O diagnóstico anti-HIV no município do Rio de Janeiro: processos dos cuidados em saúde.

Abstract

The magnitude and the changes resulting from the AIDS epidemic in Brazil led the Ministry of Health to recommend in 2001 the incorporation of serological diagnosis of HIV infection in primary care services of public health, aiming at increasing the universality andthe population's access to these exams. The diagnostic process in the case of AIDS, involves beyond the simple availability of testing, but also covering the demands of prevention, prophylaxis, treatment and appropriate referrals into the care system. The study aimed at investigating how the offer of this diagnosis has been going on, expected to be done together with pre-and post-test counseling, using as a locus a set of services the primary care network in the municipality of Rio de Janeiro. The descriptive-analytic work applied a qualitative methodological approach, conducting semi-structured interviews with twenty-two health professionals from various categories involved in the process of HIV testing, and three managers, seeking to understand how this health care is being offered. Examination of material obtained allowed the identification of the following analytical categories: supply test in primary care network and dilemmas related to this process, counseling actions that accompany testing, results of HIV testing and difficulties in their communication to users; structural and organizational dimensions and management of the testing process; and training of human resources. It was found that the process of offering the HIV test is often limited to the representation of the disease and a need for greater dialogue on the relationship of health professional/user, considering the intersubjectivity of the subjects involved. This diagnostic process demands techniques such as support, welcoming and qualified hearing of the health needs, understood beyond the biological complaints of the subjects that are not always present in the care services investigated. As a pressing challenge in the provision of HIV diagnosis, it is emphasized that counseling should be a tool used and reinforced in the context of health services that treat patients with STD/AIDS. Another challenge, besides the training of qualified human resources involved, is the need for ongoing evaluation of the offer process that has been performed in the basic health services, enabling to rethink the activities of prevention, care and the listening, as well as the sharing of ideas among professionals working daily in the health units and the local managers. The plurality of questions into healthcare requires that health services and their leaders promote new arrangements for the provision of HIV testing, as a health action, be carried out based on the humanization, and in full respect for the civil rights, contributing to the improvement of care in health centers and to its quality.