[The sexuality of HIV-positive adolescents: rights and challenges for healthcare]. / A sexualidade de adolescentes vivendo com HIV: direitos e desafios para o cuidado.

Sexuality and reproductive healthcare represent relevant issues for comprehensive care of HIV-positive adolescents. However, public policies and health services give this issue insufficient attention. The scope of this article is to assess how HIV-positive young people and teenagers cope with their sexuality, dating and the urge to have children and start a family. In a qualitative study, in-depth interviews were staged with 21 HIV-positive (contracted by vertical, sexual or intravenous transmission) teenagers and 13 caregivers of children and youths living in Sao Paulo and Santos. The interviews revealed the different ways teenagers cope with their sexuality and with the anxiety of HIV disclosure in this context. Lack of information about HIV prevention, lack of support and skills to cope with their sexuality were revealed in the reports. Furthermore, stigma and discrimination were the most frequently reported difficulties. The main challenges to be faced in Brazil in regard to this issue are discussed, especially the need to consider HIV-positive youth as entitled to sexual rights. Recommendations are also made for incorporating the issue into a humanized and comprehensive care approach for HIV-positive children and young people.

A sexualidade de adolescentes vivendo com HIV: direitos e desafios para o cuidado / The sexuality of HIV-positive adolescents: rights and challenges for healthcare

Sexualidade e saúde reprodutiva configuram questões relevantes para o cuidado integral à saúde de pessoas vivendo com HIV. Políticas públicas e serviços de saúde, entretanto, têm dedicado insuficiente atenção ao assunto. O objetivo deste trabalho é compreender como adolescentes e jovens soropositivos lidam com suas experiências sexuais e projetos de namoro, desejo de constituir família e de ter filhos. O estudo qualitativo entrevistou em profundidade 21 adolescentes vivendo com HIV (por transmissão vertical, sexual ou sanguínea) e 13 cuidadores de crianças e jovens, vivendo em São Paulo e em Santos, Brasil. As narrativas descrevem como aprenderam a lidar com a sexualidade e a ansiedade da revelação do diagnóstico nesse contexto. Destacam-se nas narrativas o despreparo, a desinformação sobre prevenção e a falta de apoio para lidar com a situação, assim como o estigma e a discriminação que atravessa grande parte das dificuldades relatadas. O artigo discute criticamente alguns dos desafios postos para uma adequada atenção à questão no Brasil, especialmente a consideração de jovens soropositivos como sujeitos de direitos sexuais, sugerindo diretrizes para a incorporação desta temática a um cuidado integral e humanizado de crianças e jovens vivendo com HIV.

Sexuality and reproductive healthcare represent relevant issues for comprehensive care of HIV-positive adolescents. However, public policies and health services give this issue insufficient attention. The scope of this article is to assess how HIV-positive young people and teenagers cope with their sexuality, dating and the urge to have children and start a family. In a qualitative study, in-depth interviews were staged with 21 HIV-positive (contracted by vertical, sexual or intravenous transmission) teenagers and 13 caregivers of children and youths living in Sao Paulo and Santos. The interviews revealed the different ways teenagers cope with their sexuality and with the anxiety of HIV disclosure in this context. Lack of information about HIV prevention, lack of support and skills to cope with their sexuality were revealed in the reports. Furthermore, stigma and discrimination were the most frequently reported difficulties. The main challenges to be faced in Brazil in regard to this issue are discussed, especially the need to consider HIV-positive youth as entitled to sexual rights. Recommendations are also made for incorporating the issue into a humanized and comprehensive care approach for HIV-positive children and young people.

[Disclosure of HIV infection from the perspective of adolescents living with HIV/AIDS and their parents and caregivers]. / A revelação do diagnóstico na perspectiva dos adolescentes vivendo com HIV/AIDS e seus pais e cuidadores.

The purpose of this study was to identify relevant issues in the disclosure of HIV-positive status in children and adolescents, aiming to improve the quality of their healthcare. A qualitative study included adolescents living with HIV/ AIDS and their parents and caregivers at AIDS reference services in São Paulo and Santos, Brazil. In-depth interviews and focus group were used. The main reasons for disclosure were: poor treatment adherence, sexual maturity, adolescent's request, and inadequate procedures by medical staff. Disclosure was a critical moment for adolescents, with a strong impact on their life plans and horizons. Adolescents infected through sexual transmission and drug use reported the most problematic scenes involved in disclosure. Despite its initial negative impact, disclosure resulted in improved healthcare and better dialogue among the adolescents, caregivers, and healthcare providers. The adolescents also requested clear, no-nonsense, honest information. The authors conclude that health services need to actively provide an adequate approach to facilitate disclosure of HIV-positive status to children and adolescents, realizing that it is a long-term process supported by the family and a multidisciplinary team.

A revelacão do diagnóstico na perspectiva dos adolescentes vivendo com HIV/AIDS e seus pais e cuidadores / Disclosure of HIV infection from the perspective of adolescents living with HIV/AIDS and their parents and caregivers

O objetivo deste estudo foi identificar aspectos da revelacão do diagnóstico da infeccão pelo HIV a criancas e adolescentes relevantes para a melhoria do cuidado de sua saúde. Trata-se de estudo qualitativo envolvendo entrevistas em profundidade e grupo focal com adolescentes vivendo com HIV/AIDS e seus pais ou cuidadores, em servicos de referência nas cidades de São Paulo e Santos, Brasil. Os resultados apontam como principais razões para a revelacão: má adesão ao tratamento, iminência de início da vida sexual, demanda da crianca ou adolescente e abordagem inadequada de profissional. A revelacão mostrou-se momento crítico, com repercussões sobre projetos e horizontes de vida dos adolescentes. As mais problemáticas foram narradas por adolescentes infectados por via sexual e por uso de drogas. Apesar do impacto negativo inicial, a revelacão repercutiu positivamente sobre os cuidados de saúde, com melhoria do diálogo com cuidadores e servicos. Os adolescentes enfatizaram ainda a necessidade de receber informacões claras e honestas. Conclui-se pela necessidade de otimizar o processo de revelacão, tratando-o como tarefa de longo prazo, negociada ativamente com a família e conduzida por equipes multidisciplinares.

Vulnerability, human rights, and comprehensive health care needs of young people living with HIV/AIDS.

We sought to identify and understand the health care needs of young people living with HIV/AIDS, particularly in terms of their psychosocial well-being. We conducted a qualitative analysis of HIV-positive young people and their caregivers, focusing on the implications of an HIV diagnosis for health care needs. Stigma was a recurrent issue that arose in the interviews conducted with the respondents, and it was evident that youths had been denied many rights related to health. We concluded that young people living with HIV need comprehensive care based on a human rights approach. In this regard, we offer some practical recommendations for health programs.

[Sexuality of women living with HIV/AIDS in São Paulo]. / Sexualidade de mulheres vivendo com HIV/AIDS em São Paulo.

The social and cultural setting which increases female vulnerability to HIV does not disappear when women living with HIV/AIDS discover that they are infected. Following diagnosis, new challenges arise in their emotional lives, an issue which has received little attention in the literature. This study interviewed 1068 women living with HIV/AIDS using a questionnaire consisting of both open and closed questions, aimed at describing aspects of their sexual and reproductive lives and how they perceive counseling at Reference Centers in two cities in the State of São Paulo, where they have access to free antiretroviral therapy. Of the women with stable sexual partners, 63% used condoms in all their sexual relations, or three times the national average; 43% of the partners were HIV-negative and 14% had unknown serological status; 73% of the women had children and 15% were considering becoming pregnant. Knowledge on mother-to-child transmission was less than expected, and the interviewees complained of limited space and receptiveness for discussing sexuality, especially with regard to their childbearing wishes. Counseling on sexuality should be a continuing process and requires interdisciplinary training for the professional team working in health care services, with an emphasis on sexual and reproductive rights.

Sexualidade de mulheres vivendo com HIV/AIDS em Säo Paulo / Sexuality of women living with HIV/AIDS in Säo Paulo

O contexto sócio-cultural que aumenta a vulnerabilidade feminina ao HIV näo desaparece quando as mulheres vivendo com HIV/AIDS (MVA) se descobrem infectadas. Diagnosticadas, novos desafios väo aparecer na sua vida afetiva, poucos descritos na literatura. Foram entrevistadas 1.068 MVA com a utilizaçäo de um questionário composto de questöes abertas e fechadas, visando descrever aspectos da sua vida sexual e reprodutiva e como elas percebem o aconselhamento nessa área, quando säo atendidas em Centros de Referência, em duas cidades de Säo Paulo onde têm acesso gratuito aos medicamentos anti-retrovirais. Das mulheres que têm parceiro sexual estável, 63 por cento usam camisinha em todas as relaçöes sexuais, o triplo da média nacional; 43 por cento dos parceiros säo HIV negativos, 14 por cento têm sorologia desconhecida; 73 por cento têm filhos e 15 por cento pensam em tê-los. O conhecimento sobre transmissäo materno-infantil é menor do que o esperado, e as entrevistadas referem pouco espaço e acolhimento para discutir sexualidade, em especial suas intençöes reprodutivas. O aconselhamento sobre sexualidade deve ser um processo contínuo no atendimento e requer o treinamento interdisciplinar dos profissionais atuando em serviços de saúde, com ênfase nos direitos sexuais e reprodutivos

[Vulnerability to HIV and AIDS of short route truck drivers, Brazil]. / Caminhoneiros de rota curta e sua vulnerabilidade ao HIV, Santos, SP.

OBJECTIVE: To describe the vulnerability to sexually transmitted HIV/AIDS of short distance truck drivers. METHODS: Using a snowball sampling procedure, 279 truck drivers working in the port area and vicinities, unions and workers' associations of Santos, Brazil, were selected and interviewed. Face-to-face interviews were carried out using open and closed questions covered demographic characteristics, sexual practices, drug use, knowledge of HIV and AIDS, previous contact with HIV prevention programs, and perception of their vulnerability to HIV and Aids. A descriptive analysis was carried out and reports are presented to illustrate some scenarios of vulnerability. RESULTS: Of all 279 truck drivers interviewed, 93% had a stable female partner, 40% engaged in casual sexual with female partners, and 19% said to have sex with other regular partners. Vulnerability to HIV is increased by inconsistent condom use in all categories of sexual partners. Long periods away from home seem not to be the only factor for their vulnerability to HIV as seen in studies on long distance truck drivers. CONCLUSIONS: The macho culture and traditional male behaviors are prominently seen among truck drivers. There is a need of investing more on prevention in this professional group. Prevention programs at the work environment seem to be a promising strategy, since it allows a better understanding of the workers' setting and development of customized educational interventions.

Caminhoneiros de rota curta e sua vulnerabilidade ao HIV, Santos, SP / Vulnerability to HIV and AIDS of short distance truck drivers stationed, Brazil

OBJETIVO: Descrever a vulnerabilidade, de caminhoneiros de rota curta, à transmissäo sexual do HIV e da Aids. MÉTODOS: Foram entrevistados 279 caminhoneiros com vínculo de trabalho na cidade de Santos, SP, em locais de concentraçäo na área portuária e suas proximidades, sindicatos e associaçöes, recrutados pela amostragem do tipo "bola-de-neve". Foram realizadas entrevistas utilizando perguntas abertas e fechadas sobre questöes sociodemográficas, práticas sexuais, uso de drogas, conhecimento sobre o HIV e a Aids, contato prévio com programas de prevençäo à Aids em Santos, percepçäo de sua vulnerabilidade ao HIV e à Aids. Foi realizada análise descritiva da amostra, e apresentados relatos para ilustrar algumas situaçöes de vulnerabilidade. RESULTADOS: Do total de 279 caminhoneiros entrevistados, 93 por cento declararam ter parceira fixa, 40 por cento referiram manter relaçöes sexuais com parceiras casuais, e 19 por cento referiram manter relaçöes sexuais com parceiras freqüentes. A principal situaçäo de vulnerabilidade ao HIV ocorre devido ao uso inconsistente do preservativo, interligado ao vínculo estabelecido com cada parceira. O tempo fora de casa parece näo ser o principal fator para situaçöes de vulnerabilidade, conforme demonstram estudos com caminhoneiros de rota longa. CONCLUSOES: A cultura "machista" e os papéis tradicionais masculinos säo emblemáticos entre os caminhoneiros de rota curta. Certamente é necessário investir mais na prevençäo nessa categoria profissional. A prevençäo em locais de trabalho parece promissora, pois permite entender melhor seu universo, propiciando intervençöes educativas adequadas a essa categoria profissional