Representações sociais do HIV em adolescentes e jovens

Abstract

BACKGROUND: The age group comprising adolescents and young people has shown, in the last decade, a worrying increase in the number of new HIV cases, while in the other age groups this number has been decreased or stabilized and an it was noticed an increase in HIV infection rates in young men, especially among men who have sex with men (MSM). The Theory of Social Representations shows that, even today, the diagnosis of HIV infection is laden with stigma and discrimination associated with promiscuous relationships and homophobia. These social representations compromise the acceptance of the diagnosis and the attachment to the treatment. Diagnostic communication is an important factor in this process of linking young people to antiretroviral therapy (ART) and care. Public policies to combat the HIV epidemic in Brazil are strongly linked to new strategies for preventing HIV transmission, through the Combined Prevention method, with the use of (ART), which seeks immunological success with the viral suppression. This research is justified due to the growth in the number of cases of HIV infection among young people and adolescents, which refers to the importance of deepening knowledge about issues that go beyond clinical interventions of programs aimed at AJVHIV, as subjective and emotional issues go hand in hand with the biomedical advances to combat HIV transmission. AIM: To understand the social representations of HIV in adolescents and young people. METHODOLOGICAL PROCEDURES: Qualitative study with in-depth semi-structured interviews that were carried out in the city of São Paulo-SP, from October 2019 to February 2020, as part of a qualitative investigation inserted in the context of the PrEP 15-19 study. Adolescents and young men aged between 18 and 20 were invited to participate in the research. The development of the analytical-interpretative process was carried out from extensive and meticulous readings of the transcripts and, from this material, particularities emerged that guided the construction of the categories of analysis, allowing for a deeper understanding of the social representations of the HIV diagnosis, by the young people who tested positive, understanding the psychological, social and cultural factors in which they are immersed, in the conceptual light of discourse analysis (DA). RESULTS: Five young people aged between 18 and 20 years old, living in the city of São Paulo, were interviewed. Affective and welcoming diagnostic communication was associated with a reduction in feelings of abandonment and rejection and were analyzed as a facilitating factor for the young person's attachment to care and ART. The stigmas and discrimination suffered when young people came out as homosexual were revived when they discovered the positive result for HIV. This moment was accompanied by fear of rejection and judgment by family members, colleagues and teachers. Young people perceived the diagnosis as more stigmatizing than their homosexual orientation, which is why disclosing the HIV diagnosis to their acquaintances had a greater weight than revealing their sexual orientation did for them. The way they found was to keep the diagnosis a secret, as self-protection. The reduction in self-esteem was presented as a barrier to job search and involvement in new romantic relationships. Access to information about HIV, such as forms of prevention and access to ART were seen as facilitators for accepting the diagnosis and strengthening autonomy for care. The relationship between the diagnosis of the infection and mental health was mentioned when young people reported changes in their behavior, depressive or anxious symptoms after learning about the diagnosis. Young people referred to the importance of psychotherapy to address this issue and other aspects of life, because, for them, their lives are not restricted to the diagnosis of HIV. The early initiation of sexual relations, in some cases from the age of 10, reveals the fragility of the care of children and adolescents by the family, school and society in general. The use of alcohol and other drugs was analyzed as a barrier to preventing transmission of the virus. Care for quality of life, through healthy eating, exercise, search for spirituality and reports of plans for the future, indicated the presence of facilitating movements for the acceptance and continuity of ART. DISCUSSION: The discussion of the results is presented in three parts. In the first part, we present the social representations of HIV in the diagnostic experience of adolescents and young people and draw a parallel with studies carried out in other parts of the world. In the second part, we present a reflection on the stigma, secrecy and feelings present in the knowledge of the HIV diagnosis and the difficulties and suffering reported by the adolescents and young people in our study, as well as the approximations with studies from other countries. The third part is a reflection on the attachment to care, the barriers and facilitators for starting and continuing treatment. CONCLUSION: Understanding the social representations of HIV in adolescents and young people includes stigmas linked to promiscuity and death, which were incorporated by common sense and are associated with the beginning of the epidemic, in the 1980s and 1990s. Information and knowledge of new forms of prevention can reduce existing barriers to acceptance and continuity of treatment, as successful treatment can be understood as preventing HIV transmission. The creation of public policies and investments in actions that expand the possibilities and perspectives for the future of young people must consider the school universe, as a space for dialogue, acceptance and reflection, which can act as a facilitator for the linking of adolescents and young people living with HIV with their physical and mental care and increase their responsibility to society by understanding the success of treatment as prevention of HIV transmission.