HIV/AIDS prevention in municipalities in Baixada Fluminense, Rio de Janeiro, Brazil: gaps between global policy and local responses

Global and national AIDS response policies emphasize treatment as prevention, pre and post- exposure prophylaxis, and combination prevention. This article analyzes the implementation of such policies at local level drawing on the findings of a social study conducted in municipalities in the metropolitan region of Rio de Janeiro , Brasil, centered on HIV/AIDS prevention and care and the vulnerability of gays, transvestites, and prostitutes. The gaps between policy and local action are addressed focusing on four issues: the expansion of HIV testing, challenges facing targeted actions, the distance between testing and treatment, and the reach of combinations in combination prevention. We demonstrate the importance of understanding the social processes that cut across the implementation of the global recommendations and guidelines and suggest that these processes must to be taken into account to effectively tackle the HIV/AIDS epidemic.