Sociopolitical determinants of an AIDS prevention program: multiple actors and vertical relationships of control and influence

Abstract

In every country, health and prevention "come down" from the authorities responsible for this mission by way of planners, local authorities, and peer educators until it reaches the target population. International and national systems function on the premise of a top-down transmission, with little room for integrating local information that might provide a better understanding of the implementation process. This analysis is based on an empirical evaluative research of HIV/AIDS prevention projects with sex workers in a remote area of northern Brazil. It illustrates how nursing sociopolitical analysis can reveal how political interests can have perverse effects by contaminating the group's internal relations and with established partnerships, thereby weakening the impact of prevention programs. These effects can seriously affect community relations and social practices, far beyond the technical division of work and political hierarchies in the sociosanitary network.