The specific objectives of the study were to explore and analyze consistencies and mismatches between existing official Brazilian policy guidelines and program implementation in the area of HIV/AIDS prevention and health care among female sex workers.
Data analysis and major findings discussed throughout the report are organized around five major themes as follows:
1) STD/HIV/AIDS prevention policies and programs directed at sex workers evolved in the last two decades;
2) The political legitimacy of key civil society actors directly engaged with commercial sex and the impact of the epidemics on persons involved in the activity and, the emergence of other related agendas at play in the public policy scenario;
3) The effects of political pressures exerted by these actors on the state since very early in the pandemics, and the resulting adjustment of public health policies to the demands and health needs of sex workers;
4) The experience and perception of female sex workers concerning public health services and HIV prevention initiatives; and
5) The perceptions of health policy managers about HIV prevention among sex workers and providers, and the status of current discussions about this question.
Based on the above themes, some of the most important findings are:
a) The National STD/HIV/AIDS prevention policies and programs directed at sex workers adopted in Brazil since the late 1980s have had significant positive effects in opening spaces for prostitutes to participate as citizens, provide visibility to their experiences, promote human rights, and thus contribute to overcoming stigma and discrimination related to sex work. In the late 1990’s and early 2000’s the shift towards a specific national strategy to respond to the AIDS epidemic among women inevitably implied a policy shift that included prevention and treatment guidelines specifically geared to sex workers.
b) With regard to the discontinuity of USAID funds in 2005, in the interviews conducted, research participants by and large positively appraised the decision to suspend the agreement even though most of them were not aware of the side effects suffered. Many underlined their support to the primacy of national sovereignty over the impositions of another country whose views were contrary to our human rights principles and legislation. But, it should be said, that most people had not enough information or clarity about the problems caused by the discontinuity of funding.
c) While the observation of services performed by the study was not exhaustive it shows that both in Porto Alegre and Rio de Janeiro the quality of the public health response to the needs of sex workers’ prevention and healthcare remains limited and poor. When asked about scope and quality of services provided to prostitutes, health managers say that by and large, it is restricted to health promotion.
d) Prejudice, stigma, and discrimination are recurrent themes in the interviews with health professionals in Porto Alegre and Rio de Janeiro. Although health managers and professionals interviewed demonstrated great sensitivity about issues of stigma, prejudice, and discrimination, biases were also identified in the ways they portray sex workers.
e) Over and above the debate on universality vs. differential treatment, several health managers and professionals interviewed consider that the HIV/AIDS policy has been losing vigor.
f) Finally, the impacts of the discontinuity of USAID funds in 2005 were examined. The report takes into account that the suspension of funds did not directly affect public program budgets, but the sustainability of nongovernmental organizations (NGOs) involved in prevention projects. Even though public health program mangers didn’t mention the issue, in the NGO community the episode was intensely experienced.
(Abstract authors’ own)
Cristina Pimenta, Sonia Corrêa, Ivia Maksud, Soraya Deminicis and Jose Miguel Olivar