Caring for People Living with HIV/Aids in Primary Health Care: a new agenda for facing vulnerabilities?

Abstract

The expansion of the role of Primary Health Care (PHC) in the treatment of people living with HIV/AIDS (PLWHA) has the potential to expand access to health care. This article aim to analyze the implications of the decentralization of services for PLWHA to PHC and its impact on the (re)production or reduction of vulnerabilities. The concepts of symbolic violence; intersectionality; precariousness and vulnerabilities guided the entry into the field and the analysis of the results. This study involved participant observation, focus groups with professionals and semi-structured interviews with users and professionals from two primary health care units of the city of Rio de Janeiro. The results highlight the implications of vulnerabilities associated with armed violence and gender issues in the health care, the presence of paradoxical effects of territorial logic, as well as tensions between the organization of work processes in PHC and the needs and expectations. Advances in the expansion of access coexist with the production of new risks for the continuity and quality of care. We underscore the need to strengthen worker-user interactions and to reconsider new arrangements for the organization of work processes that may result in more protection and care than in the expansion of vulnerabilities.