Vulnerabilidade de mulheres que fazem sexo com mulheres às infecções sexualmente transmissíveis
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2017-09-06
Autores
Andrade, Juliane [UNESP]
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Universidade Estadual Paulista (Unesp)
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Introdução: Vulnerabilidade é a possibilidade de a pessoa se expor ao adoecimento, considerando-se fatores individuais e coletivos, dividindo-se em três dimensões analíticas articuladas: a individual, a social e a programática. Em mulheres que fazem sexo com mulheres (MSM) a vulnerabilidade às infecções sexualmente transmissíveis (IST) perpassa por questões de luta por visibilidade social e política, diferença de gênero, padrão heteronormativo, despreparo profissional e o próprio desconhecimento sobre questões relativas à prevenção das IST/aids, ainda pouco estudadas no cenário nacional. Objetivo: Analisar a vulnerabilidade de mulheres que fazem sexo com mulheres às IST/aids. Método: Estudo transversal que integra estudo mais amplo sobre acesso a serviços de saúde e saúde sexual e reprodutiva de MSM. A amostra de 150 MSM residentes no interior Paulista foi constituída por meio da técnica de amostragem Bola de Neve, indicação de profissionais de saúde e liderança LGBT (Lésbicas, Gays, Bissexuais, Travestis e Transexuais) e por procura espontânea, a partir da divulgação do projeto nas redes de sociabilidade, comunicação de massa, serviços de saúde e grupos de ativismo. As variáveis estudadas foram classificadas mediante o referencial teórico da vulnerabilidade. Os dados foram obtidos de janeiro de 2015 a março de 2017, por meio da aplicação de questionário, exame ginecológico e coleta de sangue periférico. Para o diagnóstico das infecções pelo papiloma vírus humano, Chlamydia trachomatis e Neisseria gonorrhoeae empregou-se a reação em cadeia da polimerase, para confirmação do HIV (Vírus da Imunodeficiência Humana), os testes ELISA e Western Blot, para Hepatite B o ensaio ARCHITECT HBsAg. Para sífilis foi considerado resultado reagente a mulher que teve teste treponêmico e VDRL reagente ou os dois treponêmicos positivos, sem história de tratamento prévio adequado. A identificação do Trichomonas vaginalis se deu a partir da coloração de Papanicolaou. Para análise dos dados foi empregada a estatística descritiva e as associações foram verificadas por regressão logística múltipla e as comparações do escore de vulnerabilidade entre mulheres com e sem histórico de relação sexual com homens foram feitas por meio do teste de Mann-Whitney. Resultados: A mediana de idade das MSM investigadas foi de 26 anos (18-62), 74,7% eram brancas, 73,3% não unidas, 51,3% tinham 12 ou mais anos de estudo concluídos, 74% estavam inseridas no mercado de trabalho e 50,7% tinham renda per capta familiar maior que R$ 1.019,00. A maioria tinha história de relacionamento sexual com homens durante a vida (74,7%), entretanto, nos últimos doze meses, apenas 21,3% se relacionaram com homens. O diagnóstico de alguma IST foi constatado em 47,3% das mulheres. A análise de regressão logística multivariada apontou apenas variáveis da dimensão individual independentemente associadas às IST/aids: não ter realizado sorologia para IST/aids [OR=2,80 (1,13 – 6,94); p=0,027], ter histórico de IST [OR=4,00 (1,03–15,50); p=0,045] e ter tido relação sexual com homem nos últimos 12 meses [OR=8,65 (2,39–31,38); p=0,001]. Segundo a estratégia de análise do grau de vulnerabilidade adotada, nenhuma mulher investigada estava isenta, sendo que a vulnerabilidade programática foi a que apresentou maior mediana do escore de vulnerabilidade, 9,6 pontos (0-24) e a social, a menor, 7,5 pontos (0-19). As mulheres com ou sem histórico de relação sexual com homens na vida não diferiram quanto ao escore de vulnerabilidade na dimensão social e programática e aquelas que se relacionaram com homens na vida apresentaram maior escore na dimensão individual [10,0 (4,0–17,0 vs. 8,0 (4,0–13,0); p= 0,001]. As MSM que tiveram relação com homem nos últimos 12 meses tiveram maior escore de vulnerabilidade individual e social em comparação com aquelas sem este histórico [12,0 (6,0–17,0) vs. 9,0 (4,0–15,0); p=0,000 e 10,0 (0,0–19,0) vs. 5,0 (0,0–14,0); p=0,042, respectivamente] e não apresentaram diferença quanto ao escore de vulnerabilidade programática. Conclusão: As MSM investigadas apresentavam elevada vulnerabilidade às IST/aids nas três dimensões, confirmada pela alta prevalência dessas infecções, sugerindo necessidade de atenção individualizada e qualificada, com vistas à sua redução. Assim, os dados da presente investigação podem proporcionar à Enfermagem e a outros profissionais de saúde elementos que facilitem a sistematização do cuidado a esse grupo populacional, permitindo intervenções que considerem as três dimensões da vulnerabilidade, implicando maior potencial de transformação do processo-saúde-doença.
Vulnerability is the possibility of exposing oneself to illness, considering individual and collective factors, divided into three articulated analytical dimensions: individual, social and programmatic. In women who have sex with women (MSM), vulnerability to sexually transmitted infections (STI) is based on issues of struggle for social and political visibility, gender difference, heteronormative pattern, health care unpreparedness and lack of knowledge about STI /aids prevention, which has been little explored in the national scenario. Objective: To analyze the vulnerability of women who have sex with women to STI /aids. Method: A cross-sectional (transversal) study integrating a broader research project related to MSM access to health services and sexual and reproductive health. The sample of 150 MSM residents in countryside of Sao Paulo province was constituted by means of the snowball sampling technique, in a referral chain among healthcare professionals and LGBT leadership (Lesbian, Gay, Bisexual, Transvestite and Transsexual) and by spontaneous demand, from the disclosure of the Project in social networks, media, health services and activism groups. The variables studied in the present research were classified according to the theoretical reference of vulnerability. The data were obtained from January 2015 to March 2017 through the application of questionnaires, gynecological examinations and peripheral blood collections. For the diagnosis of human papillomavirus infections, Chlamydia trachomatis and Neisseria gonorrhoeae, the polymerase chain reaction was used to confirm HIV (Human Immunodeficiency Virus), ELISA and Western blot tests, for Hepatitis B the ARCHITECT HBsAg assay. For syphilis diagnosis, women whose treponemal and VDRL reagent test or the two treponemics positive, without a history of adequate pretreatment, was considered a reagent result. The identification of Trichomonas vaginalis occurred from the staining of cervical smear. Descriptive statistics were used for analysis of the data and associations were verified by multiple logistic regression and comparisons, using Mann-Whitney test, of the vulnerability score between women with and without a history of sexual intercourse with men. Results: The median age of the MSM investigated was 26 years (18-62), 74.7% were white, 73.3% single, 51.3% were school educated for 12 or more years, 74% were employed or self-employed and 50.7% had per capita family monthly income greater than R $ 1,019.00. The majority had a history of sexual intercourse with men during their lifetime (74.7%), however, in the last twelve months, only 21.3% had sexual intercourse with men. The diagnosis of some STI was found in 47.3% of the women. Multivariable logistic regression analysis showed only variables of individual dimension independently associated with STI /aids: no serology for STI /aids [OR = 2.80 (1.13 - 6.94); P = 0.027], have a history of STI [OR = 4.00 (1.03-15.50); P = 0.045] and had had sexual intercourse with men in the last 12 months [OR = 8.65 (2.39-31.38); P = 0.001]. According to the vulnerability analysis strategy adopted, all women investigated were vulnerable, and the programmatic vulnerability was the one with the highest median vulnerability score of 9.6 (0-24) and the social, the lowest, 7.5 points (0-19). Women with or without a history of sexual intercourse with men in their life did not differ on the vulnerability score in social and programmatic dimensions; and those who have sexual intercourse with men in their life had a higher score in the individual dimension [10,0 (4,0-17 , 0 vs. 8.0 (4.0-13.0), and p = 0.001. Moreover, MSM that had a relationship with men in the last 12 months had a higher individual and social vulnerability score than those without this history [12.0 (6.0-17.0) vs. 9.0 (4.0-15.0), p = 0.000 and 10.0 (0.0-19.0) vs. 5.0 (0.0 - 14.0); p=0.042, respectively] without programmatic vulnerability score differences. Conclusion: The MSM investigated presented high vulnerability to STI /aids in all three dimensions, confirmed by the high prevalence of these infections. This outcome suggests the need for individualised and qualified healthcare programme aiming the reduction of MSM vulnerability. Therefore, the results of the present investigation can provide nurse-led care and other healthcare professionals criteria to facilitate the systematization of care to this group, allowing interventions that consider the three dimensions of vulnerability, contributing in great potential, for transformation of the health-disease process.
Vulnerability is the possibility of exposing oneself to illness, considering individual and collective factors, divided into three articulated analytical dimensions: individual, social and programmatic. In women who have sex with women (MSM), vulnerability to sexually transmitted infections (STI) is based on issues of struggle for social and political visibility, gender difference, heteronormative pattern, health care unpreparedness and lack of knowledge about STI /aids prevention, which has been little explored in the national scenario. Objective: To analyze the vulnerability of women who have sex with women to STI /aids. Method: A cross-sectional (transversal) study integrating a broader research project related to MSM access to health services and sexual and reproductive health. The sample of 150 MSM residents in countryside of Sao Paulo province was constituted by means of the snowball sampling technique, in a referral chain among healthcare professionals and LGBT leadership (Lesbian, Gay, Bisexual, Transvestite and Transsexual) and by spontaneous demand, from the disclosure of the Project in social networks, media, health services and activism groups. The variables studied in the present research were classified according to the theoretical reference of vulnerability. The data were obtained from January 2015 to March 2017 through the application of questionnaires, gynecological examinations and peripheral blood collections. For the diagnosis of human papillomavirus infections, Chlamydia trachomatis and Neisseria gonorrhoeae, the polymerase chain reaction was used to confirm HIV (Human Immunodeficiency Virus), ELISA and Western blot tests, for Hepatitis B the ARCHITECT HBsAg assay. For syphilis diagnosis, women whose treponemal and VDRL reagent test or the two treponemics positive, without a history of adequate pretreatment, was considered a reagent result. The identification of Trichomonas vaginalis occurred from the staining of cervical smear. Descriptive statistics were used for analysis of the data and associations were verified by multiple logistic regression and comparisons, using Mann-Whitney test, of the vulnerability score between women with and without a history of sexual intercourse with men. Results: The median age of the MSM investigated was 26 years (18-62), 74.7% were white, 73.3% single, 51.3% were school educated for 12 or more years, 74% were employed or self-employed and 50.7% had per capita family monthly income greater than R $ 1,019.00. The majority had a history of sexual intercourse with men during their lifetime (74.7%), however, in the last twelve months, only 21.3% had sexual intercourse with men. The diagnosis of some STI was found in 47.3% of the women. Multivariable logistic regression analysis showed only variables of individual dimension independently associated with STI /aids: no serology for STI /aids [OR = 2.80 (1.13 - 6.94); P = 0.027], have a history of STI [OR = 4.00 (1.03-15.50); P = 0.045] and had had sexual intercourse with men in the last 12 months [OR = 8.65 (2.39-31.38); P = 0.001]. According to the vulnerability analysis strategy adopted, all women investigated were vulnerable, and the programmatic vulnerability was the one with the highest median vulnerability score of 9.6 (0-24) and the social, the lowest, 7.5 points (0-19). Women with or without a history of sexual intercourse with men in their life did not differ on the vulnerability score in social and programmatic dimensions; and those who have sexual intercourse with men in their life had a higher score in the individual dimension [10,0 (4,0-17 , 0 vs. 8.0 (4.0-13.0), and p = 0.001. Moreover, MSM that had a relationship with men in the last 12 months had a higher individual and social vulnerability score than those without this history [12.0 (6.0-17.0) vs. 9.0 (4.0-15.0), p = 0.000 and 10.0 (0.0-19.0) vs. 5.0 (0.0 - 14.0); p=0.042, respectively] without programmatic vulnerability score differences. Conclusion: The MSM investigated presented high vulnerability to STI /aids in all three dimensions, confirmed by the high prevalence of these infections. This outcome suggests the need for individualised and qualified healthcare programme aiming the reduction of MSM vulnerability. Therefore, the results of the present investigation can provide nurse-led care and other healthcare professionals criteria to facilitate the systematization of care to this group, allowing interventions that consider the three dimensions of vulnerability, contributing in great potential, for transformation of the health-disease process.
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Palavras-chave
Vulnerabilidade, Infecções sexualmente transmissíveis, Lésbicas, Homossexualidade feminina, Enfermagem, Vulnerability, Sexually transmitted infections, Lesbians, Female homosexuality, Nursing