AIDS and primary care (editorial)

With the spread of the AIDS epidemic in Spain the number of patients hospitalized with complications of AIDS and the number of HIV-seropositive persons obtaining periodic outpatient care from hospitals have both increased. Several years often intervene between seroconversion and the time when a seropositive patient will almost surely require hospitalization. Primary care fills important roles in the control of most illnesses. Primary care offers the advantages of trained staff the continuity of care required in chronic and progressive diseases coordination between different specializations and attention to psychosocial needs. Primary level services will undoubtedly play a larger role in care of HIV-positive patients in the future. At present HIV-positive patients consult primary care centers for bureaucratic reasons for minor illnesses or infections and to obtain detoxification services. The present role of primary care centers is limited by their inability to offer diagnostic procedures such as CD4 assessment or to dispense certain needed drugs. Apart from offering detoxification services primary care centers have other potential contributions to make in the area of AIDS prevention and control. They can provide health education to the general population and to high risk groups and early management of HIV-infected patients including prescription of antiretroviral drugs and primary prophylaxis of opportunistic infections. They can care for patients requiring medical services but not sick enough for hospitalization. A close relationship to referral hospitals is required initially to train health teams in the care of seropositive patients and subsequently to develop protocols for joint action and coordination of patient follow-up. A significant collaborative effort will be required from health professionals at the primary level and in hospitals to prepare primary care facilities to assume the major role in the care of the HIV-infected population that they will almost inevitably be called upon to carry out.