XVIII International AIDS Conference


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The trajectory of AIDS in São Paulo: infectologists facing death and dying

E. Shimma1, M.C. Fantini Nogueira-Martins2, L.A. Nogueira-Martins3, M.H. Silva1, A.T. Viso4

1STD/AIDS Reference and Training Center, São Paulo Health Department, São Paulo, Brazil, 2Department of Health, Institute for Health of the State of São Paulo, São Paulo, Brazil, 3Federal University of São Paulo - UNIFESP, Department of Psychiatry, São Paulo, Brazil, 4Centro de Referência e Treinamento em DST/Aids, São Paulo, Brazil

Background: The first AIDS cases were diagnosed in Brazil in the city of São Paulo, in the early 1980's. In the São Paulo State, were reported 179,403 cases with 91,113 deaths (1980-06/2009). This study has the objective of describing the experiences of infectologists facing death and dying of their AIDS patients, determine their perceptions and coping mechanisms used in the face of these situations, as well as the medical training received to deal with these issues.
Methods: Qualitative approach. The composition of the sample was held by the process of snowball, the sample size determined by the criterion of saturation. For the analysis of data was used thematic analysis procedure, which is to discover the meaning units in the pool of collected material related to the objective of the study. The study was approved by the Ethics Committee of the Federal University of Sao Paulo.
Results: Twenty interviews were conducted with infectologists who attend HIV / AIDS in São Paulo city. These content was organized into four themes:
  1. Experiences before the HAART era.
  2. Experiences after the HAART era.
  3. Ways to deal with death.
  4. Medical training and the theme of death and dying.
In the first phase of the epidemic, the professionals were confronted with much loss of patients, which were generated experiences of frustration, helplessness and depressive states. In the post HAART, the death of patients occurs after a long period of interaction producing feelings of sadness and frustration. The main defense mechanism reported was the rationalization. Discussions about death and dying were poorly discussed during medical education.
Conclusions: The study highlights the importance of considering, during training and in professional practice, suffering, emotional overload and defense mechanisms related to death and dying, to preserve the global health of physicians and the quality of care they provide to patients.

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