TY - JOUR
T1 - The search for social validation and the sexual behavior of people living with HIV in Rio de Janeiro, Brazil
T2 - Understanding the role of treatment optimism in context
AU - Kerrigan, Deanna
AU - Bastos, Francisco I.
AU - Malta, Monica
AU - Carneiro-Da-Cunha, Claudia
AU - Pilotto, J. H.
AU - Strathdee, Steffanie A.
N1 - Funding Information:
The authors would like to thank all of the study participants who gave generously of their time and of themselves to benefit others. We would like to thank all of the clinic staff at the three public health centers, the Hospital Geral de Nova Iguacu, the Ambulatorio da Providencia and the Instituto de Pesquisas Evandro Chagas, where we conducted this research including Rosa Maria Pinheiro Rezende, Monica Fortuna, and Maria Ines Linhares de Carvalho. We would also like to thank our funding sources including the Johns Hopkins University Center for AIDS Research (CFAR), Grant P30 AI42855, and the National Institute of Mental Health, Grant K01 MH3491.
PY - 2006/5
Y1 - 2006/5
N2 - The primary aim of this qualitative study was to explore the influence of HIV treatment optimism on the sexual behavior of people living with HIV/AIDS (PLWHA) receiving highly active anti-retroviral therapy (HAART) at public health clinics in Rio de Janeiro, Brazil. We also explored the psycho-social dynamics of participants' sexual relationships in order to understand more broadly how these factors influence the sexual behavior of PLWHA and how they shape HAART-related beliefs. Twenty-three semi-structured, in-depth interviews were conducted with three groups: heterosexual women, heterosexual men and men who have sex with men living with HIV who reported being sexually active in the last year and were currently receiving HAART. We found that the availability of HAART was conceptualized as a rationale for unsafe sex among a minority of study participants and that this was more common among men than among women. Specific examples of treatment optimism appeared to be employed as a means to avoid acknowledging how deeper psychosocial issues may have been influencing participant's sexual behavior. Most participants' sexual behavior appeared largely to be a product of their desire for social validation and linked to feelings of shame and denial, including but not limited to HIV. Participants from all three groups expressed a considerable amount of fear and/or anxiety regarding behaviors such as disclosure and condom use as a result of the unexplored conflict between implementing these behaviors and continuing with their strategies for social validation within the context of their sexual relationships. We conclude that short-term information, education and communication interventions surrounding treatment optimism, disclosure and condom use are appropriate and necessary; but that they are not sufficient to address the core challenges to unsafe sex among PLHWA. These deep-rooted psychosocial issues may be better addressed by longer-term individual and group-level opportunities for exploration and critical reflection regarding sense of self and its relationship to social solidarity among PLWHA.
AB - The primary aim of this qualitative study was to explore the influence of HIV treatment optimism on the sexual behavior of people living with HIV/AIDS (PLWHA) receiving highly active anti-retroviral therapy (HAART) at public health clinics in Rio de Janeiro, Brazil. We also explored the psycho-social dynamics of participants' sexual relationships in order to understand more broadly how these factors influence the sexual behavior of PLWHA and how they shape HAART-related beliefs. Twenty-three semi-structured, in-depth interviews were conducted with three groups: heterosexual women, heterosexual men and men who have sex with men living with HIV who reported being sexually active in the last year and were currently receiving HAART. We found that the availability of HAART was conceptualized as a rationale for unsafe sex among a minority of study participants and that this was more common among men than among women. Specific examples of treatment optimism appeared to be employed as a means to avoid acknowledging how deeper psychosocial issues may have been influencing participant's sexual behavior. Most participants' sexual behavior appeared largely to be a product of their desire for social validation and linked to feelings of shame and denial, including but not limited to HIV. Participants from all three groups expressed a considerable amount of fear and/or anxiety regarding behaviors such as disclosure and condom use as a result of the unexplored conflict between implementing these behaviors and continuing with their strategies for social validation within the context of their sexual relationships. We conclude that short-term information, education and communication interventions surrounding treatment optimism, disclosure and condom use are appropriate and necessary; but that they are not sufficient to address the core challenges to unsafe sex among PLHWA. These deep-rooted psychosocial issues may be better addressed by longer-term individual and group-level opportunities for exploration and critical reflection regarding sense of self and its relationship to social solidarity among PLWHA.
KW - Brazil
KW - HAART
KW - HIV/AIDS
KW - Sexual behavior
KW - Treatment optimism
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U2 - 10.1016/j.socscimed.2005.10.037
DO - 10.1016/j.socscimed.2005.10.037
M3 - Article
C2 - 16310301
AN - SCOPUS:33645064821
VL - 62
SP - 2386
EP - 2396
JO - Ethics in Science and Medicine
JF - Ethics in Science and Medicine
SN - 0277-9536
IS - 10
ER -