Troche Gutierrez Ingrid Yolercy
Facultad de Ciencias de la Salud; Universidad Surcolombiana. Neiva. Colombia.
Rev Esp Salud Publica. 2024 Mar 11;98:e202403018.
Health policies and programs for people living with HIV have been subordinated to current economic policies based on the neoliberal development model that shapes the current healthcare system. The study's objective was to analyze the influence of the Colombian health system on the care of people who lived with HIV enrolled in the Subsidized Regime through Benefit Plan Administrating Entities and treated in Neiva (Colombia).
A qualitative study framed within the framework of the Critical Discourse Analysis was conducted. Nineteen people participated, including HIV patients, non-formal caregivers, and health workers. The participants were recruited from two Health Service Providers Institutions in the city of Neiva. In-depth interviews were conducted. Data were coded, categorized and organized in Excel for analysis.
The interpersonal relationship and the health system functioning were two phenomena that interfered with caring for people with HIV by favoring or imposing barriers to practices. Failures were found in the informative-educational process from the moment of diagnosis, stigmatization, and discrimination, particularly in non-HIV-specialized health institutions, and multiple barriers to access to health services. 55.5% of the patients expressed having been discriminated against by health personnel at some point since their diagnosis. 100% of the patients interviewed identified different types of barriers to health services, contextualized in improper treatment, untimely care and abuse of power; only 22.2% resorted to the filing of complaints, petition rights or guardianships to claim their right to health.
Health care praxis is carried out regardless of patients' situation, forgetting that those from a lower socioeconomic level have greater structural vulnerability related to poverty. The lack of healthcare exacerbates health inequalities.
针对艾滋病毒感染者的卫生政策和项目已从属于基于新自由主义发展模式的现行经济政策，而这种模式塑造了当前的医疗体系。本研究的目的是分析哥伦比亚卫生系统对通过福利计划管理实体加入补贴制度并在哥伦比亚内瓦接受治疗的艾滋病毒感染者护理工作的影响。
开展了一项以批判性话语分析框架为背景的定性研究。19人参与其中，包括艾滋病毒患者、非正规护理人员和卫生工作者。参与者从内瓦市的两家卫生服务提供机构招募。进行了深入访谈。数据在Excel中进行编码、分类和整理以进行分析。
人际关系和卫生系统运作是两种通过对实践行为给予支持或设置障碍来干扰艾滋病毒感染者护理工作的现象。从诊断之时起，在信息教育过程、污名化和歧视方面发现存在不足，尤其是在非艾滋病毒专科医疗机构，并且在获得卫生服务方面存在多重障碍。55.5%的患者表示自诊断以来曾在某个时候受到卫生人员的歧视。100%接受访谈的患者指出了卫生服务存在的不同类型障碍，具体表现为治疗不当、护理不及时和权力滥用；只有22.2%的患者诉诸投诉、申诉权利或监护以主张其健康权。
医疗实践不顾患者的情况而开展，忽视了社会经济水平较低者因贫困而在结构上更易受伤害这一事实。医疗保健的缺失加剧了健康不平等。
