Abstract

The access and quality of healt public programs of HIV prevention among sex workers in Brazil

S. Correa¹, M.C. Pimenta¹, J.M.N. Olívar^1,2, I. Maksud<sup>1,3

1</sup>Associação Brasileira Interdisciplinar de AIDS, Rio de Janeiro, Brazil, ²Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil, ³Universidade Federal Fluminense, Niterói, Brazil

Background: According to recent epidemiological data HIV/AIDS incidence among sex workers has slightly increased in Brazil. However, concurrently the health policy response to this particular group appears to have lost ground. The case study investigated:
a) the trajectory and current state of the Brazilian policy response to HIV/AIDS among female sex workers;
b) the access to public programs of HIV prevention and quality of health care provide to this group;
c) aspects related to struggle and advocacy for sex workers rights.
Methods: Qualitative research performed between 2008 and 2009 in Porto Alegre and Rio de Janeiro. It encompassed:
1) the review of literature and policy documents;
2) interviews and focal groups;
3) observation of health services.
A cross-cutting analysis of the material was performed, that used both deductive and inductive categories as well as discourse analysis and the contrasting of perceptions and opinions among the various actors.
Results: Concerns with health care and AIDS prevention is high among Brazilian sex workers, but access to health care and prevention is very uneven. The findings have also detected the weakening of HIV/AIDS policies and programs for the specific needs of sexworkers, a tendency related to structural problems experienced by the Public Health System, particularly under the impact of decentralization. Prevention programs are highly concentrated in the hands of civil society organizations.
Conclusions: In Brazil,“expressive policy responses” prevail over effective strategies to tackle HIV/AIDS among sex workers. In many services, the quality of health care is highly dependent on few committed people and do not translate into systemic policy measures. This tendency may clearly favor the increase of vulnerability to HIV among sex workers and compromise their quest for human rights. The study suggests that these policies and programs require systematic assessments, greater investments and, eventual re-designing of goals and methods.