Suchergebnisse

Brazil had an early and progressive response to the HIV/AIDS epidemic. Over the objections of international donors, Brazil prioritised AIDS treatment for all people living with HIV/AIDS early in the epidemic, including provision of prophylactic antiretroviral therapy to prevent mother-to-child (vertical) transmission of HIV/AIDS. By providing free and univeral access to treatment and care for pregnant women and children living with HIV/AIDS, including drugs to prevent vertical transmission of HIV, Brazil has dramatically reduced paediatric AIDS prevalence. Less is known about the broader welfare needs of orphans and non-orphans affected by HIV/AIDS in Brazil and their associated costs. The authors nevertheless present important health evidence that highlights Brazil's effective response to the welfare needs of children affected by HIV/AIDS. They conclude that Brazil has prioritised, financed and implemented many of the interventions necessary to address the welfare needs of children affected and infected by the HIV/AIDS epidemic. (IDS Bull/GIGA)

BackgroundIn 1996, Brazil became the first developing country to provide free, universal access to HAART, laboratory monitoring, and clinical care to any eligible patient. As of June 2014, approximately 400,000 patients were under treatment, making it the most comprehensive HIV treatment initiative implemented thus far in a middle-income country, worldwide. The Brazilian epidemic is highly concentrated among men who have sex with men (MSM).MethodsFour national information systems were combined and Cox regression was used to conduct retrospective cohort analysis of HAART availability/access on all-cause mortality among MSM diagnosed with AIDS reported to the information systems between 1998-2008, adjusting for demographic, clinical, and behavioral factors and controlling for spatially-correlated survival data by including a frailty effect. Multiple imputation by chained equations was used to handle missing data.ResultsAmong 50,683 patients, 10,326 died during the 10year of period. All-cause mortality rates declined following introduction of HAART, and were higher among non-white patients and those starting HAART with higher viral load and lower CD4 counts. In multivariable analysis adjusted for race, age at AIDS diagnosis, and baseline CD4 cell count, MSM diagnosed in latter periods had almost a 50% reduction in the risk of death, compared to those diagnosed between 1998-2001 (2002-2005 adjHR: 0.54, 95% CI:0.51-0.57; 2006-2008 adjHR: 0.51, 95% CI:0.48-0.55). After controlling for spatially correlated survival data, mortality remained higher among those diagnosed in the earliest diagnostic cohort and lower among non-white patients and those starting HAART with higher viral load and lower CD4 lymphocyte counts.ConclusionsUniversal and free access to HAART has helped achieve impressive declines in AIDS mortality in Brazil. However, after a 10-years follow-up, differential AIDS-related mortality continue to exist. Efforts are needed to identify and eliminate these health disparities, therefore improving the Brazilian response towards HIV/AIDS epidemic.

BackgroundIn 1996, Brazil became the first developing country to provide free, universal access to HAART, laboratory monitoring, and clinical care to any eligible patient. As of June 2014, approximately 400,000 patients were under treatment, making it the most comprehensive HIV treatment initiative implemented thus far in a middle-income country, worldwide. The Brazilian epidemic is highly concentrated among men who have sex with men (MSM).MethodsFour national information systems were combined and Cox regression was used to conduct retrospective cohort analysis of HAART availability/access on all-cause mortality among MSM diagnosed with AIDS reported to the information systems between 1998-2008, adjusting for demographic, clinical, and behavioral factors and controlling for spatially-correlated survival data by including a frailty effect. Multiple imputation by chained equations was used to handle missing data.ResultsAmong 50,683 patients, 10,326 died during the 10year of period. All-cause mortality rates declined following introduction of HAART, and were higher among non-white patients and those starting HAART with higher viral load and lower CD4 counts. In multivariable analysis adjusted for race, age at AIDS diagnosis, and baseline CD4 cell count, MSM diagnosed in latter periods had almost a 50% reduction in the risk of death, compared to those diagnosed between 1998-2001 (2002-2005 adjHR: 0.54, 95% CI:0.51-0.57; 2006-2008 adjHR: 0.51, 95% CI:0.48-0.55). After controlling for spatially correlated survival data, mortality remained higher among those diagnosed in the earliest diagnostic cohort and lower among non-white patients and those starting HAART with higher viral load and lower CD4 lymphocyte counts.ConclusionsUniversal and free access to HAART has helped achieve impressive declines in AIDS mortality in Brazil. However, after a 10-years follow-up, differential AIDS-related mortality continue to exist. Efforts are needed to identify and eliminate these health disparities, therefore improving the Brazilian ...

Policy analysis in Brazil is part of the International Library of Policy Analysis and is the first book to paint a comprehensive panorama of policy analysis activities in Brazil. Highlighting the unique features of the Brazilian example, it brings together 18 studies by leading Brazilian social scientists on policy analysis as a widespread activity pursued in a variety of policy fields and through different methods by governmental and non-governmental institutions and actors. It shows how policy analysis emerged as part of Brazilian state-building from the 1930s onwards. With the democratisation process of the late 1980s, policy analysis began to include innovative elements of social participation in public management. This unique book offers key insights into the practice of this field and is indispensable reading for scholars, policy makers and students of the social sciences interested in learning how policy analysis developed and functions in Brazil