Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 14 nº 1 - Jan/Mar - 2017

Original Article Imprimir 

Páginas 45 a 54


Women's vulnerability to human immunodeficiency virus - HIV: Sociodemographic profile and youth sexual behavior

Vulnerabilidad femenina al virus de la inmunodeficiencia humana - HIV: Perfil sociodemográfico y de comportamiento sexual de jóvenes

Vulnerabilidade feminina ao vírus da imunodeficiência humana - HIV: Perfil sociodemográfico e comportamental sexual de jovens

Autores: Jordana de Almeida Nogueira1; Jailson Alberto Rodrigues2; Rafael Pablo da Silva3; Gleibson Moura Ferreira4; João Márcio Nunes de Alencar5; Núbia Rafaella Rodrigues6; Isabele Cruz Luna7; Ulisses Umbelino dos Anjos8

1. Post-Doctorate, Ribeirão Preto Nursing School, São Paulo University (USP). Ribeirão Preto, São Paulo State,. Lecturer, Clinical Nursing Department, Paraíba Federal University (UFPB). João Pessoa, Paraíba State
2. Doctoral student in Decision Models and Health. Master's Degree in Decision Models and Health, Paraíba Federal University (UFPB). João Pessoa, Paraíba State. Lecturer, Piauí Federal University (UFPI). Picos, Piauí State, Brazil
3. Final Year Nursing Student, Piauí Federal University (UFPI). Floriano, Piauí State, Brazil
4. Final Year Nursing Student, Piauí Federal University (UFPI). Floriano, Piauí State, Brazil
5. Final Year Nursing Student, Piauí Federal University (UFPI). Floriano, Piauí State, Brazil
6. Bachelor's Degree in Dentistry, Faculdades Integradas de Patos (FIP) college. Patos, Paraíba State
7. Family Health Specialist, Faculdades Integradas de Patos (FIP) college. Patos, Paraíba State. Welfare Nurse, Deoclécio Marques de Lucena Regional Hospital. Parnamirim, Rio Grande do Norte State, Brazil
8. PhD in Statistics, São Paulo University (USP). Lecturer, Statistics Department, Paraíba Federal University (UFPB). João Pessoa, a major challenge today is rephrase that Paraíba State

Jailson Alberto Rodrigues
Rua França, 11, Jardim Europa
Patos, PB, Brasil. CEP: 58705 -090
jailsonalbertorodrigues@yahoo.com.br

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Keywords: HIV, health vulnerability, women's health.
Palabra Clave: HIV, vulnerabilidade en saúde, saúde de la mulher.
Descritores: HIV, vulnerabilidade em saúde, saúde da mulher.

Abstract:
OBJECTIVE: Analyze the sociodemographic profile of the youth sexual behavior of João Pessoa - PB, in the context to HIV women's vulnerability, as well as the factors and aspects that can be correlated and/or influence the behavior of these vulnerable young people.
METHODS: We conducted a descriptive study, of an inquiry type, with 233 young women between 12 and 19 years, white and black individuals from public schools, sexually active or not. It was applied a structured questionnaire comprising eligibility issues and dichotomous multiple-choice questions, divided into two sections, separated by standardization scales and thematic blocks. We conducted bivariate analysis to verify the relationships between variables, specifying the Spearman correlations. It was tested a statistical significance at the 0.05 alpha level (5%) by the hypothesis test for one proportion.
RESULTS: It was observed that none of the sociodemographic variables were statistically significant. In terms of the proportions test, none of the variables related to the adoption of sexual vulnerability practices was statistically significant. It is worth mentioning the frequency of young people with first sexual intercourse between 15 and 18 years and that their last relation occurred with an eventual partner.
CONCLUSION: The women's vulnerability to HIV is attributed to multiple factors. The sociodemographic variables do not have an influence on women's vulnerability to HIV for young people in contexts of the city of João Pessoa - Paraiba State.

Resumen:
OBJETIVO: Analizar el perfil sociodemográfico y el comportamiento sexual de jóvenes de João Persona - PB, dentro del contexto de la vulnerabilidad femenina al HIV, así como los factores y aspectos que pueden tener correlación y/o influenciar en el comportamiento de vulnerabilidad de esas jóvenes.
MÉTODOS: se realizó un estudio descriptivo, del tipo expediente, con 233 jóvenes del sexo femenino con edad entre 12 y 19 años, blancas y negras, sexualmente activas o no, estudiantes de escuelas públicas municipales. Se aplicó un cuestionario estructurado que comprende cuestiones de selección y de múltiple elección, dicotómicas, dividido en dos secciones, separadas por bloques de estandarización de escalas y temática. Se realizó análisis bivariado para verificación de las relaciones entre las variables estudiadas, especificándose las correlaciones de Spearman. Se testeó la significancia estadística a nivel alfa de 0,05 (5%), a través del test de hipótesis para una proporción.
RESULTADOS: se observó que ninguna de las variables sociodemográficas presentó significancia estadística. Tratándose de teste de proporción, ninguna de las variables relacionadas a la adopción de prácticas sexuales por las jóvenes presentó significancia estadística. Se destaca la frecuencia de jóvenes con sexarca ente 15 y 18 años, y que su última relación ocurrió con un 'quedante'.
CONCLUSIÓN: La vulnerabilidad femenina al HIV es atribuida a múltiples factores. Las variables sociodemográficas no presentan influencia en la vulnerabilidad femenina al HIV para las jóvenes en los contextos de la capital paraibana.

Resumo:
OBJETIVO: Analisar o perfil sociodemográfico e o comportamento sexual de jovens de João Pessoa - PB, dentro do contexto da vulnerabilidade feminina ao HIV, bem como os fatores e aspectos que podem ter correlação e/ou influenciar no comportamento de vulnerabilidade dessas jovens.
MÉTODOS: Realizou-se um estudo descritivo, do tipo inquérito, com 233 jovens do sexo feminino com idade entre 12 e 19 anos, brancas e negras, sexualmente ativas ou não, estudantes de escolas públicas municipais. Aplicou-se um questionário estruturado que compreende questões de elegibilidade e de múltipla escolha, dicotômicas, dividido em duas seções, separadas por blocos de padronização de escalas e temática. Realizou-se análise bivariada para verificação das relações entre as variáveis estudadas, especificando-se as correlações de Spearman. Testou-se a significância estatística ao nível alfa de 0,05 (5%), através do teste de hipóteses para uma proporção.
RESULTADOS: Observou-se que nenhuma das variáveis sociodemográficas apresentou significância estatística. Em se tratando de teste de proporção, nenhuma das variáveis relacionadas à adoção de práticas sexuais pelas jovens apresentou significância estatística. Destaca-se a frequência de jovens com sexarca ente 15 e 18 anos e que sua última relação ocorreu com um 'ficante'.
CONCLUSÃO: A vulnerabilidade feminina ao HIV é atribuída a múltiplos fatores. As variáveis sociodemográficas não apresentam influência na vulnerabilidade feminina ao HIV para as jovens nos contextos da capital paraibana.

INTRODUCTION

Among today´s major challenges are Human Immunodeficiency Virus (HIV) infections, constituting an epidemic known on all continents, and encompassing aspects that extend beyond individual components.

HIV may be transmitted sexually and vertically through blood, with the sexual pathway being the main form of transmission in Brazil. Particularly noteworthy is heterosexual exposure, especially among girls and women, resulting in what are known as the heterosexualization and feminization of these infections1.

Among other factors, the extent to which HIV has spread had eased the stigma for what were known as 'risk groups', mainly homosexuals, injectable drug users, sex professionals and hemophiliacs. Furthermore, there are other factors resulting in multi-faceted HIV infections, releasing it from the segregative aspect caused by the high-risk groups. For example, this epidemic is more severe in areas that are socially underprivileged, constituting a situation of pauperization, with its spread into upstate towns and hamlets constituting its interiorization 1-3.

This set of factors, with different levels of magnitudes, affects the likelihood of people becoming infected by HIV to a greater or lesser extent. The comprehensiveness, subjectivity and understanding of the various contexts of vulnerability are key elements for a risk reduction approach. However, each person is vulnerable to infection in different ways, due to aspects that may be individual (biological, cognitive and behavioral); programmatic (prevention, education, control and assistance programs, in addition to political will); social (linked to economic and social issues); and cultural (submission to moral standards and beliefs, hierarchies, power relationships, and gender-related issues); in addition to contextual causes3-5.

Women are naturally more vulnerable to HIV, due to biological factors, historical contexts related to oppression, subjugation and limited power in affective-sexual relationships, or through submission imposed in relationships. Women are more likely to be raped and forced into intercourse, with less access to information and guidance, leaving them vulnerable in many different ways6.

Rising HIV rates among women indicate not only difficulties in providing institutional responses that are able to curtail this epidemic, but above all refer back to gender-related issues that have shaped the social roles of men and women, where asymmetrical relationships increase female vulnerability to HIV, with one obstacle being awareness of vulnerability to infection by this virus6-7.

In the current context of the HIV dissemination, and bearing in mind the upsurge in the number of cases in heterosexual groups, especially women, the profile of current cases warrants special attention from the authorities, healthcare practitioners and the population in general. This consequently underscores the need to seek replies to the following question: What are the factors leaving young women more vulnerable to HIV in João Pessoa, Paraíba State?

Through reflecting on this feminization of the HIV/AIDS epidemic, it will be possible to outline methods for lowering the number of cases among women, redirecting policies targeting their sexual and reproductive health. This is why this study attempts to identify the social and demographic profiles, together with sexual behavior factors among young women in João Pessoa, Paraíba State, and their links with vulnerability to HIV.


METHODS

This study is a descriptive enquiry conducted by the HIV/AIDS and Sexuality Studies Center (NEHAS) at Paraíba Federal University (UFPB) in partnership with the Bachelor´s Degree Nursing Course at the Amílcar Ferreira Sobral Campus (CAFS), Piauí Federal University (UFPI), which is linked to the Structural Equations Modelling Project: a tool for describing the determining factors of contexts of vulnerability to HIV.

This survey was conducted at 71 municipal government schools in João Pessoa, Paraíba State, offering classes in the second segment of primary school. Divided into nine Education Hubs, they cater to 17,051 boys and girls. As it was not possible to learn the exact number of female students, an anticipative proportion of 50% of this population was used for the sample calculation, with a significance level of <0.05 and a sampling error or <0.07. The sampling calculation lead to a minimum sample of 194 girls. In order to achieve this, and bearing in mind potential losses, this sample was increased by 20% (39 girls), reaching a final sample of 233 girls between 12 and 19 years of age.

The finite probabilistic sample was defined through a two-phase sampling process: first, stratification by municipal Education Hub; next, a sample was selected randomly by conglomerate, clustering the schools, as the selection through a random draw of a single school in each hub is justified by the similarity among them, in terms of the composition within the same hub.

The sample encompasses all the Education Hubs, where a weighted draw was conducted by the number of pupils. Finally, a weighted draw was conducted for the class that would complete the questionnaires.

The selected schools were requested to provide a list of classes in the second segment of primary school, and only youngsters duly enrolled in the grades constituting this segment were included in the study.

A structured questionnaire was completed, initially presenting questions on eligibility and multiple choice (on a Likert scale) as well as dichotomic questions, divided into two sections separated by scale and theme standardization blocks:

Part I - Social and demographic information, including questions on gender, age, ethnicity, education and income.

Part II - Questions related to aspects indicating vulnerability to HIV.

The research tool was checked previously through a pilot test and then submitted to analysis by three adjudicators, in order to define its clarity and sensitivity, in addition to prompting criticisms and suggestions for its improvement and checking correlations among the questions. It was completed in classrooms during the normal school hours, with voluntary participation, always overseen by one of the researchers in order to provide additional information that could clear up doubts and help with answering the questions.

The data were digitized and saved to a Microsoft Office Excel 2003 electronic spreadsheet. After coding all the variables, a database was set up into which the data was fed using a double entry validation technique (keying-in). With keying-in completed and data consistency checked, the information was imported into the SPSS AmosTM 18.0.0 package for analysis.

A bivariate analysis was conducted in order to examine links among the variables studied, specifying the Spearman correlations. Statistical significance was tested at an alpha level of <0.05 (5%) through the hypothesis test for a proportion.

The work proposal was initially submitted to the Municipal Education Bureau in João Pessoa, for its information and authorization. Subsequently, it was submitted to the Ethics and Research Committee at the Faculdades Integradas Patos college in order to assess its feasibility, with research activities beginning after its approval through Opinion Nº 043/2012.

As the respondents were minors, authorization was sought from their parents and guardians through the participant institution, signing Deeds of Informed Consent. Furthermore, as they showed sufficient discernment, the girls also signed Deeds of Informed Assent.


RESULTS AND DISCUSSION

None of the social and demographic variables presented statistical significance, as shown in Table 1. This might demonstrate an absence of links to female vulnerability to HIV or a difference in the values of proportion found for the event (sampled variable) in relation to the real population of youngsters vulnerable to this virus. This might have also have been influenced by the fact that most of the girls were not sexually active.




The Acquired Immunodeficiency Syndrome (AIDS) epidemic has spread to a greater extent among women, with its transmission predominant among those engaging in heterosexual intercourse. This phenomenon is influenced by the complex connections among biological, social, economic and cultural factors8-9.

With regard to the social and economic factors analyzed in Table 1, most of the respondents (77.3%) identified themselves as other than white, with mixed race (69.5%) predominant. Just over half of the respondents (56.6%) stated that they were in a relationship, with the 'hooking-up' and 'going steady' categories scoring significantly high among them, at 42.9% and 54.9% respectively. In terms of the job status of these youngsters, 83.7% stated that they did not work, with most of them reporting family incomes of up to two minimum wages and more than three family dependents, with 60.9% of them not receiving financial aid; with regard to religion, most of them stated that they were Roman Catholic or Evangelical, at 43.8% and 29.2% respectively.

A cross-sectional study conducted by Maciel and Bizani10 in Canoas, Rio Grande do Sul State, in order to describe the characteristics of users requesting HIV tests at a specialized walk-in clinic showed a predominance (82.5%) of white women. This also corroborates the study conducted by Bassichetto et al11, which assessed the profile of the clientele at a Counselling and Testing Center (CTA) in São Paulo, where a predominance (65.2%) of white women was also noted, followed by mixed-race women (24.1%).

The vulnerability of women to HIV infection may be attributed to social, cultural and economic factors that are firmly interwoven with historic issues related to racial and social segregation, access to healthcare facilities by certain segments of society, and also cultural aspects of a macho-minded patriarchal society where women often agree to unprotected intercourse due to the paradigm of stability for safe and solid affective and sexual relationships12.

Table 2 shows that 76.2% of these girls were not sexually active. Among those who were active, 62.2% had intercourse for the first time between 15 and 18 years of age with most of them stating that they had not had multiple sex partners. With regard to their last partner in intercourse, it is important to underscore the percentage of girls (around 10%) who had intercourse with a hook-up partner.




The frequencies with which variables occurred were tested, in order to identify their statistical significance. None of the variables related to the adoption of sexual practices leaving girls vulnerable proved significant. Through inference, this suggests that the frequency with which events occur (variables studied) in the real-life population of girls differs from their real percentage in the universe, and may be presented as a far broader scale.

Condom use between stable heterosexual partners is still a major stumbling block, particularly if use is requested by the woman, as this may indicate a loss of trust in her partner, in addition to the belief that wearing condoms reduces pleasure, with their placement also causing embarassment13.

Based on a correlation analysis of the variables with the behaviors leaving them vulnerable, Tables 3, 4 and 5 show that ethnicity, job status, family income, number of dependents, receiving financial aid of some sort, being sexually active, sexual option, multiple sex partners and last partner in intercourse were correlated to a statistically significant extent.








The ethnicity (p-value <0.043*), family income (p-value <0.030*), number of dependents (p-value <0.023*), being sexually active (p-value <0.067*), sexual option and last partner in intercourse variables were statistically significant in terms of intercourse with multiple sex partners, although only the last partner in intercourse variable (p-value <<0,0001*) presented a strong positive linear correlation.

Close correlation between unfavorable social and economic indicators and rising HIV/AIDS rates has been noted. The epidemiological profile of this disease has reflected this correlation, as AIDS is increasingly more frequent among the less educated, with lower incomes, living in areas with low Human Development Index (HDI) rates, and girls10.

It is believed that gender inequalities and underprivileged participation in society leave women more vulnerable. Gender inequalities permeate sexuality and also influence condom use (or avoidance). These and other social and economic factors that are unfavorable for women play important roles in the feminization of HIV/AIDS14.

Less education is linked to more sex partners and poorer compliance with preventive methods. Consequently, the role of education is stressed in the adoption of safe sex and reproductive practices. At all social and economic levels, it is increasingly more frequent for people with incomplete primary schooling to become sexually active at very young ages. This has pumped up AIDS rates, due to more frequent casual intercourse with lower condom use, compared to people with higher educational levels15.

Being sexually active demonstrates a negative linear link to sexual option, as shown in Table 4. In other words, as the proportion of one of the variables rises, the influence of the other decreases, in terms of female vulnerability to HIV. The ethnicity (p-value <0.006*), job status (p-value <0.013*), family income (p-value <0.024*), receiving financial aid (p-value <0.005*) and last partner in intercourse (p-value <0.009*) variables demonstrate statistical significance in terms of their correlation with sexual option, although only the being sexually active variable presented a strong linear correlation.

Sexual transmission of HIV predominates among women, even in homosexual relationships. A series of factors may potentiate HIV infection during intercourse with an HIV-positive person, including: unprotected sexual practices, previous sexually transmitted diseases, ulcerated lesions, and others that may offer risks of contact with blood or other body fluids16.

Female vulnerability to HIV is due to many different factors. Becoming sexually active at a young age, generally from 15 years old onwards, undermines physical development, together with the social contexts that these young women start to explore as they seek new spaces and adopt sexual practices that were once considered improper female behavior, such as fleeting relationships, multiple sex partners and spontaneous intercourse, are all factors underpinning this vulnerability12.

In terms of sexual activity, being sexually active or not; only the multiple sex partners and last partner in intercourse variables proved statistically significant (Table 5). Nevertheless, no variable presented a strong linear correlation. This demonstrates that they do not mean that sexually active girls are more vulnerable to HIV.

Considering aspects and sexuality among girls living in ten favela slums in Rio de Janeiro, the context surrounding sexuality and vulnerability to HIV/AIDS is related to the gender system, which is weighted against females, who have weaker powers of decision over sexual practices and the use of contraceptive methods within this context of sexuality17.

The moralistic social standards imposed on the sexual and reproductive lives of women leave them more vulnerable to sexually transmitted infections (STI) or unplanned pregnancies. In contrast to men, they seek affection rather than just pleasure when engaging in intercourse, allowing them to trust their partner and be driven by feelings of faithfulness, thus feeling that condom use is unnecessary17.

Males are relatively more likely to use condoms than females. This is probably due to the fact that they regularly engage in casual sex with unknown women, outside their fixed relationships. This makes them more aware of the need to protect themselves, in contrast to women, who engage in intercourse with only a few partners, trusting them and failing to protect themselves18.

Over the years, youngsters have become sexually active at increasingly early ages, with the rising proportion of women infected by HIV - mainly those with little education - has prompted concern among the public health authorities. This is a negative aspect that could have severe after-effects on women´s lives, resulting from their sexual and social relationships and the psychological aspects around them, triggering feelings of revolt and depression, in addition to social stigma that may prevent them from reaching out and continuing to visit healthcare facilities for their treatment19.


CONCLUSION

Social and demographic variables did not seem to influence female vulnerability to HIV for girls in the contexts studied in the Paraíba State capital. However, despite lacking statistical significance, even the sexual behaviors reported by these girls showed significant correlation to the following variables: ethnicity, family income, number of dependents, being sexually active, sexual option and last partner in intercourse, linked to increased vulnerability resulting from multiple sex partners. The ethnicity, job status, family income, receiving financial aid and last partner in intercourse variables presented significance in the correlation with sexual option.

Two factors heightening individual vulnerability for the trend towards feminization of HIV infection among girls in the Paraíba State capital are particularly noteworthy among their behavior, especially being sexually active, sexual option and last partner in intercourse.

In view of the constraints on healthcare facilities, it is thus necessary to implement systematized actions with specific tools that can be tailored to each reality, in order to provide well-qualified comprehensive care to different segments of the population.

As youngsters are naturally resilient, healthcare practitioners must ensure better access to them, encouraging compliance and trust among them, in order to ensure successful health promotion and protection practices.


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