Civil society perspectives on tuberculosis care for people living with HIV in Brazil: A study informed by Social Representations Theory

Abstract

In Brazil, tuberculosis–human immunodeficiency virus (TB–HIV) coinfection remains a major public health challenge despite advances in antiretroviral therapy and tuberculosis preventive treatment (TPT) Civil society has historically contributed to HIV responses, but little is known about how it perceives TB care for people living with HIV (PLHIV). This study examined how organized civil society perceives and represents TB care for PLHIV. We conducted a qualitative study guided by Social Representations Theory, with five focus groups involving 37 representatives from civil society organizations in five Brazilian state capitals in 2025. Three thematic categories were identified: (1) social and institutional neglect of TB, evidenced by the absence of campaigns, delayed diagnosis, and shortages of medications in some localities; (2) stigma, poverty, and social exclusion in the context of coinfection, in which TB–HIV coinfection was described as a factor that exacerbates these phenomena; and (3) civil society and non-governmental organizations (NGOs) as mediators of care, which act as a bridge between socially vulnerable populations and health services. Participants acknowledged that persistent barriers to TB care are further intensified by the presence of HIV. This study advances current knowledge by explicitly framing civil society not only as a mediator, but as a co-producer of TB–HIV care, particularly in contexts of social vulnerability.