da Fonseca Elize Massard, Bastos Francisco Inacio
Center for Business Studies, Insper, São Paulo, Brazil.
Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil.
Int J Health Plann Manage. 2018 Jan;33(1):e238-e250. doi: 10.1002/hpm.2452. Epub 2017 Sep 6.
Brazil was the first low- and middle-income country to provide universal treatment access to people living with the acquired immunodeficiency syndrome (AIDS), becoming a widely acclaimed model for best practice to managing this epidemic. However, we know little about important challenges to the key pillars of Brazil's response. This article discusses how the evolution of the country's health system institutions and international advancements in AIDS treatment and prevention affected the national response. Decentralization of health system resources and policy making brought fresh challenges to the centralized governance of the national AIDS program and to civil society, weakening their coordination and advocacy capacity. Regardless, AIDS treatment and prevention strategies in Brazil remain aligned with the current international protocols, but unfortunately have been restricted in some geographic areas and/or populations.
巴西是首个为获得性免疫缺陷综合征（艾滋病）患者提供普遍治疗机会的低收入和中等收入国家，成为管理这一流行病的最佳实践中广受赞誉的典范。然而，我们对巴西应对措施的关键支柱所面临的重大挑战知之甚少。本文探讨了该国卫生系统机构的演变以及艾滋病治疗与预防方面的国际进展如何影响国家应对措施。卫生系统资源和决策的权力下放给国家艾滋病项目的集中治理以及民间社会带来了新的挑战，削弱了它们的协调和宣传能力。尽管如此，巴西的艾滋病治疗和预防策略仍与当前的国际协议保持一致，但遗憾的是，在一些地理区域和/或人群中受到了限制。
