Brazil's HIV/AIDS response program is considered a success story. As early as 1987, Brazil became the first developing country to guarantee free treatment. The country is also known for its social activism, which helped build the Unified Health System (SUS) and shape public policies based on scientific evidence and human rights.
Important milestones in the fight against AIDS emerged through the alliance between civil society, public health professionals, and the government, such as universal and free access to antiretroviral drugs and the domestic production of diagnostic tests. One notable decision was the patent waiver for the antiretroviral drug efavirenz in 2007.
However, after decades of success, this leading role has lost momentum. The field of activism, once guided by a certain political consensus, has become fragmented. This is due to the changing profile of people living with HIV ("pauperization" of the epidemic) and the reorientation of health policies, which has also led to a shift in civil society's priorities. Consequently, anti-AIDS activism in Brazil has become depoliticized. Helena Achcar of the Center for Public Sector Policy and Economics at the Getulio Vargas Foundation (CEPESP-FGV) reached this conclusion in an article published in the journal Sociology of Health & Illness.
"The movement's decline can't be explained by a lack of funding alone, but above all by the changing profile of activists and the priorities imposed by the pauperization of the epidemic. Also contributing to this trend are technological advances and the growing medicalization of the response to HIV, which favor quick, biomedical solutions at the expense of public health and the fight against inequalities," Achcar told Agência FAPESP.
"It's important to emphasize that the idea that AIDS has been resolved is misleading, and therefore activism remains one of the pillars of the Brazilian response," the researcher adds.
The study, supported by FAPESP , is based on the theory of practice (or field theory) developed by the French sociologist Pierre Bourdieu.
Achcar examined the demobilization of the AIDS movement in Brazil through four main, interrelated concepts: the social space of struggle and competition among different actors (which Bourdieu calls the field); the actions internalized by movement members (habitus); the economic, social, cultural, and symbolic resources in contention (capital); and the dominant, naturalized discourse governing what is considered legitimate within the field (doxa).
"By analyzing the movement as a social field in which NGOs, networks, and the state compete for power and legitimacy to define legitimate activism, I sought to capture the field's symbolic and internal dynamics and its interaction with changes in external environments," she says.
A bit of history
Achcar explains that in the 1980s, leaders such as the sociologist Betinho and the writer and former guerrilla fighter Herbert Daniel (among others) developed a radical, intellectualized, deeply political form of activism. They framed AIDS as an issue of democracy and social justice. This movement originated in the middle class and formed strategic alliances with the public health movement.
However, starting in the 1990s, HIV began to spread among more vulnerable populations with lower levels of education and income. New participants joined the movement with urgent demands for food, housing, and access to basic services. These demands shifted priorities and fragmented the political culture that had been built in previous decades.
"The thesis I advocate, inspired by Bourdieu, is that we all develop a kind of mental framework over the course of our lives [what Bourdieu calls 'habitus']. This habitus shapes our actions and the way we see the world. It isn't individual but shared by social groups. When the AIDS epidemic began to affect people with a habitus associated with more disadvantaged classes, the political debate within the movement shifted as well, and basic issues such as access to food, housing, and income became central," Achcar explains.
Starting in the 2010s, the medicalization of AIDS policies gained momentum. "The 'end of AIDS' narrative reduced the disease to a biomedical issue and masked the structural inequalities that many policies and the movement sought to address," states the researcher.
The study points out that the response to HIV was progressively absorbed by a neoliberal logic that prioritizes rapid biomedical solutions, technical management, and measurable results. "Historically politicized NGOs were pressured to professionalize in order to raise funds, becoming service providers and losing part of their activist capital," she says.
Another significant change in the external landscape occurred in the late 2000s when Brazil ceased to be a priority for international donors, and when domestic budget cuts reduced opportunities for social participation. "The promise of an end to AIDS through a supposed magic formula reinforced the idea that the epidemic would be resolved solely through medication, downplaying debates about structural inequalities," the researcher continues.
Activists interviewed by Achcar describe the current movement as weak and unable to fight as it once did. "Tensions between long-standing NGOs and new identity-based networks have deepened the fragmentation. The former universalist identity that mobilized activism as a whole has given way to disputes over legitimacy and scarce resources," she says.
She concludes, "This study shows that the future of Brazil's response to HIV depends on the ability to rebuild alliances, restore the movement's political character, and address the inequalities that continue to fuel the epidemic."
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