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Community participation as a strategy in health aims to increase the role of citizens in health decision-making which are contextualised within the institutions of democracy. Electoral representation as the dominant model of democracy globally is based on the elite theory of democracy that sees political decision-making a prerogative of political elites. Such political elitism is counter to the idea of democratic participation. Neoliberalism together with elitism in political sphere have worsened social inequities by undermining working class interests. Latin America has seen adverse consequences of these social inequities. In response, social movements representing collective struggles of organised citizens arose in the region. This paper explores the theoretical underpinnings of democratic participation in contemporary Latin American context at the nexus of emerging social movement activism and policy responses. The paper will use empirical examples to highlight how such democratic practices at the societal level evolved while demanding political inclusion. These societal democratic practices in Latin America are redefining democracy, which continues to be seen in the political sphere only. Health reforms promoting participatory democracy in several Latin American countries have demonstrated that establishing institutions and mechanisms of democratic participation facilitate collective participation by the organised citizenry in state affairs. [ABSTRACT FROM AUTHOR]

This paper examines the decline of the AIDS Programme in Brazil, the Latin American country most affected by the epidemic, with emphasis in the second decade of the twenty-first century. For many years, Brazil served as a model in Global Health due to a comprehensive preventive policy, a partnership between the government and health activists and the support of life-saving drugs as public goods rather than commodities. The regression of AIDS policies in Brazil interacted with developments in the United States as well as with multilateral agencies like UNAIDS that emphasised biomedicalisation in the response to the disease where broad human-rights programmes and alliance with activists were not priorities. International programmes like the 'Ending AIDS' campaign indirectly undermined the exceptional status AIDS enjoyed since the late 1980s. The backlash in Brazilian policies to fight AIDS was a result of the fragmentation of the left and the empowerment of radical conservative authoritarian and religious forces. The result was the breakdown of the long-held belief that successful anti-AIDS disease programmes could simultaneously help control the disease and build better healthcare systems and ultimately prompted the end of the special place AIDS' policy had in Brazil. [ABSTRACT FROM AUTHOR]

Drawing on ethnographic research conducted from 2011 to 2015 and the authors' long-term engagement in diverse aspects of HIV and human rights advocacy in Brazil, this paper explores key elements of the Brazilian sex workers' movement response to HIV and the broader political factors that profoundly influenced its trajectory. We argue that the movement has constantly challenged representations of prostitution by affirming sex workers' roles as political actors, not just peer educators, in fighting the HIV epidemic and highlight their development of a sex positive and pleasure centred response that fought stigma on multiple fronts. Moments of tension such as the censorship of an HIV prevention campaign and implementation of 'test and treat' projects are analysed, as are the complex questions that Brazil's 2016 political and economic crisis evokes in terms of how to develop and sustain responses to HIV driven by communities but with material commitment from the State. We conclude with what we see to be the unique, central components of Brazilian sex workers' approach to HIV prevention and what lessons can be learned from it for broader collective health movements in Latin America and beyond.

Brazil's large-scale, successful HIV/AIDS treatment programme is considered by many to be a model for other developing countries aiming to improve access to AIDS treatment. Far less is known about Brazil's important role in changing global norms related to international pharmaceutical policy, particularly international human rights, health and trade policies governing access to essential medicines. Prompted by Brazil's interest in preserving its national AIDS treatment policies during World Trade Organisation trade disputes with the USA, these efforts to change global essential medicines norms have had important implications for other countries, particularly those scaling up AIDS treatment. This paper analyses Brazil's contributions to global essential medicines policy and explains the relevance of Brazil's contributions to global health policy today. [ABSTRACT FROM AUTHOR]

In 2012, the World Health Organization guidelines for HIV prevention recommended the decriminalisation of sex work as their number one good practice. Although human rights language played a key role in the international scientific and activist endorsement of the WHO policies, since then there have been few initiatives in terms of advancing the kinds of structural and political changes endorsed. In this Commentary, we reflect on sex work's place in the broader field of the biomedicalization of responses to HIV. The analysis is based on literature reviews and our research trajectories, including preliminary results from a qualitative study on the implementation of PrEP in Rio de Janeiro, Brazil. We argue that sex workers occupy an ambiguous and less visible role in current AIDS policies, and that such policies are increasingly characterised by their prioritisation of biomedical approaches over structural factors. These shifts should be understood as part of a broader, global hegemony of clinical responses to HIV prevention and the continuation of a neoliberal discourse around human rights, without adequate investment in the material conditions necessary to guarantee these rights. [ABSTRACT FROM AUTHOR]

The purpose of this article is to understand the 'Rio Negro, We Care' campaign in its cosmopolitical implications for discussions of global health and human rights. This article is part of a collaborative process centred on the city of São Gabriel da Cachoeira and the Alto Rio Negro region of Brazil. This campaign was developed by the Department of Women of the Federation of Indigenous Organizations of Rio Negro (DMIRN/FOIRN) at the beginning of the COVID-19 pandemic. It had significant effects on the pandemic experience in the region during 2020. The Brazilian responses to the COVID-19 pandemic highlight complex, intersectional and neocolonial processes, associated with what has been understood as the necropolitics led by the Brazilian federal government. At the same time, such responses shed light on the limitations of the biopolitical orientation of public and global health for the management of the pandemic. We seek to narrate a cosmopolitical intervention located 'in culture' as a counterpoint to this process. Our analysis highlights questions in the field of global and planetary health milestones, such as the conditions of legitimacy for cosmological knowledge and care technologies, or the ontological implications of the persistent biopolitical bias of mainstream public health interventions. [ABSTRACT FROM AUTHOR]

The responses to the judicialisation are based on legal discourses and local practices that impact on access to health and justice. How citizens understand rights is key to holding government accountable. On a human right in health approach and emphasising the right to health and access to justice, this article explores these links through in-depth interviews of claimants at the Rio de Janeiro State Department, whose assist vulnerable groups. To the interviewees, the right to health was a remote, legal fiction, and entitlement and application were liable be treated 'flexibly'; judicialisation was a last resort to meet urgent demands and the impossibility of 'consuming' by their own means; the lawsuits as 'slow', 'painful' and unreliable in ensuring rights; access to health involved sacrifices and the need to fight for their rights. They understood was intimately bound up with the vulnerabilities, obstacles and service denial they had encountered previously. The bureaucratic, technological and technocratic dimensions of health care were incomprehensible and created barriers to access and conflicts. The findings suggested ineffective government responses to the main health problems of vulnerable populations and call for urgent efforts to address equitable and emancipatory implementation of health and justice policies. [ABSTRACT FROM AUTHOR]

In this article, I discuss how love and anger have affected the political struggles of putafeministas/whore-feminists in Brazil. Love, considered to be at the centre of diverse social justice and, particularly, feminist projects, is a relevant assertion of decolonial feminism, a line of thought that has vastly disseminated during the last years in the country. In an ominous political context, marked by growing conservatism and the destablisation of rights that had been previously guaranteed, feminisms' expansion has led to the incorporation of an array of heterogeneous ideas. Putafeministas political struggles have taken place in a milieu in which the multiplicity of histories, needs and strategies of different categories of women seemed to be recognised and celebrated. Yet, far from being acknowledged by lines of decolonial thinking, putafeministas have faced a growing spiral of violence and anger from other Brazilian feminists. I explore this process, basing myself on ethnographic studies conducted since 2010 about relations between feminisms and prostitution in Brazil. My main point is that these confrontations are related to the incorporation of transnational flows of feminist ideas regarding 'rape culture' that associating sex work with paid rape encompass decolonial possibilities. [ABSTRACT FROM AUTHOR]

Brazil’s response to the HIV/AIDS epidemic was characterised by an innovative alliance of governmental and non-governmental actors inspired by a strong progressive tradition in public health. Brazil eventually moved to decentralise HIV/AIDS programmes to its states and cities, a policy endorsed and supported financially by the World Bank as consistent with the mix of public and private elements central to the country’s HIV/AIDS strategy. However, decentralisation has not provided the results anticipated. Through interviews with key informants, government officials and patient advocates as well as observation of treatment sites, we outline how the shift of administration and resources to state and municipal bodies operated in practice. The Bank promoted decentralisation as an uncontroversial technical matter, and its programmatic guidelines implied that the nonprofit sector would be strengthened by it. However, instead of bringing HIV/AIDS policy closer to the grassroots, decentralisation has undermined the country’s early work and opened the door to a rejuvenated epidemic by empowering unsympathetic local elites, marginalising the human rights focus, and removing federal oversight. Its experience holds crucial lessons for developing countries facing similar conditions. [ABSTRACT FROM AUTHOR]

In 31 August 2016, Brazilian president Dilma Rousseff was impeached and replaced by her vice president Michel Temer. Herein, we examine how the conservative agenda of Mr Temer and his supporters is influencing key decisions in the human rights and public health arena in Brazil. The government’s austerity agenda includes severe cuts in critical areas such as health, education and science, jeopardising well-known strategies such as the Brazilian Public Health System (SUS) and nationwide cash transfer program, ‘Bolsa Familia’ - both benefited millions and were the largest of their kind in the world. Mr Temer’s decisions show not only severe cuts in critical areas but also a political agenda that clearly demonstrates a broad shift away from the progressivism and social agenda presented and supported by its predecessors. Most vulnerable groups such as the LGBTQ community, women, people who use drugs and disenfranchised communities have been severely affected. Mr Temer’s administration is putting Brazil far from its once nationwide goal to foster free and universal health care access and social equity for all its citizens. The near future for Brazil is unknown, but both national and international communities anticipate severe problems within the national human rights arena, if nothing changes. Abbreviations: CCT: Conditional Cash Transfer; LGBTQ: Lesbian, Gay, Bisexual, Transgender and Queer (and/or Questioning); SUS: Brazilian Public Health System [ABSTRACT FROM AUTHOR]

Studies have demonstrated that an early HIV diagnosis is a critical first step towards continued engagement in care. We examined HIV testing experiences in Salvador, Brazil, to understand how a focus on quality services can inform service provision more generally in the post–2015 global health agenda. Seventeen semi-structured interviews were conducted with HIV-positive pregnant women in Salvador, a large urban centre of north-east Brazil. Interviews were transcribed, translated and coded for analysis. Deductive codes confirmed factors identified in the literature review. Inductive codes highlighted new factors emerging from the initial coding. ‘Quality’ was defined according to global and national guidelines as HIV testing with informed and voluntary consent, counselling and confidentiality (3Cs). No pregnant woman experienced all elements of the 3Cs. Three women did not experience any informed and voluntary consent, counselling or confidentiality. Few women provided consent overall and none received pre-test counselling. Post-test counselling and confidentiality of services were more consistently provided. This study suggests that testing in Salvador – the third-largest city in the country – is not of the quality called for by global and national guidelines, despite the fact that HIV testing is being routinely provided for HIV-positive pregnant women in Brazil. Going forward, additional clarity around the 3Cs is necessary to improve how the quality, not just the quantity, of HIV services is measured. [ABSTRACT FROM PUBLISHER]