RESEARCH ARTICLES
Knowledge and awareness of vulnerability to HIV / AIDS among students of a private university
Anderson Pinto da SilvaI; Paulo Roberto Ferreira MachadoII; Elizabeth Rose da Costa MartinsIII; Cristiane Maria Amorim CostaIV; Raphaela Nunes AlvesV; Raquel Conceição de Almeida RamosV
INurse. Graduated from Veiga de Almeida University. Rio de Janeiro, Brasil. E-mail: anderson@gmail.com
IINurse. Public Health specialist. Basic Health Unit Management, National School of Public Health. MBA in Healthcare Management. Rio de Janeiro, Brazil. E-mail: prfm@gmail.com
IIINurse. Doctorate in Nursing. Assistant Professor of Nursing Faculty of State University of Rio de Janeiro. Brazil. E-mail: oigresrose@uol.com.br
IVNurse. Doctoral candidate in Nursing. Assistant Professor of Nursing Faculty of State University of Rio de Janeiro. Section Chief of the Urology ward of Pedro Ernesto University Hospital. Rio de Janeiro, Brazil. E-mail: cristiane.costa@ig.com.br
VNurse. Doctoral candidate in Health and Society Psychoanalysis. Assistant Professor of Nursing Faculty of Veiga e Almeida University. Rio de Janeiro, Brazil. E-mail: rvelemem@hotmail.com
VINurse. Postgraduate in Surgical and Intensive Care Nursing. Contracted professor of Nursing faculty of State University of Rio de Janeiro. Men's Health Care Program nurse in Piquet Carneiro Polyclinic. Rio de Janeiro, Brazil. E-mail: raquel_rcar@msn.com
ABSTRACT: This study aimed at identifying the level of knowledge and awareness of vulnerability to Human Immunodeficiency Virus / Acquired Immunodeficiency Syndrome (HIV / AIDS) and adherence to anti-HIV testing among college students. It is a descriptive quantitative approach piece of research, conducted at a private university in the city of Rio de Janeiro, RJ, Brazil. Subjects totaled 160 students, regularly enrolled in healthcare courses in the first term of 2013. Data were collected through a questionnaire and treated on the basis of statistical analysis. Results show that the majority understands preventive measures and ways of HIV transmission, goes through Anti-HIV testing regularly, and has partial awareness of the optimal time for testing after exposure, despite misconceptions identified. It is necessary to broaden the debate on the subject, in face of the responsibility of those professionals-to-be.
Keywords: HIV; students, health occupations; knowledge; AIDS serodiagnosis.
INTRODUCTION
This is a study with the object of the meanings of prevention and vulnerability of the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) for students of health courses at a University.
Despite having recently completed three decades of pandemic, health officials from around the world have faced great challenges, because the current epidemiological profile of the disease, can still find alarming numbers with significant increase of people with this virus (HIV +).
It is estimated that about 33 million people are living with HIV worldwide. Globally only in 2009, 2.6 million people were infected with HIV and 2 million died as a result of AIDS, mostly because of inadequate access to treatment services and attention1.
From 1980 to June 2011, in Brazil, 608,230 cases of AIDS have been reported. In 2010 were notified 34,218 new cases, with national incidence rate of 17.9/100,000 inhabitants and sex ratio of 1.7 new cases in men to each case in women2.
HIV can be transmitted by blood, vaginal secretions, semen and breast milk. Currently, the sexually is the main form of transmission in the country, especially the heterosexual exposure among men and women, with respective percentages of 43.4% and 96.3%. It is evidenced, also, the involvement of age groups in reproductive age, mostly between 20 and 49 years3.
With the course of the epidemic evolution, new knowledge were incorporated on the transmission of HIV and the notion of risk group was modified to the focus of risky behavior. Remaining so for a certain time, coming most recently adopted the conception that values the possibility of exposure to infected person sexual adjustment occurs by intrauterine route (pregnant/fetus, this is vertical transmission) or in cases of non-consensual sex (rape).
The integrality, subjectivity and understanding the various contexts of vulnerabilities are fundamental elements for the risk reduction approach. The vulnerability is the set of factors of biological nature, epidemiological, social, cultural, political and economic whose interaction enlarges or reduces the risk or damage protection. Three main dimensions of vulnerability should be considered: individual, related to the behaviors adopted by the individual; social, regarding the impact of social and economic factors; and institutional, which refers to the absence of public policies4.
Based on this and other concepts that put the individual as the center line of care at different levels of attention, in which health is understood as quality of life and not just as the absence of disease, and that their reach is promotion and education in health, arises the concern: before the phenomenon transmissibility of HIV/AIDS, is the university oriented for self-care?
To answer this quest, the following objectives were defined: Identifying the level of knowledge and awareness of vulnerabilities to HIV/AIDS among university students; and verify if they perform the anti-HIV test, analyzing their reasons for doing. This study aims to contribute to the formulation of public policies for the control of HIV, because it is necessary to control, systematically, the current information and risk perception of the population.
To get the conditions that affect the individual vulnerability, it is possible to rethink, at all levels, education and prevention strategies of HIV/AIDS. The information on the meaning and implications of the anti-HIV test to day by day are just as important as the test. The construction of knowledge about HIV/AIDS is not restricted to informative issues, it also involves the individual perception of the problem, this is the understanding and the ability to assimilate this information, which allows asserting that self-care and advice are interconnected practices.
Health education, to prevent diseases and diseases in human beings, potentiates the reduction of costs among the various contexts of assistance and encourages the promotion of self-care and the development of patient responsibility on decisions related to their health5.
LITERATURE REVIEW
The Brazilian public policies for the prevention and control of HIV/AIDS are recognized by various international entities as a reference for other countries because impacted considerably in reducing infection in groups that were considered vulnerable, such as sex workers, homosexuals and intravenous drug users. Include strategies on three pillars, namely: epidemiological surveillance, prevention and assistance. Can highlight the HIV test, licensed in 1985; the compulsory notification established in 1986; the serological screening in blood banks, obligatory throughout the country, starting in 1988, diagnostic support, such as counseling and testing centers (CTA) created between 1987-1988, then designated serological guidance and support centers (COAS) for free, confidential and anonymous HIV testing; the law 9313/96 that ensures universal access to anti-retroviral therapy (TARV) high activity against HIV, causing it to fall into the 50% mortality by disease, growing at 12 times the survival rate of patients from 5 to 58 months2-4. The ministerial decree No. 2104 of 11/18/2012 establishing the project was born to avoid vertical transmission6. In addition to the investment in the disease, a large focus on prevention and care in the distribution of male and female condoms7-9.
The National STD/AIDS Program (PN-DST/AIDS) have demonstrated their concern with ethical issues related to the provision of HIV test, citizenship and respect to the human person, noting that the ethical pillars of Testing and Counseling Centers (CTA), ensure the gratuity of the services, user privacy and professional time and willingness to dialogue, creating ties and ensuring the confidentiality of the information8.
Health units specializing in HIV test need to be organized and prepared to act warmly. Health teams that engaged in this practice, given the process of stigmatization and discrimination involved, must have sufficient competence to create bond with the user, acting to ensure citizenship and respect for the human person, through the actions that compose the essential objectives of counseling. As a precautionary measure early diagnosis search offer integral health clinical care that allow the reduction of morbidity and mortality and so reduce the vertical transmission, parenteral and sexual by the smallest circulation of HIV from the reduction of viral load9.
The trace of infection begins with a test called Elisa, conclusive method, which for being cheap and very sensitive, allows a conclusive diagnosis as a result no reagent for HIV, there is no need for further testing by other methods. In the reagents or inconclusive results, as conduct, it adopted a new immunoassay-immunofluorescence, imunoblot or wester blot – different from the first in its antigenic constitution or methodological principle as confirmatory tests10.
METHODOLOGY
This is a study, conducted among healthcare university students, about knowledge and prevention measures and control for HIV/AIDS.
It was held a descriptive and an area study, with a quantitative approach. The descriptive research has as primal objective the description of the characteristics of a particular population or phenomena or the establishment of relationship between the variables. As for the area research, carrying out the observation of facts and phenomena as they occur in reality, to the collection of the data and, finally, the analysis and interpretation of such findings, based on a consistent theoretical foundation, in order to understand and explain the problem researched11.
On quantitative approach, the phenomena are analyzed according to the variables of study and application of statistical analysis11.
The survey was conducted at a University located in the municipality of Rio de Janeiro, during the period from July 2012 to July 2013 after approval by the Research Ethics Committee (CEP) under opinion number 13436013.2.0000.5291. The sample gathered 160 university students, regularly enrolled in the first half of 2013, in courses in the health areas (60 of nursing, 20 of odontology, 30 of physiotherapy, 20 of biology, 20 of speech therapy and 10 of psychology) morning hours, afternoon and night, of both sexes, aged between 18 and 49 years old, who have had free will to participate in the survey by signing an Free Informed Consent (TCLE), with a guarantee of no risk in this activity.
As being a research that involves humans, were observed the ethical aspects governed by Resolution No. 466/2012 National Health Council12, ensuring the participants the exemption of any cost related to the study, confidentiality regarding the information provided, anonymity, included in the mentioned TCLE.
The data were collected, after approval, by a questionnaire containing variables about the profile of the subject of the search and nine objective questions about HIV prevention and control.
For analysis, the data were subjected to statistical analysis, with absolute frequency calculations and percentage and discussion of relevant findings, interpreted in the light of relevant literature. The results of this study were discussed in the light of the relevant literature1-10,13-19.
RESULTS AND DISCUSSION
Can be checked the socio-demographic profile of interviewed individuals, in Table 1. The subjects of research covering 160 subjects with age range predominantly of 18 to 24 years-old (43.13%), being prevalent female (76.25%); as to sexual orientation, the majority of respondents (95.62%) considers heterosexual.
AQUI DEVERÁ ENTRAR A TABELA 1
The participants’ knowledge, with regard to the forms of transmission and prevention of HIV and the ideal place to test is listed in Table 2. As to the transmission form, were available 10 options. Most of the subjects understand that HIV can be transmitted by sexual routes, to the baby through the infected mother, by contact with infected blood and by the sharing of syringes. On the prevention forms, most (96.88%) correctly understands that the condom is the most effective way to prevent HIV transmission.
When asked about the ideal place to test anti-HIV, the majority (75%) correctly indicated the health post, followed by the CTA (17.5%).
Aqui deverá entrar a Tabela 2
The understanding of the subject in relation to the vulnerability to HIV/AIDS is exposed in table 3. When asked about testing for HIV, the majority (51.87%) answered that at some point in life already held.
In addition, was asked the reason of respondents to perform the test anti-HIV. Among the subjects who achieved, 32.5% say they do it periodically, 19.2% during the prevention campaigns, 18% during the prenatal period, 12% for sexually related without condom and 3.6% for observe prenup. Among the subjects who scored the other option, were related to the following justifications: pre-and postoperative period; work accident; admission exams and blood donation.
On the optimal time to perform the test for anti-HIV after risk exposure, predominated (24.38%) 7 days option, followed by reply immediately, both incorrect options. Only 25% pointed to the correct term-of 30 to 60 days.
As regards the reasons for the anti-HIV test, 64% of respondents replied that support disease prevention, 63.75% consider that can improve the life quality, and no one mentioned the early detection of HIV.
AQUI DEVERÀ ENTRAR A TABELA 3
The subjects of the study participants, for a total of 160 (100%) university students of the six academic courses of the health area of a private University in Rio de Janeiro, in their majority, are female, being the prevalent age range of 18 to 24 years and orientation is heterosexual.
In Brazil, the rate of prevalence of HIV infection in young people, presents increase trend. Since the beginning of the epidemic, the incidence rate of AIDS cases in young people from 15 to 24 years, has increased progressively, with 9.5/100,000 inhabitants2-4.
Although AIDS has firmed as a pandemic in men who have sex with men, changes in the epidemiological profile shows that the difference between the cases of HIV in female population is increasing in relation to the male population. In 1989, the ratio of sexes was about 6 AIDS cases in males for each female in case, in 2011, the relationship has become 1.7 in case of men for every 1.0 women2.
Despite the greater number of cases of the Brazilian population infected by HIV be heterosexual individuals, the epidemic is still concentrated in population groups whose behaviors expose them to a higher risk of HIV infection7,9,13-19.
As regards preventive measures used to prevent HIV infection, it is necessary to consider that the knowledge of preventive measures of infection should be a priority, when they are expected to decrease rates of incidence and prevalence of HIV. The media, through such campaigns propagated, is a great ally in this matter. The minority ignores preventive measures. Despite the current 4th decade of the pandemic, there are still individuals who are unaware or have uncertainty about the forms of transmission and prevention and have partial understanding of the immunological window and the importance of early detection of infection13-19.
Healthcare academics, as future professionals, have to be attentive to these information to promote self-care without excesses and decrease stigma about HIV in society18.
The HIV detection test is free, confidential and a citizen's right, but is not mandatory, being the individual received, through the professional link x client, with the guarantee of confidentiality of information8. On occasion, is aware of the importance of doing so, when will authorize such procedure. Testing should not be done indiscriminately and at all times, the advisable is that any person who has been through a risk situation, as do unprotected sex, take the examination.
Only the fourth part, in this study, pointed out correctly the term to perform the test. After HIV infection, the immune system takes about a month to produce sufficient amount of detectable antibodies for the test, period called biological or immunological window. Because of this, the ideal period for the test is 30 to 60 days14.
Early detection of HIV is critical to reducing the risks of transmission and emergence of other complications, both for the individual as for the partners. When knows that is infected, the individual should be advised to adopt prophylactic measures of infection monitoring and self-care to ensure quality of life.
The individual can perform the test on any primary health care unit, in CTAs, UPAs only perform the test when the client requires hospitalization and shows signs and symptoms suggestive of infection or opportunistic infections.
CONCLUSION
The social profile of the health university students surveyed area is characterized by most young female 18 to 30 years old and heterosexual orientation.
Regarding the vulnerability to HIV/AIDS, most know the preventative measures and reported to have performed the anti-HIV test at some point in life, however, only the fourth part pointed correctly the ideal timeframe to accomplish it-of 30 to 60 days (immunological window).
In relation to the reasons that led to the early detection of HIV/AIDS, the majority stressed the prevention of disease and improving the quality of life.
It emphasized the importance of continuity of studies on the subject, as was evidenced the need for greater investment in information and communication actions and reviewing the strategies that have been developed, focused on the ways of transmission and prevention of DST/AIDS, allowing the individual to recognize their vulnerabilities and risks to these harms arising from their behavior.
Because they are future health professionals, we need to broaden the dialogue to be identified knowledge and practices of persons and groups on the subject, allowing greater appropriation of knowledge for their own self-care and the safe guidance of clientele.
It must take into consideration some limitations of the study, due to the stigma and intimate issues that the topic still rises, which may have interfered in the responses. The limited sample prevents the generalization of the findings.
It is hoped that this study makes a rethink for the implementation of actions to take care, particularly with emphasis on educational practices in the teaching area, research and extension.
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