Family medicine, primary health care and HIV medicine — a ‘new’ clinical speciality and its role in the South African HIV pandemic

Abstract

Context: Because of the extent of the HIV pandemic, but also due to some specific historical conditions, HIV medicine has evolved as a field of its own in South African medicine. With the massive scale of the roll-out of antiretroviral drugs (ARVs) in South Africa, the need to devolve ARV roll-out into primary health care (PHC) services is currently being discussed. Family medicine was recognised in South Africa as a specialist qualification in August 2007 and is still undergoing an exciting process of defining its content and future role in the community of medical specialities. The South African approach to family medicine focuses strongly on the role of the family physician in the PHC setting at district hospitals and in PHC facilities within the South African district health framework.

Objectives: The objectives of this article are to discuss the relation between family medicine and the field of HIV medicine.

Key message: Family medicine in the South African context is the clinical discipline most suitable to house HIV medicine. The projected future of the ARV roll-out parallels the structures necessary for the care of (other) chronic conditions in the PHC setting, and the clinical governance for this health care delivery lies in the hands of family medicine. Thus HIV medicine should be regarded and developed as part of family medicine.

Conclusion: For the future development of family medicine, it is a natural and necessary step to incorporate HIV care. The field of HIV care as a professional area will benefit from being part of a recognised clinical speciality. Training for the treatment of HIV/AIDS will have to be included as an integral part of the registrar programme in family medicine.