Garcia Ionara Ferreira da Silva, Hennington Élida Azevedo
Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
Cad Saude Publica. 2021 Dec 1;37(11):e00303420. doi: 10.1590/0102-311X00303420. eCollection 2021.
HTLV is a retrovirus that affects the human T-lymphocytes. Transmission is bloodborne, sexual, or mother-to-child. Most infected persons are asymptomatic carriers, but some may develop severe cases such as tropical spastic paraparesis, leukemia/lymphoma, and other manifestations. Brazil is considered the country with the highest absolute number of cases, with an estimated 800,000 infected individuals. This article aimed to investigate and analyze the process of inclusion of HTLV on the government agenda in the states of Bahia and Minas Gerais, and which impacted health sector actions and policies. Interviews were held with key actors, and a document search was performed for analysis, using as the main reference the Multiple Streams framework proposed by John Kingdon. Various factors contributed to the theme's inclusion on the health sector agenda in Bahia, the state of Brazil with the widest range of policies on HTLV, involving high prevalence of the infection, a favorable political context, and activism by infected individuals. In Minas Gerais, we observed difficulties in the implementation of this health sector policy; due to the lack of organized advocacy groups, the problem was not a priority in the state's Health Departments. In the current context, individuals with HTLV infection and other stakeholders still have a long road ahead with social mobilization for investments in the area, drafting and implementation of public policies, and guarantee of social rights.
人类嗜T淋巴细胞病毒（HTLV）是一种影响人类T淋巴细胞的逆转录病毒。传播途径为血液传播、性传播或母婴传播。大多数感染者是无症状携带者，但有些人可能会发展为严重病例，如热带痉挛性截瘫、白血病/淋巴瘤及其他表现。巴西被认为是病例绝对数最高的国家，估计有80万感染者。本文旨在调查和分析巴伊亚州和米纳斯吉拉斯州将HTLV纳入政府议程的过程，以及这一过程对卫生部门行动和政策的影响。我们与关键行为者进行了访谈，并进行了文献检索以供分析，主要参考约翰·金登提出的多源流框架。多种因素促使该主题被纳入巴伊亚州的卫生部门议程，巴伊亚州是巴西对HTLV制定了最广泛政策的州，该州感染率高、政治环境有利且感染者积极行动。在米纳斯吉拉斯州，我们观察到该卫生部门政策在实施过程中存在困难；由于缺乏有组织的倡导团体，该问题在该州卫生部门并非优先事项。在当前背景下，HTLV感染者及其他利益相关者在社会动员以推动该领域投资、起草和实施公共政策以及保障社会权利方面仍有很长的路要走。
