The role of the primary care physician

Increased emphasis on community-based care of people with human immunodeficiency virus (HIV) infection and AIDS is recommended by the National HIV/AIDS Strategy. Patients prefer to be treated within their community, and primary care reduces the demand on scarce, costly, and already overloaded hospital facilities. Thus, there is an increasingly large role for primary care physicians to play in the management of people infected with HIV. The traditional primary health care approach of health promotion and disease prevention that focuses on case-finding, continuity of care and problem resolution, adapts well to HIV/AIDS. Primary care is holistic, patient based, and has as its focus healing rather than cure. Primary care physicians have a role in the prevention of HIV infection, in identifying asymptomatic seropositive people, in offering early therapeutic interventions, in the early detection of opportunistic infections and HIV-related malignancies, and in the ongoing management of chronic ill-health. For most people, the primary care sphere is the appropriate level for palliative and terminal care. There is also a role for primary care physicians in the psychosocial management of people with HIV/AIDS in supporting those close to the patient, and in educating the community in general about the social parameters of HIV/AIDS.