Representations of sexuality of the patients with mental illness: the importance of considering the social vulnerability on strategies for AIDS prevention
J.A.G. Barbosa1, R.C.A. Leite1, M.D.C. Guimarães2, M.I.F. Freitas1, GPEAS
1Universidade Federal de Minas Gerais, Enfermagem em Saúde Coletiva, Belo Horizonte, Brazil, 2Universidade Federal de Minas Gerais, Departamento de Medicina Preventiva e Social, Belo Horizonte, Brazil
Background: The prevention of AIDS is limited, in part, due to the lack of consideration given to the subjectivities involved in self-care. In face of high rates of AIDS found among patients with mental illness in Brazil, their ways of thinking and acting on sexuality were analysed in order to identify barriers to prevention.
Methods: Having as reference the Social Representations Theory, open interviews were carried out with 39 patients selected from mental health institutions in Brazil. Analysis was conducted by means of structural narrative method.
Results: There were 22 men and 17 women, aged between 18 and 72 years old. The population was characterized by low levels of education and income, low self-esteem, difficulties to maintain a marital relationship and social and family helplessness. One fourth of them were victims of sexual violence. In the sexual trajectory of males, there was a wider range of partners and of sexual practices. The female trajectory was characterized by heterosexual relationships with few partners and submission to male partners. Few of them used condom while AIDS knowledge was low. Representations on sexuality indicated gender asymmetry. For women, the sexual act was connected to affection, and they felt the obligation to please the male partners. AIDS prevention was seen in the establishment of one partner or abstinence. Males thhoughtof their sexuality regardless of their affection, and perceived their sexual performance as an identity factor. Male's sexuality was represented by both genders as more instinctive, which “authorized" multiple partners. The autonomy and skill to the self-care is low in this group.
Conclusions: The representations are influenced by gender roles, which contribute to risk behaviours, and these are necessary l when considering AIDS prevention strategies. Mental health patients may present higher social vulnerability against AIDS by social exclusion and prejudice, requiring larger public policy interventions.
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