Jan 21st 2023

An Analysis of TB/HIV Policies in Brazil, Mozambique, and Portugal


Original Research by Mariana de Sousa Valdivino

According to the WHO, Brazil and Mozambique are on the list of high-burden countries for TB and TB/HIV. Although this burden cannot be compared, Portugal ranks third with Europe’s highest proportion of TB/HIV. Besides sharing this tendency, the countries have a historical past together, where Portugal was Brazil’s and Mozambique’s colonizer until 1822 and 1975, respectively. Additionally, they all share the Portuguese language.

A biomedical approach characterizes the TB field. However, this tendency is changing, and more social researchers are being recognized. This study analyses TB and TB/HIV policies in the countries mentioned above, focusing on gender, stigma, and social inequities. A critical discourse analysis was conducted to answer the main research question ‘How are stigma, gender, and social inequity conceptualized and addressed in national tuberculosis and TB/HIV policies?’. Three policies for each country were selected based on inclusion criteria and then analyzed with a heuristic framework comprising three approaches, Bacchi’s, Intersectionality-Based Policy Analysis, and the Health Equity Framework.

The results showed how gender was never clearly defined, but all the policies addressed it based on a binary perspective, only focusing on women when pregnancy or HIV was being discussed. Social inequities were the most common and cited topic, with most policies recognizing their role in TB and TB/HIV problematization, even if just superficially. Lastly, despite the global efforts to address it, stigma was an underrepresented topic, and stigmatizing language was the norm in policies from Portugal and Mozambique.

These results were consistent with the existing literature, and they provide new evidence of the differences and similarities that exist between the literature and the policies being produced in the TB field in these three countries. Ultimately, these results should be taken into consideration when creating new policies, so they can be better attuned to a social science perspective. Yet they should also be considered for academia – as a departure for further discursive analysis in TB and TB/HIV policy.

This project contributed to Mariana’s Master in Global Health degree at Maastricht University, The Netherlands. Mariana plans to continue working in social sciences research and is contemplating a PhD.

Geographies Brazil Mozambique Portugal

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