Programmatic vulnerability and public care: Overview of HIV and Aids prevention policies for gay and other MSM in Brazil

Abstract: The resurgence of the HIV epidemic among gay men and other men who have sex with men (MSM) is indicative of limitations or failures in prevention policies directed to this group. Based on the theoretical approaches of vulnerability and Care, we analyze the panorama of HIV/AIDS prevention policies for gays and other MSM in Brazil using national documents that support prevention policies of HIV/AIDS and documents produced by nongovernmental organizations and by the LGBT National Conferences. We identified, in the documents analyzed, three readings that support prevention policies: a) epidemiological; b) preventive responsibility; c) based on human rights and vulnerability. The dispute, denial and hegemony of each of these perspectives at different times allows us to understand some of the challenges and barriers faced in preventing HIV and AIDS among gays and other MSM. Our analysis shows changes in the intensity and quality of the dialogue between state and society. The fragile formalization and restricted scope of the documents stand out as limitations in the effectuation of a prevention approach based on vulnerability and human rights, as well as the incorporation of the Public Care perspective. We reiterate the importance of a qualified dialogue with the individuals involved in the policies to hear their needs, aspirations and critics.

摘要：男同性恋者及其他男男性行为者（men who have sex with men, MSM）群体中HIV疫情的反弹，反映出针对该群体的预防政策存在局限与失效。本研究基于脆弱性与照护的理论视角，依托支撑HIV/AIDS预防政策的国家级文件、非政府组织文件以及全国LGBT大会编制的文献，对巴西男同性恋者及其他男男性行为者群体的HIV/AIDS预防政策全景展开分析。本次分析所涉文件中，存在三类支撑预防政策的解读视角：a）流行病学视角；b）预防责任视角；c）基于人权与脆弱性的视角。这些视角在不同时期的争论、否定与霸权主导，有助于我们理解男同性恋者及其他男男性行为者群体HIV/AIDS预防工作中面临的部分挑战与障碍。本研究分析显示，国家与社会间对话的强度与质量均发生了变化。这些文件形式化程度薄弱、覆盖范围有限，成为落实基于脆弱性与人权的预防路径以及纳入公共照护视角的显著局限。本研究重申，与政策相关主体开展高质量对话，以倾听其需求、诉求与批评意见，具有重要意义。