Boas práticas em saúde integral para travestis, transexuais e outras variabilidades de gênero/gêneros diversos: experiência do Ambulatório de Saúde Integral para Travestis e Transexuais (ASITT) do Centro de Referência e Treinamento DST/Aids-SP, Secretaria de Estado da Saúde de São Paulo / Good practices in integral health for travestis, transsexuals and other variabilities of gender/different genders: experience of the Health Outpatient Clinic for Travestis and Transsexuals (ASITT) of the STD/AIDS Reference and Training Center-SP, State Department of Health of Sao Paulo

O Centro de Referência e Treinamento DST/Aids-SP da Secretaria de Estado da Saúde de São Paulo, inaugurou, em junho de 2009, em suas dependências, o primeiro ambulatório voltado exclusivamente à saúde integral de travestis e transexuais do país, com ênfase no processo transexualizador do Sistema Único de Saúde (SUS) e nas necessidades dessa população. Este artigo tem por objetivo apresentar as modalidades assistenciais ofertadas no serviço, as demandas da população atendida no ambulatório, suas vulnerabilidades, fatores de risco e resiliência a que está submetida, assim como as considerações e os desafios no campo da política pública voltada à população trans para promover seu acesso à atenção em saúde de forma acolhedora, livre de preconceito, julgamentos morais e práticas discriminatórias.

Relato de casos em saúde sexual e reprodutiva e HIV/Aids em homens trans / Cases report on sexual and reproductive health and HIV/Aids among transgender men

O artigo relata e discute alguns casos recentes e desafiadores entre homens trans adolescentes e jovens atendidos no Centro de Referência e Treinamento DST/Aids (CRT DST/Aids) de São Paulo. O avanço em direitos e visibilidade de pessoas trans tem lhes propiciado novas possibilidades de existência social que, por sua vez, têm repercutido nos âmbitos de relacionamentos e sexualidade. Tais mudanças implicam em pelo menos duas responsabilidades para os profissionais de saúde: a possibilidade de gestação por pessoas transmasculinas e sua inserção em redes sexuais de alta circulação do HIV e de outras infecções sexualmente transmissíveis (IST). Os casos abordados são: 1. contracepção e profilaxia pré-exposição ao HIV (PrEP) para um adolescente trans pansexual se relacionando com uma mulher trans; 2. uma gestação não planejada e vulnerabilidade ao HIV e IST em um jovem homem trans gay se relacionando com um homem cis; 3. cervicite gonocócica recorrente em um jovem homem trans pansexual vivendo com HIV que se relaciona com uma mulher cis; 4. o processo de transição de gênero, social e médica, em um homem trans com aids que adquiriu o HIV por transmissão vertical; e 5. o planejamento pré-concepcional em um casal formado por homem trans e mulher trans. Os casos chamam a atenção para o fato de que três campos distintos da rede de saúde ­ saúde sexual, saúde reprodutiva e cuidados às pessoas vivendo com HIV/Aids ­ precisam se renovar e incluir as necessidades específicas de homens trans e pessoas transmasculinas em geral.

Qualidade de vida e nutrição em idosos participantes de centros de convivência / Quality of life and nutrition of elderly participants of living centers senior citizens / Calidad de vida y nutrición de ancianos participantes de centros comunitarios

O envelhecimento populacional é uma das maiores preocupações na área da saúde, exigindo políticas públicas adequadas para que o envelhecer aconteça de forma ativa. O objetivo deste estudo foi conhecer os idosos que frequentavam os Centros da Terceira Idade, quanto às características demográficas e nutricionais, à percepção da qualidade de vida e à satisfação com a saúde. Tratou-se de estudo transversal com características analíticas e descritivas, no qual foram incluídos 150 idosos. Como instrumentos foram utilizados: questionários sobre dados demográficos, Whoqol-bref e a Mini Avaliação Nutricional (MAN). A aplicação dos questionários foi realizada em Centros da Terceira Idade de São Caetano do Sul, São Paulo, no período de abril a julho de 2011. Para análise, os participantes foram divididos em dois grupos de acordo com o estado nutricional (EN): 125 (85,4%) no grupo nutrido (GN) e 22 (14,6%) no grupo em risco de desnutrição (GRN). Houve diferenças estatisticamente significativas entre os grupos (GN e GRN) quanto à satisfação com a energia diária, capacidade de locomoção e capacidade para o trabalho. Concluiu-se que a prática da atividade física e a alimentação adequada são fundamentais em qualquer etapa da vida para a preservação da integridade física, do equilíbrio psicológico e do relacionamento social.

Population aging is a major concern in healthcare, requiring appropriate public policies for the aging to happen actively. The aim of this study was to investigate seniors who attend Third Age Centers, regarding demographic and nutritional characteristics, quality of life perception and satisfaction with health. This was a cross-sectional study with annalistic and descriptive characteristics comprising 150 elderly. The instruments used were: demographic characteristics questionnaire, the Whoqol-bref and the Mini Nutritional Assessment. The questionnaires were applied from April 2011 to July 2011. For analyses, participants were divided into two groups according to their nutritional status (NS): 125 (85.4%) in the nourished group (NG) and 22 (14.6%) in the group at risk of malnutrition (GRN). There were statistically significant differences between the groups with respect to the satisfaction with daily power, ability to move and ability to work. In conclusion, the practice of physical activity and proper nutrition are essential at every stage of life to preservation of physical integrity, psychological well being and social connections.

El envejecimiento de la población es una de las principales preocupaciones en el área de la salud, lo que requiere políticas públicas adecuadas para que el envejecimiento ocurra de manera activa. El objetivo de este estudio fue conocer los ancianos que frecuentan a los centros de la tercera edad, en cuanto a las características demográficas y nutricionales, la percepción de la calidad de vida y la satisfacción con la salud. Se trató de un estudio transversal con características analíticas y descriptivas, en que se incluyeron 150 ancianos. Como instrumentos fueron utilizados: cuestionarios sobre datos demográficos, WHOQOL-BREF y la Mini Evaluación Nutricional. Los cuestionarios fueron aplicados en los Centros de la Tercera Edad de São Caetano do Sul, de abril a julio de 2011. Los participantes fueron divididos en dos grupos de acuerdo con el estado nutricional (EN): 125 (85,4%) en el grupo nutrido (GN) y 22 (14,6%) en el grupo en riesgo de desnutrición (GRN). Hubo diferencias estadísticamente significativas entre los grupos (NG y GRN) en cuanto a la satisfacción con la energía diaria, la capacidad de locomoción y la capacidad para el trabajo. Se concluyó que la práctica de actividad física y la nutrición adecuada son esenciales en todas las etapas de la vida para la preservación de la integridad física, del equilibrio psicológico físico y de las relaciones sociales.

Estratégias de educação em saúde para idosos: experiências e desafíos / Estrategias de educación en salud para ancianos: experiencias y desafíos / Health education strategies for older people: experiences and challenges

Esta é uma revisão integrativa que tem como objetivo avaliar a produção científica relacionada à educação em saúde para idosos no Brasil, entre 2007 a 2013. Como bases de busca se usaram a Biblioteca Virtual em Saúde - BVS, Redalyc e Scielo, a partir do cruzamento dos descritores: idoso e educação em saúde. Se levantou 14 artigos que responderam aos objetivos e, que após leitura se elucidou três categorias, a saber: Experiências em Educação em Saúde com Idosos, Experiências de Formação e Necessidades de Capacitação relacionadas à Educação em Saúde e Atividade Física como instrumento para Educação em Saúde para Idosos. Verifica-se que dentre as principais lacunas está à ampliação de estudos e experiências com abordagens didáticas mais amplas, a valorização de aspectos para além de doenças, bem como a importância da atividade física, mas também de questões como lazer, geração de renda, relações familiares, além de melhor capacitação de profissionais de saúde para lidar com ações de educação em saúde para idosos (AU)

Esta es una revisión integrativa que pretende evaluar las publicaciones científicas relacionadas con la educación de salud para ancianos en Brasil entre 2007-2013. Cómo bases de búsqueda de datos se utilizó la Biblioteca Virtual en Salud - BVS, Scielo, Redalyc y con los descriptores: educación en salud y anciano. Se evidenciaron 14 artículos que respondieron a los objetivos y, que después de leerlos se ha dilucidado tres categorías, a saber: experiencias en educación para la salud con personas mayores, experiencias de formación y necesidades de capacitación relativas con educación para la salud y la actividad física como una herramienta para la educación de salud para los ancianos. Las principales necesidades de investigación y experiencias son la ampliación de estudios y experiencias con enfoques didácticos más lejos, la apreciación de los aspectos más allá de enfermedades, así como la importancia de la actividad física, pero también temas como la generación de ingresos, el ocio, las relaciones familiares, además de mejor formación de los profesionales de salud para hacer frente a las acciones de educación en salud para ancianos (AU)

This is an integrative review which aims to assess the scientific literature related to health education for elderly in Brazil, between 2007 to 2013. How to search databases used the Virtual Health Library - VHL, Scielo, Redalyc and from the intersection of descriptors: aged and health education. Rose 14 articles that responded to the goals and, that after reading it he elucidated three categories, namely: Experiences in health education with elderly people, Experiences of training and capacity-building Needs related to health education and physical activity as a tool for health education for the elderly. It turns out that one of the main gaps are the extension of studies and experiences with didactic approaches further, the appreciation of aspects beyond diseases, as well as the importance of physical activity, but also issues such as leisure, income generation, family relationships, in addition to better training of health professionals to deal with health education activities for the elderly (AU)

Saúde mental, suporte familiar e adesão ao tratamento: associações no contexto HIV/Aids / Mental health, family support and treatment adherence: associations in the context of HIV/AIDS / Salud mental, soporte familiar y adhesión al tratamiento: asociaciones en el contexto VIH/Sida

A adesão dos pacientes ao tratamento antirretroviral tem sido um dos maiores desafios no contexto HIV/Aids. São muitos os fatores implicados, e este estudo buscou privilegiar os relativos à saúde mental e suporte familiar, investigando sua associação com a adesão. Para tanto, foram utilizados um questionário semiestruturado composto de informações sociodemográficas, clínicas e adesão, e os instrumentos Questionário de Saúde Geral de Goldberg (QSG) e Inventário de Percepção de Suporte Familiar (IPSF). A amostra foi composta por 73 pacientes com HIV/Aids, com idades entre 29 e 67 anos, em tratamento antirretroviral em um ambulatório de São Paulo. Os resultados apontaram índices significativos de adesão irregular aos antirretrovirais e de perfis sintomáticos para transtornos mentais nessa população. Foram encontradas correlações significativas entre adesão e o fator "desejo de morte" do QSG, e entre adesão e quase todos os fatores do IPSF, evidenciando a importância desses fatores na adesão ao tratamento.(AU)

The patient's adherence to the antiretroviral drug therapy has been one of the biggest challenges in the HIV/Aids context. Among the many implicated factors, this study sought to study the factors related to mental disorders and family support, investigating their association with the adhesion. For that matter, a semi-structured questionnaire composed by social-demographic, clinical and adherence information was applied. The Goldberg General Health Questionnaire (GHQ) and the Perceived Family Support Inventory (PFSI) were also used. The sample was composed by73 HIV/Aids patients in antiretroviral therapy, aged between 29 and 67 years old on health service in São Paulo. The results point at significant indicators of irregular adherence to the antiretroviral therapy and of symptomatic profiles of mental disorders in this population. A considerable correlation between adherence and the "death wish" factor of GHQ were found, and also between adherence and almost all the PFSI factors, demonstrating the importance of these factors in therapy adherence.(AU)

La adhesión de los pacientes al tratamiento antirretroviral es uno de los mayores desafíos en el contexto VIH/Sida. En este estudio han sido privilegiados e investigados los factores relativos a la salud mental y soporte familiar. Para esto, se aplicó un cuestionario semiestructurado compuesto por informaciones sociodemográficas, clínicas y de adhesión, y los instrumentos Cuestionario de Salud General de Goldberg (QSG) e Inventario de Percepción de Soporte Familiar (IPSF). La muestra estuvo compuesta por 73 pacientes con VIH/Sida, entre 29 y 67 años, en tratamiento antirretroviral en un ambulatorio de São Paulo. Los resultados mostraron indicios significativos de adhesión irregular a los antirretrovirales y de perfiles sintomáticos para trastornos mentales en esta población. Se encontraron correlaciones significativas entre adhesión y el factor "deseo de muerte" del QSG, y entre adhesión y prácticamente todos los factores del IPSF, mostrando la importancia de estos factores en la adhesión al tratamiento.(AU)

Saúde mental, suporte familiar e adesão ao tratamento: associações no contexto HIV/Aids / Mental health, family support and treatment adherence: associations in the context of HIV/AIDS / Salud mental, soporte familiar y adhesión al tratamiento: asociaciones en el contexto VIH/Sida

A adesão dos pacientes ao tratamento antirretroviral tem sido um dos maiores desafios no contexto HIV/Aids. São muitos os fatores implicados, e este estudo buscou privilegiar os relativos à saúde mental e suporte familiar, investigando sua associação com a adesão. Para tanto, foram utilizados um questionário semiestruturado composto de informações sociodemográficas, clínicas e adesão, e os instrumentos Questionário de Saúde Geral de Goldberg (QSG) e Inventário de Percepção de Suporte Familiar (IPSF). A amostra foi composta por 73 pacientes com HIV/Aids, com idades entre 29 e 67 anos, em tratamento antirretroviral em um ambulatório de São Paulo. Os resultados apontaram índices significativos de adesão irregular aos antirretrovirais e de perfis sintomáticos para transtornos mentais nessa população. Foram encontradas correlações significativas entre adesão e o fator "desejo de morte" do QSG, e entre adesão e quase todos os fatores do IPSF, evidenciando a importância desses fatores na adesão ao tratamento...

The patient's adherence to the antiretroviral drug therapy has been one of the biggest challenges in the HIV/Aids context. Among the many implicated factors, this study sought to study the factors related to mental disorders and family support, investigating their association with the adhesion. For that matter, a semi-structured questionnaire composed by social-demographic, clinical and adherence information was applied. The Goldberg General Health Questionnaire (GHQ) and the Perceived Family Support Inventory (PFSI) were also used. The sample was composed by73 HIV/Aids patients in antiretroviral therapy, aged between 29 and 67 years old on health service in São Paulo. The results point at significant indicators of irregular adherence to the antiretroviral therapy and of symptomatic profiles of mental disorders in this population. A considerable correlation between adherence and the "death wish" factor of GHQ were found, and also between adherence and almost all the PFSI factors, demonstrating the importance of these factors in therapy adherence...

La adhesión de los pacientes al tratamiento antirretroviral es uno de los mayores desafíos en el contexto VIH/Sida. En este estudio han sido privilegiados e investigados los factores relativos a la salud mental y soporte familiar. Para esto, se aplicó un cuestionario semiestructurado compuesto por informaciones sociodemográficas, clínicas y de adhesión, y los instrumentos Cuestionario de Salud General de Goldberg (QSG) e Inventario de Percepción de Soporte Familiar (IPSF). La muestra estuvo compuesta por 73 pacientes con VIH/Sida, entre 29 y 67 años, en tratamiento antirretroviral en un ambulatorio de São Paulo. Los resultados mostraron indicios significativos de adhesión irregular a los antirretrovirales y de perfiles sintomáticos para trastornos mentales en esta población. Se encontraron correlaciones significativas entre adhesión y el factor "deseo de muerte" del QSG, y entre adhesión y prácticamente todos los factores del IPSF, mostrando la importancia de estos factores en la adhesión al tratamiento...

Self-disclosure of HIV diagnosis to sexual partners by heterosexual and bisexual men: a challenge for HIV/AIDS care and prevention.

This study investigated the disclosure of HIV-positive serostatus to sexual partners by heterosexual and bisexual men, selected in centers for HIV/AIDS care. In 250 interviews, we investigated disclosure of serostatus to partners, correlating disclosure to characteristics of relationships. The focus group further explored barriers to maintenance/establishment of partnerships and their association with disclosure and condom use. Fear of rejection led to isolation and distress, thus hindering disclosure to current and new partners. Disclosure requires trust and was more frequent to steady partners, to partners who were HIV-positive themselves, to female partners, and by heterosexuals, occurring less frequently with commercial sex workers. Most interviewees reported consistent condom use. Unprotected sex was more frequent with seropositive partners. Suggestions to enhance comprehensive care for HIV-positive men included stigma management, group activities, and human rights-based approaches involving professional education in care for sexual health, disclosure, and care of "persons living with HIV".

Self-disclosure of HIV diagnosis to sexual partners by heterosexual and bisexual men: a challenge for HIV/AIDS care and prevention / A revelação da soropositividade por homens bissexuais e heterossexuais para parceiros sexuais: um desafio para o cuidado e a prevenção do HIV/AIDS

This study investigated the disclosure of HIV-positive serostatus to sexual partners by heterosexual and bisexual men, selected in centers for HIV/AIDS care. In 250 interviews, we investigated disclosure of serostatus to partners, correlating disclosure to characteristics of relationships. The focus group further explored barriers to maintenance/establishment of partnerships and their association with disclosure and condom use. Fear of rejection led to isolation and distress, thus hindering disclosure to current and new partners. Disclosure requires trust and was more frequent to steady partners, to partners who were HIV-positive themselves, to female partners, and by heterosexuals, occurring less frequently with commercial sex workers. Most interviewees reported consistent condom use. Unprotected sex was more frequent with seropositive partners. Suggestions to enhance comprehensive care for HIV-positive men included stigma management, group activities, and human rights-based approaches involving professional education in care for sexual health, disclosure, and care of "persons living with HIV".

Este estudo investigou a revelação da soropositividade para parceiro/as sexuais por homens, hetero e bissexuais, usuários de serviços especializados no cuidado ao HIV/AIDS. Por meio de 250 entrevistas individuais e grupo focal descrevemos a revelação segundo características das parcerias e discutimos as dificuldades para manter ou estabelecer novas relações afetivo-sexuais e com o sexo protegido. Observamos que o temor à rejeição provoca isolamento e sofrimento e dificultava a revelação para parceira/os atuais ou futuro/as. Revelar requer confiança e foi mais frequente para parceira/os fixa/os, para soropositiva/os, para mulheres, e menos frequente para parceiro/as pagos por "programa". Heterossexuais revelavam mais. A maioria usava preservativos consistentemente, embora menos frequentemente com parceiros soropositivos. Para melhorar o cuidado integral de homens soropositivos, sugere-se a "gestão do estigma", atividades em grupo e abordagens baseadas em direitos humanos que capacitem profissionais para o cuidado da vida sexual-afetiva, da revelação e ao apoio ao viver com HIV.

[Induced abortion in women of reproductive age living with and without HIV/Aids in Brazil]. / Aborto induzido entre mulheres em idade reprodutiva vivendo e não vivendo com HIV/aids no Brasil.

This study aimed to identify and compare the characteristics of women living (WLHA) and not living with HIV/AIDS (WNLHA) regarding the report of lifetime induced abortion. Data from 1,777 MVHA and 2,045 MNVHA were collected between November 2003 and December 2004 during a cross-sectional study carried out in 13 municipalities of Brazil. After adjustment for confounding variables, 13.3% of MVHA versus 11.0% of MNVHA reported induced abortion in their lifetime (p>0.05). In multivariate analysis, independent correlates of lifetime induced abortion for both groups were: age, with older women reporting greater proportions of reporting induced abortion, living in the North region of Brazil, age at sexual debut (up to 17 years old), having three or more lifetime sexual partners, having ever used drugs and self-reporting occurrence of sexually transmitted diseases. The results suggest that, in general, the characteristics of women who reported induced abortion in both groups were similar, and that the contexts associated to HIV infection and to reproductive practices and decisions among women might share similarities.

[Contexts of HIV vulnerability among Brazilian women]. / Contextos de vulnerabilidade para o HIV entre mulheres brasileiras.

This article aims to identify contexts of vulnerability related to HIV among Brazilian women. From November 2003 to December 2004, a cross-sectional study was conducted in 13 municipalities in the five Brazilian regions. The study included 1,777 women with a positive HIV diagnosis and 2,045 women attending public health care services. There were no significant differences between the two groups concerning number of sexual partners. However, HIV-positive women had a history of earlier sexual initiation and lower frequency of condom use. Higher proportions of HIV-positive women had used drugs, had a history of previous STDs, and had been victims of sexual violence some time in their life. The findings suggest the importance of considering strategies for HIV prevention focused on women's empowerment as a whole, and not focused only on their individual behaviors.

Contextos de vulnerabilidade para o HIV entre mulheres brasileiras / Contexts of HIV vulnerability among Brazilian women

Este artigo tem como objetivo identificar os contextos de vulnerabilidade para o HIV entre mulheres brasileiras. Entre novembro de 2003 a dezembro de 2004 foi realizado um estudo de corte transversal em 13 municípios distribuídos nas cinco regiões do país, incluindo, respectivamente, 1.777 mulheres com diagnóstico positivo para HIV e 2.045 mulheres usuárias de serviços públicos de atenção à saúde da mulher sem diagnóstico conhecido de soropositividade para o HIV. A comparação entre os dois grupos mostrou que as mulheres com diagnóstico de HIV/AIDS não apresentaram um número de parceiros significativamente diferente com relação às mulheres sem diagnóstico de HIV/AIDS. No entanto, as mulheres vivendo com HIV/AIDS apresentaram início da vida sexual mais precoce, menor aderência ao uso de preservativos, e uma maior proporção dessas mulheres relatou uso de drogas, ocorrência de DST e de violência sexual na vida. Tais resultados sugerem a importância de pensar em estratégias de prevenção voltadas para o fortalecimento das mulheres e não apenas focadas em seus comportamentos individuais.(AU)

This article aims to identify contexts of vulnerability related to HIV among Brazilian women. From November 2003 to December 2004, a cross-sectional study was conducted in 13 municipalities in the five Brazilian regions. The study included 1,777 women with a positive HIV diagnosis and 2,045 women attending public health care services. There were no significant differences between the two groups concerning number of sexual partners. However, HIV-positive women had a history of earlier sexual initiation and lower frequency of condom use. Higher proportions of HIV-positive women had used drugs, had a history of previous STDs, and had been victims of sexual violence some time in their life. The findings suggest the importance of considering strategies for HIV prevention focused on women's empowerment as a whole, and not focused only on their individual behaviors.(AU)

Contextos de vulnerabilidade para o HIV entre mulheres brasileiras / Contexts of HIV vulnerability among Brazilian women

Este artigo tem como objetivo identificar os contextos de vulnerabilidade para o HIV entre mulheres brasileiras. Entre novembro de 2003 a dezembro de 2004 foi realizado um estudo de corte transversal em 13 municípios distribuídos nas cinco regiões do país, incluindo, respectivamente, 1.777 mulheres com diagnóstico positivo para HIV e 2.045 mulheres usuárias de serviços públicos de atenção à saúde da mulher sem diagnóstico conhecido de soropositividade para o HIV. A comparação entre os dois grupos mostrou que as mulheres com diagnóstico de HIV/AIDS não apresentaram um número de parceiros significativamente diferente com relação às mulheres sem diagnóstico de HIV/AIDS. No entanto, as mulheres vivendo com HIV/AIDS apresentaram início da vida sexual mais precoce, menor aderência ao uso de preservativos, e uma maior proporção dessas mulheres relatou uso de drogas, ocorrência de DST e de violência sexual na vida. Tais resultados sugerem a importância de pensar em estratégias de prevenção voltadas para o fortalecimento das mulheres e não apenas focadas em seus comportamentos individuais.

This article aims to identify contexts of vulnerability related to HIV among Brazilian women. From November 2003 to December 2004, a cross-sectional study was conducted in 13 municipalities in the five Brazilian regions. The study included 1,777 women with a positive HIV diagnosis and 2,045 women attending public health care services. There were no significant differences between the two groups concerning number of sexual partners. However, HIV-positive women had a history of earlier sexual initiation and lower frequency of condom use. Higher proportions of HIV-positive women had used drugs, had a history of previous STDs, and had been victims of sexual violence some time in their life. The findings suggest the importance of considering strategies for HIV prevention focused on women's empowerment as a whole, and not focused only on their individual behaviors.

Desire to have children: gender and reproductive rights of men and women living with HIV: a challenge to health care in Brazil.

Links between HIV/AIDS care and reproductive health, including fertility options for people living with HIV (PLWH), have not been sufficiently addressed by health care providers. Moreover, few studies have addressed men in this regard. To describe attitudes toward parenthood and identify factors associated with desire to have children among men and women living with HIV a cross-sectional study involving a sample of 533 women and 206 men (bisexual and heterosexual) attending two reference sexually transmitted disease (STD)/AIDS centers in São Paulo, Brazil. Participants answered a standardized questionnaire. Desire to have children as the study outcome was compared between men and women and associated factors searched for in multivariable regression analysis. In contrast to previous studies conducted in developed countries, desire to have children in this sample was more frequent among men than among women and it was reported by 27.9% of participants (50.1% of men versus 19.2% of women). Women were more likely to anticipate doctors' strong opposition to PLWH getting pregnant and men reported lower information level about HIV/mother-to-child transmission (MTCT). Bisexual men were more likely to desire to have biologic children. Male gender, younger age, having no children, living with 1-2 children, and being in a heterosexual partnership were independently associated with desire to have children. Regardless of gender, the childless as well as the youngest should be regarded as groups to be particularly targeted by counseling, to be provided with objective information about reproductive rights and options. Further research is warranted to address the desire for children among strictly homosexual men.

Desire to Have Children: Gender and Reproductive Rights of Men and Women Living with HIV: A Challenge to Health Care in Brazil

Links between HIV/AIDS care and reproductive health, including fertility options for people living with HIV (PLWH), have not been sufficiently addressed by health care providers. Moreover, few studies have addressed men in this regard. To describe attitudes toward parenthoodand identify factors associated with desire to have children among men and women living with HIV a cross-sectional study involving a sample of 533 women and 206 men (bisexual and heterosexual) attending two reference sexually transmitted disease (STD)/AIDS centers in São Paulo, Brazil. Participants answered a standardized questionnaire. Desire to have children as the study outcome was compared between men and women and associatedfactors searched for in multivariable regression analysis. In contrast to previous studies conductedin developed countries, desire to have children in this sample was more frequent among men than among women and it was reported by 27.9% of participants (50.1% of menversus 19.2% of women). Women were more likely to anticipate doctors’ strong opposition to PLWH getting pregnant and men reported lower information level about HIV/mother-to-child tramsission (MTCT). Bisexual men were more likely to desire to have biologic children. Malegender, younger age, having no children, living with 1–2 children, and being in a heterosexual partnership were independently associated with desire to have children. Regardless of gender, the childless as well as the youngest should be regarded as groups to be particularlytargeted by counseling, to be provided with objective information about reproductive rights and options. Further research is warranted to address the desire for children among strictly homosexual men

Desire to Have Children: Gender and Reproductive Rights of Men and Women Living with HIV: A Challenge to Health Care in Brazil

Links between HIV/AIDS care and reproductive health, including fertility options for people living with HIV (PLWH), have not been sufficiently addressed by health care providers. Moreover, few studies have addressed men in this regard. To describe attitudes toward parenthoodand identify factors associated with desire to have children among men and women living with HIV a cross-sectional study involving a sample of 533 women and 206 men (bisexual and heterosexual) attending two reference sexually transmitted disease (STD)/AIDS centers in São Paulo, Brazil. Participants answered a standardized questionnaire. Desire to have children as the study outcome was compared between men and women and associatedfactors searched for in multivariable regression analysis. In contrast to previous studies conductedin developed countries, desire to have children in this sample was more frequent among men than among women and it was reported by 27.9% of participants (50.1% of menversus 19.2% of women). Women were more likely to anticipate doctors’ strong opposition to PLWH getting pregnant and men reported lower information level about HIV/mother-to-child tramsission (MTCT). Bisexual men were more likely to desire to have biologic children. Malegender, younger age, having no children, living with 1–2 children, and being in a heterosexual partnership were independently associated with desire to have children. Regardless of gender, the childless as well as the youngest should be regarded as groups to be particularlytargeted by counseling, to be provided with objective information about reproductive rights and options. Further research is warranted to address the desire for children among strictly homosexual men

Mães HIV positivo e a não-amamentação / HIV positive mothers and the not breastfeeding

OBJETIVOS: compreender o significado da experiência de não amamentar e as razões que levam as mães a seguirem tal recomendação. MÉTODOS: estudo qualitativo onde a fenomenologia social foi tomada como referencial teórico-metodológico. O grupo estudado consistiu em 17 mães de um ambulatório infantil. Algumas mães eram HIV positivo, algumas apresentavam um status de infecção não determinado. Utilizou-se o método de análise de conteúdo. RESULTADOS: entre as razões destacadas para não amamentar, foram identificados sentimentos de não se considerarem completas e valorizadas como mães. Vivenciar a não-amamentação implica na reestruturação da relação mães/bebê, traz preconceitos e discriminação. A não-amamentação é uma forma de impedir a infecção do bebê pelo HIV e uma forma de eximir-se de culpa, obtendo assim perdão da sociedade. CONCLUSÕES: os resultados mostram que "não amamentar" - conduta indentificada pelo enfaixamento dos seios - é considerado doloroso e punitivo. Envolve o desejo de manter sadio o bebê e, mais do que aspectos biológicos, implica em questões sociais, culturais e emocionais. Parecem indicar ainda falta de atenção dos profissionais da área da saúde ao sentimento das mães, quando essas enfrentam o dilema da não-amamentação.

OBJECTIVES: understand the implications of preventing mothers from breastfeeding and the reasons they follow recommendations not to breastfeed. METHODS: a qualitative method where social phenomenology was used as a theoretical and methodological reference. The group consisted of 17 mothers in an outpatient pediatrics clinic. Some of the mothers were HIV positive; some had a non determined infectuous status. The content analysis method was used. RESULTS: being prevented to breastfeed made mothers feel unfulfilled and belittled. Avoiding breastfeeding implies changing the mother and baby relationship. Prejudice and discrimination are present. Choosing not to breastfeed is a way to protect babies from HIV contamination avoiding guilt and winning Society's forgiveness. CONCLUSIONS: results indicate that "breastfeeding prohibition"- displayed by breasts in dressing - is considered painful and harsh. It involves the wish of maintaining the baby healthy based more on social, cultural and emotional issues than in biological ones. It seems to indicate that healthcare professionals ignore mothers' feelings when these mothers are faced with the problem of not being able to breastfeed.

The right to love: the desire for parenthood among men living with HIV.

Drug regimens and procedures now exist that will prevent parents from transmitting HIV to infants, and the ethical and legal obligation to promote and protect the reproductive rights of those living with HIV should form part of training for HIV/AIDS care and prevention. This paper reports a study that investigated issues of sexuality and reproduction with 250 Brazilian men living with HIV in São Paulo. We asked whether they wished to have children and whether health professionals in HIV/AIDS treatment clinics that they attended were supportive of their wishes. Health professionals were not considered by most participants to be supportive enough or even impartial about HIV-positive people having children, and paid little attention to men's fathering role. 80% of the men had sexual relationships, and 43% of them wanted children, especially those who had no children, in spite of expectations of disapproval. Few of the men received information about treatment options that would protect infants, however. In previous studies with HIV-positive women attending the same clinics, by comparison, greater knowledge about prevention of perinatal HIV transmission was reported, but women had fewer sexual relationships, fewer desired to have children, and they expected even more disapproval of having children from health professionals. We conclude that the rights of those with HIV to found a family depend as much on curing the ills of prejudice and discrimination, including among health professionals, as on medical interventions.

The Right to Love: The Desire for Parenthood among Men Living with HIV

Drug regimens and procedures now exist that will prevent parents from transmitting HIV to infants, and the ethical and legal obligation to promote and protect the reproductive rights of those living with HIV should form part of training for HIV/AIDS care and prevention. This paper reports a study that investigated issues of sexuality and reproduction with 250 Brazilian men livingwith HIV in Sa˜o Paulo. We asked whether they wished to have children and whether health professionals in HIV/AIDS treatment clinics that they attended were supportive of their wishes. Health professionals were not considered by most participants to be supportive enough or even impartial about HIV-positive people having children, and paid little attention to men’s fathering role. 80% of the men had sexual relationships, and 43% of them wanted children, especially those who had no children, in spite of expectations of disapproval. Few of the men received information about treatment options that would protect infants, however. In previous studies with HIV-positive women attending the same clinics, by comparison, greater knowledge about prevention of perinatal HIV transmission was reported, but women had fewer sexual relationships, fewer desired to have children, and they expected even more disapproval of having children from health professionals. We conclude that the rights of those with HIV to found a family depend as much on curing the ills of prejudice and discrimination, including among health professionals, as on medical interventions. A 2003 Reproductive Health Matters. All rights reserved