Vulnerabilidades presentes no percurso vivenciado pelos pacientes com HIV/AIDS em falha terapêutica

Abstract

RESUMOUm grande avanço no tratamento da AIDS deu-se com o surgimento da terapia antiretroviral. Entretanto, diversas vulnerabilidades podem estar presentes no percurso vivenciado pelos pacientes durante o tratamento. Objetivou-se analisar as vulnerabilidades dos pacientes com HIV/AIDS em falha terapêutica. Estudo qualitativo realizado com sete usuários com AIDS considerados em falha terapêutica, em uma Unidade de Serviço Ambulatorial Especializado em HIV/AIDS, em Fortaleza-CE. Para interpretação dos dados, utilizou-se uma técnica de análise de conteúdo. Nos discursos, percebeu-se que os depoentes enfrentavam confl itos na família e, no ambiente de trabalho, difi culdades de relacionamento com as pessoas e estigma. Observou-se que os pacientes haviam vivenciado diversas situações que os tornaram mais suscetíveis à infecção por HIV e ao adoecimento. Descritores: Síndrome de Imunodefi ciência Adquirida; Falha de Tratamento; Vulnerabilidade.ABSTRACT A major breakthrough in AIDS treatment occurred with the advent of antiretroviral therapy. However, several vulnerabilities may be present in the path experienced by patients during treatment. This study aimed to analyze the vulnerabilities of patients with HIV / AIDS in treatment failure. It is a qualitative study, involving seven users with AIDS considered in treatment failure in an Outpatient Service Unit on HIV / AIDS, in Fortaleza-CE. To interpret the data, it was used the technique of content analysis. In the speeches, it was realized that the deponents faced confl icts in the family and, diffi cult relationships with people and stigma at work. It was observed that patients had experienced various situations that made them more susceptible to HIV infection and illness. Key words: Acquired Immunodefi ciency Syndrome; Treatment Failure; Vulnerability. RESUMENUn gran avance en el tratamiento del SIDA se llevó a cabo con el advenimiento de la terapia antirretroviral. Sin embargo, numerosas vulnerabilidades pueden estar presentes en la ruta vivida por los pacientes durante el tratamiento. Este estudio tuvo como objetivo analizar las vulnerabilidades de los pacientes con VIH / SIDA en falla terapéutica. Estudio cualitativo en que fueran incluidos siete usuarios con el SIDA y en falla terapéutica, atendidos en una Unidad de Servicios Ambulatorios en VIH / SIDA, en Fortaleza-CE. Para interpretar los datos, se utilizó una técnica de análisis de contenido. Por medio de los discursos, verifi có-se que los pacientes enfrentaban confl ictos en la familia y, en el trabajo, relaciones difíciles con la gente y el estigma. Fue observado que los pacientes han experimentado muchas situaciones que les hizo más susceptibles a la infección por el VIH y la enfermedad.

Factors related to the perceived stigmatization of people living with HIV

“…In relation to the Stigma Scale, the highest mean distribution values of means and medians in the disclosure domain were similar to those of another study with adults living with HIV (10) , and one performed with young American adolescents and young adults recently diagnosed with HIV (15) , showing that seropositivity disclosure is still an important difficulty experienced by HIV positive people (4,9) marked by fear of non-acceptance, as well as feelings of guilt and shame (5,9) . In the analysis stratified by domain, we found that the age group between 40 and 49 years of age and previous hospitalization due to complications from HIV/AIDS contributed to stigmatization in the overall score, and for the "personalized stigma" and "negative self-image" domains.…”

“…Thus, because they are economically active, people can be confronted with the fear of not being socially accepted and let go from their jobs, as seropositivity is still a cause of high unemployment rates, and can be even higher than in the general population (4,11) ; or fear of becoming ill and unable to maintain their respective work activities, since work in addition to representing the source of income is also seen as a source of support in allowing the individual to feel economically active, in face of feeling socially disqualified (1,10) . Another persistent complaint is the difficulty of relating the disease and work due to the fear of negative attitudes from colleagues and employers with the disclosure of their diagnosis, which leads many people living with HIV who are economically active, to a feeling of self-devaluation and self-exclusion due to seropositivity (5) . The increase in stigma can also be linked to the fear of disrupting affective relationships (11)(12)14,16) .…”

“…A study carried out with adult women in the northeast of the country (15) highlighted how the discovery of HIV can change a person's life, disorganizing affective relationships. This leads many people to fear disclosure of the diagnosis to their spouses due to fear of abandonment (4)(5)12) . In disclosing HIV, there is also the fear of people's negative attitudes towards those living with HIV, since accusations of promiscuity, prostitution and even infidelity are associated with HIV which can lead people to social isolation through shame, fear and depression (12,(15)(16) .…”

“…A stigma is considered a defect or a label that defines others, diminishing them through negative stereotypes, discriminatory and prejudiced labels (1,(3)(4) . Thus, in addition to the clinical changes that HIV can bring to people's lives, the stigma can also cause serious social and psychological damage due to feelings of inferiority (1,(4)(5) , which significantly increase anxiety, loneliness, depression and the desire to die, reducing self-esteem and self-confidence, which lead to social and sexual isolation of people living with HIV (4,6) . It is estimated that 36.9 million people live with HIV worldwide (2) .…”

“…Despite epidemiological indicators pointing to a reduction in the number of cases of the disease in the country and in other regions, its stigma is still seen as a major barrier for infection control (6) . In fact, in addition to causing financial deficits due to the risk of employees being fired (4)(5) , the disease can also interfere with affective and social relationships due to feelings of guilt and shame which leads to the isolation of these individuals (1,(4)(5)9) , affecting adherence to clinical and antiretroviral follow-up by many HIV positive persons (1) . In view of the above and the need for understanding aspects related to stigmatization, the objective of this study was to analyze factors related to the perceived stigmatization of people living with HIV.…”