Lessons from the evaluation of the South African National Female Condom Programme.

BACKGROUND: Understanding of the facilitators and challenges to female condom (FC) uptake has been limited due to lack of evaluation of national FC programmes. SETTING: The FC has been an integral component of South Africa's (SA) HIV prevention programme for 20 years and is the largest government-funded FC programme worldwide. METHODS: The national FC evaluation used a mixed-methods approach and consisted of key informant interviews and a telephone survey in a national sample of public and non-public sites. A sub-sample of sites participated in client and provider interviews, and a self-administered client survey. A review of distribution statistics from South Africa's District Health Information System was also conducted. RESULTS: All 256 public-sector and 28 non-public-sector facilities reported having ever distributed FCs. Less than 5% of these facilities reported stock-outs and less than 3% reported they had a supply of expired female condoms. Systems for male condom (MC) and FC distribution were complementary, with similar ordering, delivery and reporting processes. FC promotion by providers (n = 278) varied with regard to FC training, whether attitudes about FCs influenced providers offer of FCs, and how they counselled clients about FCs. Of the 4442 self-administered client surveys in 133 facilities, similar proportions of women (15.4%) and men (15.2%) had ever used FCs. Although FCs were available at almost all sites surveyed, only two-thirds of clients were aware of their availability. CONCLUSION: Data highlight the role of providers as gatekeepers to FC access in public and non-public sectors and provide support for further FC programme expansion in SA and globally.

HIV policy in Italy and recommendations across the HIV care continuum.

The HIV epidemic has not yet ended, and there are ever more challenges: the recent Italian National Plan of Interventions against HIV and AIDS (Piano Nazionale di Interventi Contro HIV e AIDS (PNAIDS) 2017-2019) was hailed for its comprehensiveness. Its likelihood of success across the HIV care continuum was therefore assessed. Awareness interventions are sporadic and continue to miss high risk populations; if effectively implemented, the prescriptive detail in PNAIDS may help address this. Combined prevention needs greater focus and investment. However, there has been recent progress: free anonymous testing is available at multiple settings although improvements to provide access to key vulnerable populations are needed. Clinical management is available to a high standard across the country, with some areas for improvement in ensuring equality of access. Long-term management of people living with HIV is often effective, but discrepancies exist across regions and settings of care. It is recommended to enable implementation of PNAIDS as a matter of urgency, develop integrated awareness and testing interventions for STIs and HIV, make condoms free for high-risk populations, and develop a network of multidisciplinary services for long-term holistic care of people living with HIV.

Comparing HIV risk-related behaviors between 2 RDS national samples of MSM in Brazil, 2009 and 2016.

INTRODUCTION: Periodic monitoring of sociobehavior characteristics at a national level is an essential component of understanding the dynamics the human immunodeficiency virus (HIV) epidemic worldwide, including Brazil. METHODS: This paper compares descriptive sociobehavior characteristics in 2 national cross-sectional HIV biological behavioral surveillance surveys (BBSS) conducted in 2009 and 2016 among men who have sex with men (MSM) in Brazil. Respondent driven sampling (RDS) was used for recruitment in both years. Overall proportions were weighted according to Gile's estimator using RDS Analyst Software and 95% confidence intervals were calculated for comparisons between the 2 periods. Further comparisons were stratified by age groups (<25 and 25+ years old). RESULTS: Overall, 3749 and 4176 MSM were recruited in 2009 and 2016, respectively. In 2016, participants were younger than 25 years old (58.3%), with 12 or more years of education (70.4%), with higher socioeconomic status (40.7%), and had a higher proportion of whites (31.8%), as compared to 2009. Also, participants in 2016 reported less alcohol use and binge drinking, but used illicit drugs more frequently. There was an increase among MSM who self-reported their HIV risk as low and had low HIV knowledge while the proportion of those who were never tested for HIV dropped from 49.8% in 2009 to 33.8% in 2016. Although more than three-quarters received free condoms in both years, STD counseling remained low (32% and 38% for 2009 and 2016, respectively). Sexual risk behavior remained at high levels, especially unprotected anal receptive sex and sex with multiple partners. Younger MSM (<25 years old) showed riskier sexual practices than those 25+ years old, when comparing 2016 to 2009. CONCLUSIONS: Our results indicate a worrisome risk behavior trend among Brazilian MSM, especially among younger ones. These results can contribute for a better understanding of the HIV epidemics in Brazil, with timely shift in strategies so improved effectiveness in public health prevention efforts can be achieved.

"But the moment they find out that you are MSM ": a qualitative investigation of HIV prevention experiences among men who have sex with men (MSM) in Ghana's health care system.

BACKGROUND: The prevalence of HIV in Ghana is 1.3%, compared to 17% among men who have sex with men (MSM). There is limited empirical data on the current health care climate and its impact on HIV prevention services for Ghanaian MSM. The purposes of this study were to investigate (1) MSM's experiences using HIV prevention resources, (2) what factors, including health care climate factors, influenced MSM's use of prevention resources and (3) MSM self-identified strategies for improving HIV/sexually transmitted infection (STI) prevention among MSM in Ghanaian communities. METHODS: We conducted 22 focus groups (n = 137) with peer social networks of MSM drawn from three geographic communities in Ghana (Accra, Kumasi, Manya Krobo). The data were examined using qualitative content analysis. Interviews with individual health care providers were also conducted to supplement the analysis of focus group findings to provide more nuanced illuminations of the experiences reported by MSM. RESULTS: There were four major findings related to MSM experiences using HIV prevention resources: (1) condom quality is low, condom access is poor, and condom use is disruptive, (2) inaccurate information undermines HIV testing (3), stigma undermines HIV testing, and (4) positive attitudes towards HIV prevention exist among MSM. The main healthcare climate factors that affected prevention were that MSM were not free to be themselves, MSM were not understood by healthcare providers, and that MSM did not feel that healthcare providers cared about them. To improve HIV prevention MSM suggested increased education tailored to MSM should be provided to enable self-advocacy and that education and awareness are needed to protect human rights of MSM in Ghana. CONCLUSION: MSM in Ghana are exposed to negative health care climates. Health care spaces that are unsupportive of MSM's autonomy undermine the uptake of prevention measures such as condoms, HIV testing, and accurate sexual health education. These findings contribute to knowledge to inform development of HIV prevention interventions for MSM in Ghana, such as culturally appropriate sexual health education, and digital technology to connect individuals with resources supportive of MSM.

Perfil de travestis e transgêneros: tuberculose e HIV/Aids na cidade de São Paulo / Profile of transvestites and transgender women: tuberculosis and HIV/AIDS in the city of São Paulo

RESUMO Objetivo Caracterizar o perfil de travestis e mulheres transgênero que participaram de uma pesquisa sobre tuberculose e HIV/Aids na cidade de São Paulo. Métodos Estudo transversal com aplicação do questionário Knowledge, Attitudes and Practices (KAP) adaptado para coleta de dados. Foram abordados aspectos sociodemográficos, da passagem pelo sistema prisional, aspectos relativos ao processo de transição de gênero, uso de preservativo, histórico de tratamento de doenças sexualmente transmissíveis e tuberculose e conhecimento de HIV/Aids. Resultados Participaram do estudo 58 travestis e 66 transgêneros. Observaram-se diferenças entre os grupos em relação a escolaridade (P = 0,008), prostituição (P < 0,001), passagem por prisões (P < 0,001), injeção de silicone líquido (P = 0,005) e hormonioterapia sem acompanhamento médico (P = 0,004). Todas as trans (100%) e 80% das travestis referiram tratamento de sífilis; 25,9% das travestis relataram coinfecção tuberculose/HIV. Os resultados relativos ao conhecimento de HIV/Aids revelaram noções permeadas por equívocos quanto às formas de transmissão e uso irregular do preservativo. Conclusão Os resultados deste estudo mostraram a vulnerabilidade de travestis e mulheres transgênero frente a tuberculose e HIV/Aids. As diferenças observadas entre os dois grupos sugerem a necessidade de uma abordagem distinta em futuros estudos.

ABSTRACT Objective To characterize the profile of transvestites and transgender women participating in a survey regarding tuberculosis and HIV/Aids in the city of São Paulo. Method This cross-sectional study employed the Knowledge, Attitudes and Practices (KAP) questionnaire adapted for data collection. Sociodemographic aspects as well as aspects related to history of imprisonment, process of gender transition, use of condoms, previous treatment of sexually transmitted diseases and tuberculosis and knowledge regarding HIV/Aids were addressed. Results The study included 58 transvestites and 66 transgender women. There were differences between the two groups regarding schooling (P = 0.008), prostitution (P < 0.001), imprisonment (P < 0.001), silicone injections (P = 0.005), and hormone therapy without medical guidance (P = 0.004). All trans women (100%) and 80% of transvestites mentioned treatment of syphilis; 25.9% of transvestites reported tuberculosis/HIV co-infection. The investigation regarding knowledge of HIV/AIDS revealed inconsistent use of condoms and mistaken beliefs related to modes of transmission. Conclusion The present results show that transvestites and trans women were vulnerable to tuberculosis and HIV/AIDS. The differences observed between the two groups suggest the need for different approaches to transvestites and transgender women in future studies.

Projeto "saúde e prevenção nas escolas": percepções de professores e alunos sobre a distribuição de preservativos masculinos no ambiente escolar / Project "health and prevention in schools": teachers' and students' perceptions about condom distribution in schools

O artigo discute a proposta de distribuição de preservativos masculinos nas escolas a partir de uma pesquisa de campo sobre as percepções de professores e alunos adolescentes, de ambos os sexos. Distribuir preservativos masculinos nas escolas faz parte da política pública de prevenção das infecções sexualmente transmissíveis (IST/Aids) e da gravidez adolescente, intitulado "Saúde e Prevenção nas Escolas" (SPE). Com a análise das entrevistas feitas a professores e alunos, foram identificados pontos convergentes e divergentes tanto em relação às diretrizes de implementação do programa, quanto em relação às perspectivas ora distintas dos professores e da família em contraposição ao ponto de vista dos jovens. Os resultados sugerem que professores estão distantes dos alunos e da política pública no que se refere a abordagem do tema da sexualidade e distribuição do preservativo masculino nas escolas.

The article discusses the proposed distribution of condoms in schools from a field survey on the perceptions of teachers and teenage students of both sexes. Distributing condoms in schools is part of public policy on prevention of sexually transmitted infections (STI / AIDS) and teenage pregnancy, entitled "Health and Prevention in Schools" (SPE). Analyzing interviews with teachers and students, we have identified similarities and differences both in relation to program implementation guidelines, as about distinct prospects of teachers and family, as opposed to the views of young people. The results suggest that teachers are distant from students and public policy as regards the approach to the subject of sexuality and distribution of condoms in schools.

¿Cuál es el impacto de la instalación de dispensadores de preservativos masculinos sobre su uso en la población joven del país?: síntesis rápida de evidencia / What is the impact of the installation of male condom dispensers on the use of male condoms among the country's young population?: rapid evidence synthesis

ANTECEDENTES Y OBJETIVO A nivel global, 35 millones de personas en el mundo viven con VIH/SIDA y 1.5 millones mueren cada año producto de esta enfermedad. En esa línea, el uso de condón masculino se ha promovido como una alternativa importante para la prevención de Infecciones de Transmisión Sexual (ITS) y VIH. En términos de accesibilidad, algunos estudios muestran que la barrera más común para la adquisición de preservativos es la vergüenza y falta de privacidad por comprar en lugares públicos o clínicas. En esa línea, numerosos planes de Gobierno en el mundo han mencionado la importancia de contar con dispensadores de condones como estrategia para aumentar la disponibilidad y el acceso a preservativos para la población En este contexto se solicita esta síntesis de evidencia con el objetivo de informar la toma de decisiones respecto del efecto de una política para instalar dispensadores de preservativos en espacios públicos. METODOLOGÍA Se formuló una estrategia de búsqueda para ser utilizada en las bases de datos PubMed, Cochrane Library y PDQ Evidence, con el objetivo de identificar revisiones sistemáticas y estudios primarios del tema. Se seleccionaron preferentemente aquellas que incluían información relevante y que fueron publicadas en los últimos 5 años. RESULTADOS Se recuperó 1 revisión sistemática, de la cual se obtuvieron los siguientes resultados: -La instalación de dispensadores y distribución gratuita de preservativos como intervención única, aumenta el porcentaje de uso de condón en la población. -La instalación de dispensadores y distribución gratuita de preservativos en conjunto a otras intervenciones de disponibilidad y accesibilidad, aumentan el porcentaje de uso de condón en la población. -La instalación de dispensadores y distribución gratuita de preservativos pareciera no tener impacto sobre la prevalencia de ITS en la población, no obstante, numerosos factores adicionales inciden sobre esta variable. -Los dispensadores de preservativos son percibidos como un lugar frecuente para la obtención de condones. -Los hombres tienen una mayor disposición a utilizar dispensadores de preservativos que las mujeres.

La distribución gratuita de condones a trabajadoras sexuales en Ecuador: efectos en el comportamiento de compra / Free distribution of condoms to female sex workers in Ecuador: effects on purchase behavior

Los condones son considerados un método eficaz para evitar la propagación de infecciones de transmisión sexual. En Ecuador, un factor común en las políticas públicas de salud sexual es la entrega gratuita de condones a trabajadoras sexuales (TS). Esto ocurre junto con el asesoramiento sobre otras medidas preventivas y la importancia de las pruebas de detección del VIH. Este estudio busca determinar si la distribución gratuita de condones afecta la compra de los mismos y su uso consecuente. A través de una encuesta apli-cada a 2.566 trabajadoras sexuales en ocho ciudades del Ecuador, se analiza el comportamiento de compra de condones. Los datos corresponden a las encuestas realizadas por el Proyecto de Prevención de Fronteras (PPF) en Ecuador en 2006. Dado que el acceso a las políticas públicas y a los condones gratuitos no es aleatorio, existen riesgos de sesgos de selección muestral. Para ello utilizamos un procedimiento de estimación Heckman en dos etapas. En la primera se analiza la probabilidad de comprar condones, y en la segunda, la cantidad de condones comprados. Se encuentra que por cada condón recibido gratuitamente, la TS compra uno más. Este resultado muestra la efectividad de las políticas de distribución cuando son acompañadas de componentes de asesoramiento e información.

Condoms are considered an effective method to prevent the spread of sexually transmitted infections. In Ecuador, a common factor in sexual health public policy is the provision of free condoms to female sex workers. This occurs together with advice on other preventive measures and the importance of HIV screening. The present study seeks to determine whether he distribution of free condoms affects their purchase and subsequent use. A survey to assess condom purchase behavior was completed by 2566 female sexual workers (FSW) in eight cities in Ecuador. The Frontiers Prevention Project (FPP) conducted surveys during 2006. There is a risk of sample selection bias as access to public policy and free condoms is not random: we therefore used a Heckman estimation procedure in two stages. The probability of purchasing condoms and the quantity of condoms purchased were analyzed. We find that for each condom received for free, FSW purchased one more. This result shows the effectiveness of distribution policies when they are accompanied by advice and information.

Combination HIV prevention: significance, challenges, and opportunities.

No single HIV prevention strategy will be sufficient to control the HIV pandemic. However, a growing number of interventions have shown promise in partially protecting against HIV transmission and acquisition, including knowledge of HIV serostatus, behavioral risk reduction, condoms, male circumcision, needle exchange, treatment of curable sexually transmitted infections, and use of systemic and topical antiretroviral medications by both HIV-infected and uninfected persons. Designing the optimal package of interventions that matches the epidemiologic profile of a target population, delivering that package at the population level, and evaluating safety, acceptability, coverage, and effectiveness, all involve methodological challenges. Nonetheless, there is an unprecedented opportunity to develop "prevention packages" that combine various arrays of evidence-based strategies, tailored to the needs of diverse subgroups and targeted to achieve high coverage for a measurable reduction in population-level HIV transmission. HIV prevention strategies that combine partially effective interventions should be scaled up and evaluated.

Assessment of the scale, coverage and outcomes of the Avahan HIV prevention program for female sex workers in Tamil Nadu, India: is there evidence of an effect?

BACKGROUND: Avahan, the India AIDS Initiative, a large-scale HIV prevention program, using peer-mediated approaches and STI services, was implemented for high-risk groups for HIV in six states in India. This paper describes the assessment of the program among female sex workers (FSWs) in the southern state of Tamil Nadu. METHODS: An analytical framework based on the Avahan impact evaluation design was used. Routine program monitoring data, two rounds of cross-sectional biological and behavioural surveys among FSWs in 2006 (Round 1) and 2009 (Round 2) and quality assessments of clinical services for sexually transmitted infections (STIs) were used to assess trends in coverage, condom use and prevalence of STIs, HIV and their association with program exposure. Logistic regression analysis was used to examine trends in intermediate outcomes and their associations with intervention exposure. RESULTS: The Avahan program in Tamil Nadu was scaled up and achieved monthly reported coverage of 79% within four years of implementation. The cross-sectional survey data showed an increasing proportion of FSWs being reached by Avahan, 54% in Round 1 and 86% in Round 2 [AOR=4.7;p=0.001]. Quality assessments of STI clinical services showed consistent improvement in quality scores (3.0 in 2005 to 4.5 in 2008). Condom distribution by the program rose to cover all estimated commercial sex acts. Reported consistent condom use increased between Round 1 and Round 2 with occasional (72% to 93%; AOR=5.5; p=0.001) and regular clients (68% to 89%; AOR=4.3; p=0.001) while reactive syphilis serology declined significantly (9.7% to 2.2% AOR=0.2; p=0.001). HIV prevalence remained stable at 6.1% between rounds. There was a strong association between Avahan exposure and consistent condom use with commercial clients; however no association was seen with declines in STIs. CONCLUSIONS: The Avahan program in Tamil Nadu achieved high coverage of FSWs, resulting in outcomes of improved condom use, declining syphilis and stabilizing HIV prevalence. These expected outcomes following the program logic model and declining HIV prevalence among general population groups suggest potential impact of high risk group interventions on HIV epidemic in Tamil Nadu.

Condom use as part of the wider HIV prevention strategy: experiences from communities in the North West Province, South Africa.

Correct and consistent condom usage remains a pivotal strategy in reaching the target set by the South African government to reduce new HIV infections by 50% in the next 5 years. Studies have found that there has been an increase in condom usage by some categories of the population, but usage has not yet reached the desired levels in order to meet the target. This article reports on the findings of a study on condom usage in eight communities in the North West Province, which was part of a wider HIV and AIDS programme evaluation commissioned by the North West Provincial Department of Health. The main aim was to assess accessibility to condoms, and knowledge, attitudes and practices around condom use by four sampled communities in the North West Province. Eight focus group discussions were held and 50 households were interviewed. The study found positive results regarding accessibility and awareness of condoms. However, this often did not lead to the desired behavioural change of using condoms in risky sexual interactions. The majority of respondents still resisted condom usage, used condoms inconsistently, or were not in a position to negotiate protected sexual intercourse. The main reasons reported for this were: reduced pleasure, perceived and real physical side-effects, myths, lack of information, status, financial reasons, distrust in the efficacy of condoms, family planning, cultural reasons, gender-related reasons and trust. Many of the barriers to consistent condom use cannot be overcome by strategies that target the individual. Interventions need to address underlying developmental factors such as the non-biological factors that increase the susceptibility of women to HIV infection. As this falls outside of the scope of the mandate of the Department of Health, various partnerships with other key role players need to be established and/or strengthened, such as with local government, non-governmental organisations and faith-based organisations.

Opiniões e atitudes em relação à sexualidade: pesquisa de âmbito nacional, Brasil 2005 / Opinions and attitudes regarding sexuality: Brazilian national research, 2005

OBJETIVO: Descrever opiniões e atitudes sobre sexualidade da população urbana brasileira. MÉTODOS: Inquérito de base populacional realizado em 2005, em amostra representativa de 5.040 entrevistados. Realizou-se análise das atitudes diante da iniciação e educação sexual de adolescentes, considerando sexo, idade, escolaridade, renda, estado civil, religião, cor, região geográfica e opiniões sobre fidelidade, homossexualidade e masturbação. Os resultados foram contrastados com pesquisa similar realizada em 1998, sempre que possível. RESULTADOS: A maioria dos entrevistados escolheu como significado para o sexo a alternativa: "sexo é uma prova de amor". Como em 1998, a maioria manifestou-se pela iniciação sexual dos jovens depois do casamento (63,9 por cento para iniciação feminina vs. 52,4 por cento para a masculina), com diferenças entre praticantes das diversas religiões. A educação escolar de adolescentes sobre o uso do preservativo foi apoiada por 97 por cento dos entrevistados, de todos os grupos sociais. Foi elevada a proporção de brasileiros que concordaram com o acesso ao preservativo nos serviços de saúde (95 por cento) e na escola (83,6 por cento). A fidelidade permaneceu um valor quase unânime e aumentou, em 2005, a proporção dos favoráveis à iniciação sexual depois do casamento, assim como a aceitação da masturbação e da homossexualidade, em relação à pesquisa de 1998. As gerações mais novas tendem a ser mais tolerantes e igualitárias. CONCLUSÕES: Como observado em outros países, confirma-se a dificuldade de estabelecer uma dimensão única que explique a regulação da vida sexual ("liberal" vs "conservador"). Sugere-se que a normatividade relativa à atividade sexual deva ser compreendidas à luz da cultura e organização social da sexualidade ao nível local, auscultadas pelos programas de DST/Aids. A opinião favorável ao acesso livre ao preservativo na escola contrasta com resultados mais lentos no âmbito do combate ao estigma e à...

OBJECTIVE: To describe opinions and attitudes concerning sexuality of the Brazilian urban population. METHODS: A population survey was carried out in 2005 on a representative sample of 5,040 interviewees. An analysis of the attitudes regarding sexual initiation and sexual education of teenagers, considering gender, age, schooling, income, marital status, color, geographic region and opinion on fidelity, homosexuality, and masturbation. The results were contrasted with a similar survey carried out in 1998, when possible. RESULTS: Most interviewees selected the "sex is evidence of love" option when describing the meaning of sex. As in 1998, the majority was in favor of sexual initiation after marriage (63.9 percent for women vs. 52.4 percent for men initiation); results differed among religions. School teenage education on the use of condoms was supported by 97 percent of the interviewees across all social groups. The proportion of Brazilians who agreed with having access to condoms in health services (95 percent) and at school (83.6 percent) was high. Fidelity remained an almost unanimous value and there was an increase, in 2005, in the proportion of those in favor of sexual initiation after marriage, and in the rate of acceptance of masturbation and homosexuality compared to the 1998 survey. The younger generations tend to be more tolerant and equalitarian. CONCLUSIONS: As observed in other countries, this study confirms the difficulty in establishing a single dimension that guides sexual life ("liberal" vs "conservative"). The study suggests that the normativity concerning sexual activity should be understood in the light of the local culture and social organization of sexuality, considered by the STD/Aids programs. Opinions in favor of free access to preservatives at school clash with the slower results obtained in fighting the stigma and discriminating against homosexual minorities. The design of laical policies on sexuality allow...

A five-city trial of a behavioural intervention to reduce sexually transmitted disease/HIV risk among sex workers in China.

OBJECTIVES: To explore and evaluate a sexually transmitted disease (STD)/HIV intervention program targeting female sex workers working in entertainment establishments in five different settings in China. DESIGN AND METHOD: A prospective, community-based, pre/post, intervention trial set in entertainment establishments (karaoke bars, massage parlours, dance halls, beauty parlours) where sex workers operate at sites in five provinces of China: Anhui, Beijing, Fujian, Guangxi and Xinjiang. The participants were all sex workers working in targeted entertainment establishments. A Women's Health Clinic was set up near participants' places of work at each site. Clinic-based outreach activities, including awareness-raising, condom promotion, and sexual health care, were developed and delivered to sex workers. Cross-sectional surveys at baseline and post-intervention were used to evaluate changes in condom use with the last three clients, and the prevalence of chlamydia and gonorrhoea. RESULTS: In total, 907 sex workers were surveyed at baseline and 782 at 12 months post-intervention. Outreach teams made 2552 visits to the target entertainment establishments, approached 13,785 female sex workers, and distributed 33,575 copies of education material and 5102 packets of condoms. The rate of condom use with the most recent three clients increased from 55.2% at baseline to 67.5% at 12 months evaluation. The prevalence of gonorrhoea fell from 26% at baseline to 4% after intervention, and that of chlamydia fell from about 41 to 26%. CONCLUSION: The intervention was effective for increasing condom use and reducing STD among sex workers. The results were used to develop national guidelines on sex worker interventions for nationwide scale up.

[The right to prevention and the challenges of reducing vulnerability to HIV in Brazil]. / O direito à prevenção e os desafios da redução da vulnerabilidade ao HIV no Brasil.

The study evaluates the Brazilian response to the targets established by UNGASS for the prevention of HIV/AIDS. The analysis was based on national research, documents and information from the National Program STD/AIDS and on state-level action plans and targets. Brazil relies on various prevention policies to attain the UNGASS targets proposed for 2005. These include: addressing discrimination issues, promotion of HIV testing, distribution of condoms, needle exchange programs, discussion of sexuality in schools, prevention initiatives for sex workers and homosexuals and prevention in the workplace. These have resulted in increases in testing and condom use. Various challenges are discussed, including: overcoming discontinuity in action plans (particularly with more vulnerable groups), training prevention teams, increasing monitoring of quantity and quality of preventative actions and overcoming regional, racial and gender inequalities. It is concluded that the right to prevention is not a public priority, nor is it on the social movement agendas. This contrasts with the right to better HIV treatment. In order to increase the efficacy of these programs, it is suggested that they be understood and incorporated based on the promotion and guarantee of human rights, thereby advancing the ethical/political debate at local and national levels.