Decentralization of care for people living with HIV in Brazil

Bruno Raphael da Silva Feitosa, Camila Rodrigues Barbosa Nemer, Rubens Alex de Oliveira Menezes, Marlucilena Pinheiro da Silva.

Abstract

The decentralization of care for people living with HIV in Brazil represents a significant advance in public health policy, gradually transferring HIV management to Primary Health Care (PHC) since the 2000s. This strategy aims to improve infection control indicators, strengthening the care network with efficient management, professional training, and a greater supply of health actions. However, implementation faces challenges, such as the increase in cases in medium-sized municipalities, especially in the North and Northeast regions, where the supply of HIV-related services is limited. In 2020, approximately 29,000 new cases of AIDS were diagnosed and 10,417 deaths were recorded, with a greater impact on vulnerable groups, such as gays, bisexuals, homosexuals, and transgender women. Decentralization faces weaknesses, such as professionals' insecurity in communicating diagnostics and social prejudice, which hinder health actions. Furthermore, the lack of prenatal prophylaxis and treatment actions contributes to the maintenance of high rates of vertical transmission, placing Brazil behind other middle-income countries. This article aims to review the scientific literature on the decentralization of care for people living with HIV/AIDS in Brazil.