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This Article Full Text Full Text (PDF) Data Supplement All Versions of this Article: AJPH.2008.138123v1 99/6/1108    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Le Loup, G. Articles by Larouzé, B. PubMed PubMed Citation Articles by Le Loup, G. Articles by Larouzé, B. Related Collections Global Health Social Science Health Policy Access to Care HIV/AIDS

Guillaume Le Loup, MD, DTMH, Andreia de Assis, MA, Maria-Helena Costa-Couto, PhD, Jean-Claude Thoenig, PhD, Sonia Fleury, PhD, Kenneth de Camargo, Jr, PhD and Bernard Larouzé, MD

Guillaume Le Loup and Bernard Larouzé are with Paris Hospital and Institut National de la Santé et la Recherche Médicale UMRS 707, Paris, France, and Université Pierre et Marie Curie, Paris. Andreia de Assis and Sonia Fleury are with Fundaçao Getulio Vargas, Rio de Janeiro, Brazil. Maria-Helena Costa-Couto and Kenneth de Camargo Jr are with the Instituto de Medicina Social, universidade Estadual de Rio de Janeiro. Jean-Claude Thoenig is emeritus of Centre National de la Recherche Scientifique, Paris.

Correspondence: Requests for reprints should be sent to Guillaume Le Loup, MD, INSERM-UMRS 707, Université Pierre et Marie Curie (Site Saint Antoine), 27 rue Chaligny, 75012, Paris, France (e-mail: guillaume.leloup{at}u707.jussieu.fr).

Objectives. We investigated involvement and cooperation patterns of local Brazilian AIDS program actors and the consequences of these patterns for program implementation and sustainability.

Methods. We performed a public policy analysis (documentary analysis, direct observation, semistructured interviews of health service and nongovernmental organization [NGO] actors) in 5 towns in 2 states, São Paulo and Pará.

Results. Patterns suggested 3 models. In model 1, local government, NGOs, and primary health care services were involved in AIDS programs with satisfactory response to new epidemiological trends but a risk that HIV/AIDS would become low priority. In model 2, mainly because of NGO activism, HIV/AIDS remained an exceptional issue, with limited responses to new epidemiological trends and program sustainability undermined by political instability. In model 3, involvement of public agencies and NGOs was limited, with inadequate response to epidemiological trends and poor mobilization threatening program sustainability.

Conclusions. Within a common national AIDS policy framework, the degree of involvement and cooperation between public and NGO actors deeply impacts population coverage and program sustainability. Specific processes are required to maintain actor mobilization without isolating AIDS programs.