Care for people living with HIV in specialized care: an analysis in light of programmatic vulnerability.

Understand and analyze care experiences of people living with HIV (PLH) in specialized services, identifying facilitators and access barriers. Evaluative study, qualitative, carrying out 45 interviews with PLH, whose care is centered on specialty polyclinics. For thematic analysis, the framework of programmatic vulnerability was used in two dimensions: access to health services and comprehensiveness of care. Most participants were not linked to primary health care, although they were virally suppressed. Medical consultations, laboratory tests, individual preventive and educational actions were concentrated in the polyclinics. The referral for health care was assigned to the infectologist, without the involvement of a multidisciplinary team, although there was access to specialists via the internal referral flow at the polyclinics. Follow-up other health conditions was partial, due to the disarticulation between the points of care, depended on the use of private services. Although PLH found support for biomedical and relational demands in Polyclinics, the challenge of guaranteeing of integrated care remained. A model of shared care, co-responsibility, non-hierarchical, user-oriented, is suggested, with changes in the modus operandi of health care networks.