The Political Economy of HIV/AIDS in Developing Countries
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The Political Economy of HIV/AIDS in Developing Countries

TRIPS, Public Health Systems and Free Access

Edited by Benjamin Coriat

The book is based on original data and field studies from Brazil, Thailand, India and Sub-Saharan Africa. Focusing on the issue of universal and free access to treatment (a goal now taken to heart by the international community), it assesses the progress made and presents a rigorous diagnosis of the obstacles that remain, especially the constraints imposed by TRIPS and the poor state of most public health systems in Southern countries. In so doing, the book renews our understanding of the political economy of HIV/AIDS in these vast regions, where it continues to spread with devastating social and economic consequences.
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Chapter 4: The Brazilian Experience of ‘Scaling-up’: A Public Policy Approach

Guillaume Le Loup, Andreia Pereira de Assis, Maria Helena Costa-Couto, Sonia Fleury, Kenneth Rochel de Camargo and Jean-Claude Thoenig


4. The Brazilian experience of ‘scalingup’: a public policy approach Guillaume Le Loup, Andreia Pereira de Assis, Maria Helena Costa-Couto, Jean-Claude Thoenig, Sonia Fleury, Kenneth Rochel de Camargo Jr and Bernard Larouzé INTRODUCTION In 2000, Hans P. Binswanger, from the World Bank, wrote: ‘The most important issue in the fight against HIV/AIDS is how to scale up existing programmes that are only reaching small numbers of people to the national level’ (Binswanger, 2000). Subsequently, the scaling-up of the HIV/AIDS programmes of low- and middle-income countries rapidly became a new priority of the international community of scientists and health professionals. In this perspective, Brazil was recognized as a model: in 1996, it was the first and only emerging country to implement free and universal access to highly active antiretroviral therapy (HAART). It was an example of successful scaling-up. Whatever the content of the policy may be, the scalingup process implies (a) the mobilization of financial and human resources, and (b) the extension of programmes (prevention, diagnosis, care) and structures allowing a policy to be implemented throughout a whole country. The Brazilian response to the HIV/AIDS epidemic originated at the local level, in the south-east of the country, the wealthiest part of Brazil, with the best health indicators (Castilho and Chequer, 1997). At the end of the 1980s, the national IST/AIDS programme initiated and managed, with other public and non-governmental actors, a scaling-up process (Teixeira, 1997). The process has been both long and complex, due to the size of the country and...

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