What the United States can learn from Brazil in response to HIV/AIDS: international reputation and strategic centralization in a context of health policy devolution.

Contrary to what many may expect, this article argues that Brazil did a better job than the USA when it came to responding to HIV/AIDS. Because of the Brazilian government's concern about its international reputation and the partnerships it has forged with international donors and civil society, the government has been committed to strengthening decentralization processes by introducing both formal and informal re-centralization measures that strengthen health policy devolution, while effectively targeting the biggest at-risk groups. The US, in contrast, has not achieved these objectives, due to its lack of interest in increasing its international reputation and its focus on bi-lateral aid rather than investing in domestic policy. The paper closes by explaining the lessons that Brazil can teach the US and other large federations seeking to ensure that decentralization and prevention policy work more effectively.