HIV/AIDS management at the primary care level in Brazil: A challenge for the unified health system?

Abstract

In Brazil, the Unified Health System (SUS) consists of a hierarchical and regionalized network of health services coordinated from the primary health care (PHC) level, which is also the entry point into the system. Recently, as a result of new guidelines and experiences in Brazil, PCH has been assigned a more substantial role in the care and management of people living with HIV/AIDS, tasks traditionally performed at specialized clinics. The present article contextualizes and explores the problems involved in this recent process of providing decentralized care to people living with HIV/AIDS in the context of the SUS. Since 2011, new diagnostic technologies (such as rapid testing) have become available at PHC units in Brazil, expanding access to testing and leading to an increase in the number of HIV diagnoses performed at the PHC level. Since 2013, new guidelines and recommendations have also supported care for people with HIV/AIDS in PHC units. The present article examines the relationship between PHC and specialized care, issues of access, stigma, and confidentiality in PHC, and the mode of organization and functioning of family health teams, especially the formal link between residents in catchment areas and health teams and workers. In conclusion, many challenges-moral, ethical, technical, organizational, and political-have to be faced in order to increase access and quality of care in the context of PHC for people living with HIV/AIDS in Brazil.