[Care for persons living with HIV in primary health care: reconfigurations of the healthcare network?]

The study analyzes the recent experience with decentralization of care for persons living with HIV in primary health care (PHC) in Rio de Janeiro, Brazil. The study is backed by a qualitative survey in PHC units in a region of the city of Rio de Janeiro, based on participant observation, focus groups with healthcare workers, and individual interviews with the latter and with patients in 2018 and 2019. The data show (although with uneven distribution) the advanced implementation of rapid tests and expansion of the number of persons followed by the services, besides problems and innovations in the forms of access to PHC, aspects in the management of confidentiality, and the central role of family and community physicians in the care. Based on the above, we problematize paradoxes related to the notion of territory operated in PHC (meanwhile expanding access and vulnerabilities associated with the risk of stigma) as well as tensions between patients' needs and modes of the services' organization. We conclude that care for persons living with HIV can serve both to analyze PHC (studying its practices and foundations) and as a device for change (through organizational rearrangements and patient care practices), but without ignoring the possibility of guaranteeing comprehensive care solely through PHC or the challenges in this process, not only technical, but also political, organizational, ethical, and moral.