Rethinking HIV/AIDS: An Investigation of Crucial Aspects of Sustainability for the Brazilian National AIDS Program

Abstract

This thesis identifies and explores three crucial aspects for the long-term sustainability of the Brazilian National AIDS Program: (1) the structure of the Program, (2) financing HIV/AIDS policy initiatives, and (3) the increasing banalização of the Brazilian AIDS epidemic. Although Brazil’s initial response to the AIDS epidemic was extremely successful, in the last few years there have been emerging challenges to the long-term sustainability of national HIV/AIDS policies and programs. While some of the solutions to these problems are beyond the scope of this thesis, to address many of these issues and better-ensure the long-term sustainability and efficacy of the National AIDS Program, I advocate for a strong topdown approach for implementing Brazilian HIV/AIDS policy. This thesis shows that, when constrained by weak decentralization, progressive national HIV/AIDS bureaucracies, like that of Brazil, can strengthen and deploy centralized strategies through an effective top-down approach to ensure a successful, lasting response to HIV/AIDS.