hepatitis Department), Antonio Ernandes Marques da Costa (Northern Region, GRUPAJUS/Pará), Carlos Passarelli (STD, AIDS and Viral Hepatitis Department), Cristiane José (CENAIDS, Philips do Brasil), Dirceu Greco (Brazilian Tropical Medicine Society), Eduardo Barbosa (STD, AIDS and Viral Hepatitis Department), Elias Nobre Almeida (Northeast Region, Rede de Solidariedade Positiva/Ceará), Jacqueline Cortes (UNAIDS WG, UNAIDS), Jaime Marcelo Pereira (AIDS/NGO Forum – Southeast Region), José Carlos Veloso (UNGASS Forum, Gapa/SP), José Roberto Pereira (Southeast Region, Bem‐ Me‐Quer Project), José Valdez Ramalho Madruga (Brazilian Infectious Diseases Society), José Wilter Ferreira Ibiapina (Viral Hepatitis Social Movement), Luisa Guimarães Queiroz (STD, AIDS and Viral Hepatitis Department), Maria aClara Giann (STD/AIDS Actions Management Commission – COGE), Maria de Fátima Alencar Fernandes D’Assunção (Ministry of Labour), Maria Inês Costa Dourado (São Paulo University), Maria de Fátima Simas Malheiro (Ministry of Education), Mariângela Simão (STD, AIDS and Viral Hepatitis Department), Mauritânia Pereira (STD, AIDS and Viral Hepatitis Department), Nélio José de Carvalho (National Network of People Living with HIV/AIDS), Nereu Henrique Mansano (National Council of Health Secretaries), Newton Sérgio de Carvalho (Brazilian Sexually Transmitted Diseases Society), Patrícia Santana Santos (National Anti‐drugs Secretariat ‐ SENAD), Paulo César do Nascimento (Southern Region, Bom Viver), Rafael Theberge de Viveiros (Ministry of Defence), Regina Maria Lancellotti (Viral Hepatitis Social Movement), Roberto Pereira (Southeast Region, Sexual Education Centre ‐ CEDUS), Ronildo Lima e Silva (National Network of People Living with HIV/AIDS), Rosa Mari Guimarães Godinho (Mid‐west Region, CADS), Sandra Catarina Rolim Gomes (STD/AIDS Actions Management Commission – COGE), Sandro Oliveira da Rosa (Mid‐west Region, Mato Grosso NGO/AIDS Forum), Sérgio D’Ávila (STD, AIDS and Viral Hepatitis Department), Tânia Ferreira (STD, AIDS and Viral Hepatitis Department), Valdiléa Gonçalves Veloso dos Santos (FIOCRUZ), Ximena Pámela Diaz Bermudez (UNAIDS WG, OPAS). And the collaboration of Arthur Braz, Beatriz Proença, Cláudia Medeiros, Cleber Ricardo, Elaine Ramos, Ieda Fornazier, Juliana Monteiro da Cruz, Laís Garcia, Lilian Melo, Lúcio Costa, Renato Girade, Sandra Cynthia Conçalves, Silvia Reis, Wanderson Gontijo. 3 Contents Acronyms 4 Introduction 6 Chapter 1 – The process of elaborating the report 8 Chapter 2 – The Brazilian AIDS response and the National Health System 10 Chapter 3 – The AIDS epidemic in Brazil 12 3.1 – Epidemiological scenario 12 3.2 – Programmatic and organisational context 22 3.2.1 – Governance 22 3.2.2 – Prevention and reducing vulnerabilities 27 3.2.3 –STD/HIV/AIDS research and surveys 35 3.2.4 – Human Rights 38 3.2.5 – Care, support and treatment 39 Chapter 4 – Brazil’s participation in international cooperation in the fight against AIDS 47 Chapter 5 – Prospects, challenges and lessons learned 51 References 54 6.1 – Bibliography 54 6.2 – Internet sites 58 Appendix I – Indicator 1: Spending 59 Appendix II – Indicator 2: National Composite Policy Index (NCPI) 77 Appendix III – Indicators 3 to 25 136 4 Acronyms ANRS – French National AIDS and Viral Hepatitis Research Agency CAMS – National Commission for Articulation with Social Movements CAPDA – STD and AIDS Policies Monitoring Committee CENAIDS – National Corporate Council for HIV/AIDS Prevention CEP – Research Ethics Committee CICT – International Centre for Technical Cooperation in HIV/AIDS CIPA – Internal Accident Prevention Committee CNAIDS – National STD and AIDS Commission CNS – National Health Council COGE – STD/AIDS Actions Management Commission CONEP – National Research Ethics Commission COPRECOS LAC ‐ Commission for Prevention and Control of HIV/AIDS in the Latin American Armed Forces CPLP – Community of Portuguese‐speaking Nations CTA – Voluntary Testing and Counselling Centre DATANHS – National Health System IT Department DFID – Department for International Development of the United Kingdom DST – Sexually Transmitted Diseases FIOCRUZ – Oswaldo Cruz Foundation FUNASA – National Health Foundation GCTH – Horizontal Cooperation in HIV/AIDS Group GTZ – German Technical Cooperation Agency IAVI ‐ International AIDS Vaccine Initiative IBAS – India, Brazil and South Africa Consortium IDU – Injecting drug users LGBT – Lesbians, Gays, Bisexuals, Transvestites and Transsexuals LOAS – Organic Social Assistance Law MEGAS – Health Expenditure Measuring System MERCOSUL – Southern Cone Common Market MONITORAIDS – System Monitoring STD, AIDS and Viral Hepatitis Department Indicators MSM – Men that have sex with men MRG – Genotyping reference doctors MS – Ministry of Health NGO – non‐governmental organization ONG – non‐governmental organization PAHO – Pan American Health Organization PAISM – Integral Women’s Health Assistance Programme PCAP – Knowledge, Attitudes and Practices Survey of the Brazilian Population PREVINI – Prevention Commodities Monitoring System PSE – Health in Schools Programme PSF – Family Health Programme PLHA – People living with HIV and AIDS QUALIAIDS – Self‐evaluation of AIDS outpatient services quality in the NHS RDS – Respondent Driven Sampling SAE – Specialised Services SES – State Health Department
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