Acesso ao cuidado integral: percepções de pessoas vivendo com HIV em contextos de vulnerabilidade social

Abstract

Introduction: Care for people living with HIV (PLHIV) within the Brazilian Unified Health System (SUS) involves multiple points of the Health Care Network, linking diagnosis, treatment, and follow-up. At the global level, strategies such as the UNAIDS 95-95-95 targets, together with timely initiation of antiretroviral therapy (ART) and the concept of undetectable = untransmittable (U=U), reinforce the role of treatment in controlling the epidemic. In Brazil, the response to HIV has been marked by expanded access to ART and the organization of specialized services, in dialogue with social movements. In the municipality of Santos (São Paulo, Brazil), the epidemic gained particular historical relevance in the 1980s and 1990s, prompting institutional and community responses that contributed to the consolidation of a care network. Inequalities in access persist, especially in contexts of greater social vulnerability, where living conditions and social position affect the possibilities of diagnosis, treatment, and continuity of care. Objective: To understand how people living with HIV in contexts of greater social vulnerability perceive access to comprehensive health care, identifying their needs, demands, perceptions, and expectations regarding health services. Methods: This qualitative, interpretive study was based on narratives of care experiences and was part of the “Babado Certo!” investigation, a community-based participatory study. In-depth, semi-structured interviews were conducted with 15 PLHIV recruited from a specialized service, a non-governmental organization, and through peer recruitment in Santos, Brazil. Data were collected between December 2025 and April 2026. Interviews were transcribed, anonymized, and analyzed using Content Analysis, following Bardin, with support from MAXQDA software. Interpretation was guided by Ayres’ Care framework. Results: Health needs took on different meanings throughout participants’ trajectories. Clinical control of HIV and adherence to ART emerged as central dimensions, coexisting with needs related to mental health, autonomy, social support, and material living conditions. Treatment trajectories included immediate, delayed, or irregular initiation of ART, as well as interruptions and resumptions associated with different living conditions and experiences. Homelessness, economic difficulties, transportation barriers, and fragile support networks affected the possibilities of continuity of care. Experiences also differed according to the period of diagnosis and treatment, including needs related to aging with HIV. Specialized services remained an important reference for HIV care, whereas experiences with Primary Health Care were heterogeneous and related to geographic proximity, trust, confidentiality, previous experiences, and the perceived ability of services to respond to needs. Welcoming practices, bonds with professionals, social support, and peer relationships contributed to sustaining care. Conclusion: Access to comprehensive care for PLHIV in contexts of social vulnerability is related to the articulation between health needs, living conditions, and care experiences. The availability of treatment and services is fundamental, but their incorporation and continuity in everyday life also depend on the concrete conditions under which people live and receive care. Articulating technical success in controlling HIV infection with the relational dimensions of care and the heterogeneity of experiences may contribute to broader responses to the needs of PLHIV.