HIVAIDS in Rural Areas of Brazil: Cultural Implications for Health Promotion.

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HIV/AIDS in Rural Areas of Brazil Cultural
Implications for Health Promotion.

• Patricia Neves Guimaraes, PhD Candidate
• State University of Montes Claros-Mental and
  Public Health Department, Brazil
• McGill University-Division of Social and
  Transcultural Psychiatry, Canada

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Introduction

• The HIV/AIDS epidemic in Brazil is currently
  characterized by heterosexual transmission
  persistent growth among women, poor communities,
  low level of education.
• Little is known about Aids in rural areas in
  Brazil

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Objective

• To identify and understand social and cultural
  constructions of HIV/AIDS and implications for
  prevention activities in rural areas of the
  northern of Minas Gerais State, Brazil.

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Methods

• Ethnography including semi-structured qualitative
  interviews
• Participant-observation
• Two-year period in three different
  settings-outpatient clinics in the State
  University of Montes Claros, patients home,
  communities-at-large in 14 different
  municipalities
• 52 HIV-positive patients (30 males and 22
  females) were interviewed

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Results

• Patients age ranged between 25 and 70 years, and
  their average education was 8 years. Their
  employment was for the most part seasonal, from
  farm work to informal jobs.
• Rural to urban migration is a relevant aspect of
  HIV infection in this region
• The most important destiny to look for a job is
  Sao Paulo state, where they may get the disease.

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Results

• Sao Paulo is the richest state in Brazil and has
  the highest HIV / AIDS occurrence in the country.
  
• According to Ministry of Health (2008) Sao Paulo
  state corresponds to 50 of the HIV cases in
  Brazil.
• Patients were always involved with homosexual
  prostitution during the period out of their local
  communities
• This may explain the way that they get infected
  by HIV / AIDS in that region

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Moral representations of HIV

• HIV/AIDS was perceived by patients as a big-city
  or foreigners disease and thus not belonging to
  the reality of their rural communities.
• The most common representation is that the virus
  doesnt exist in the rural areas of Brazil.
• HIV/AIDS was often rationalized through a
  religious discourse as being provoked by
  malignant forces or by God, as a form of
  punishment for previous socially or morally wrong
  behavior.

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Moral representations of HIV

• Patients perceive themselves as people who broke
  moral or social rules.
• It seems that for the patients, people who live
  in big cities are considered more immoral than
  people who live in the rural area.
• HIV/AIDS infected people in this context do not
  perceive themselves at risk of contracting or
  transmitting HIV

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Moral representations of HIV

• A cure would only be possible through Gods
  intervention.
• This disease came as a warning to a lot of
  people about faithfulness, honesty, obedience.
  The disease came just to prove this
• Because the disease if it comes in us, I think
  that it doesnt change..., to change, only God.
  Because God changes, right? Because if He thinks
  that we deserve a cure, God willing, we can
  receive it.

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Social experience of HIV/AIDS Stigma

• Changing social and family relationships
  following the disclosure of HIV status was one of
  the biggest problems.
• It was my stepmother, you see. They put me in a
  separate house, as if...a kind of isolation. Then
  they brought me water and food... This is a
  separate house, a house to put tools,
  wheelbarrows, planting tools, that kind of stuff,
  you know. Horse shed... I stayed there, in that
  shed. She brought water, food it was like
  that... I was kind of trapped, you see. Yeah, but
  I got over it, took it without complaint and so
  on, without hurt feelings, without anger towards
  anyone! I got over it

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Social experience of HIV/AIDS Stigma

• The virus had to do with coming in contact with a
  contaminated object or person through social
  relations.
• These ideas contributed to develop a fear of
  social contact with HIV-positive patients and
  perpetuate the stigmatizing attitudes towards
  them.
• Patients tried to hide the HIV diagnosis from the
  community and the families

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Social experience of HIV/AIDS Stigma

• What do you think? Do you think I can even
  drink water at home, at my mothers home? No one
  touches my hand! Oh, I am hurt! I go out and
  leave my children with her do you think they
  allow him to lie on the bed? They put the
  mattress on the floor and put him on it Oh, I am
  resentful because my mother, I told her, and she
  spread the news in the neighborhood. And when I
  got back, the neighbors knew about it. Then that
  was it! The news spread everywhere, right? Then,
  people started rejecting me, and I got really
  upset with it, I didnt want for fear of being
  infected simply by being in proximity to that
  person.

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Social experience of HIV/AIDS Stigma

• No, but it is because AIDS is more persecuted,
  right? Ah, I am ashamed, and the story that I
  told you about, I am ashamed because the place is
  small, people talk a lot and so on. You start to
  know that this disease is so... so persecuted
  that when this problem... came in me that I got
  sick, people already talked it.
• it was common for people to run way from an
  HIV-positive person

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Conclusion

• Local cultural representations of HIV/ AIDS
  contribute to the spread and raise of HIV
  prevalence in rural areas of North of Minas
  Gerais State.
• Popular conceptions of the disease make this
  population more vulnerable to HIV infection.
• Health programmers need to understand local
  culture contexts if they want to access this
  population

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Conclusion

• Biomedicine and public health interventions must
  take into account that HIV patients in these
  rural areas refer more to the local symbolic
  reality of HIV than to the biomedical one.
• Powerlessness was experienced by most of the
  HIV-positive patients and has important
  implications for both primary and secondary
  prevention of HIV in these rural regions.

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Acknowledgements

• I am grateful to the CAPES Foundation (Brazil)
  for their support during the writing of the paper
  through a doctorate fellowship at McGill
  University
• THANK YOU !