Local Institutions and Resistance to test for HIV/AIDS. Some lessons of a survey in the city of Fortaleza, Brazil

In the field of the fight against the HIV / AIDS substantial resources have been used regularly both in all of Brazil to Fortaleza. All these means affected populations more numerous and demographic cohorts constantly renewed and sexually active. One would therefore expect that all of these initiatives have had the effect of making effective incentives for voluntary practice test. However quantitative and qualitative researches shows that if the number of tests performed has steadily increased over time, they raise the reluctance persists continuously as in the general population as well as than in the social categories considered vulnerable because most exposed than others to the risk of being affected by HIV / AIDS.The question suggested by this situation is to try to identify and characterize the factors that make intelligible the persistence of resistance to the voluntary practice test or, equivalently, to understand the limitations of the effectiveness of incentives to take the test. We question here especially the world of local institutions, public ones and those within the third sector, involved in the fight against HIV / AIDS. This institutional landscape, despite or because of its thickness and its complexity, presents a number of shortcomings, limitations, dysfunctions that tend to weaken the expected efficacy of the structures, reduce the universalizing objective of test campaigns, hinders the understanding of the information generated around this struggle by the people.\r\n\r\nThe survey results suggest that, in a context of individual and collective factors, maintaining these complex relationships, the local institutional apparatus, despite efforts to raise the level of participation in HIV testing, contributes to a climate of uncertainty and lack of knowledge about the existence and importance of the test. The overall incentive system in practice has not achieved the desired effectiveness. And the persistence of vulnerabilities and the survival of reluctance and resistance to HIV meet involuntary allies in the actual functioning of local institutions.