This research note assesses participatory health governance practices for HIV and AIDS in Brazil. By extension, we also evaluate municipal democratic governance to public health outcomes. We draw from a unique dataset on municipal HIV/AIDS prevalence and participatory health governance from 2006–17 for all 5,570 Brazilian municipalities. We use negative binomial regression and coarsened exact matching with treatment effects to estimate the influence of community health governance institutions on HIV/AIDS prevalence. Municipalities with participatory health councils experience 14% lower HIV/AIDS prevalence than other municipalities, all else equal. Family Health Program coverage, municipal state capacity, and municipal per capita health spending are also associated with systematically lower HIV/AIDS prevalence. We conclude that participatory health governance may combat HIV and AIDS through municipal spending, education, and community mobilization. Municipal health councils can facilitate these strategies and offer opportunities for improving well-being around the world.

This research note contributes updated and extended point estimates of the ideological positions of Brazilian political parties and novel estimates of the positions of all presidents since redemocratization in 1985. Presidents and parties are jointly responsible for the operability of Brazil’s version of coalitional presidentialism. Locating these key political actors in a unidimensional left–right space over time reveals rising challenges to the institutional matrix, particularly since 2013. Ideological polarization among parties has sharply increased, presidents have become more distant from Congress, and the political center has become increasingly vacated. Coalitional presidentialism is being subjected to unprecedented ideological stress as President Luiz Inácio Lula da Silva begins his third term in office.