40 In health services, practices that contribute to the perpetuation of the stigma related to the virus can also be observed, such as stimulating the sterilization of infected women, offering condoms exclusively as a method of sexual prevention or prioritizing the reduction of vertical transmission among pregnant women, to the detriment of actions aimed at the construction of living with HIV.
41 In fact, another aspect to be considered in the analysis of the stigma processes in relation to women living with HIV concerns reproduction. The current scenario of the epidemic in Brazil, marked by the increased survival of people living with HIV / AIDS and the spread of actions to reduce vertical transmission, allows a greater number of HIV-positive people to choose to have children.
The expansion of anti-HIV testing
At the same time, in prenatal care increased the diagnosis of HIV in women of reproductive age, meaning that from pregnancy or childbirth, many who considered themselves distant from AIDS become aware of positive serology. The way professionals communicate the diagnosis and build the relationship with the woman can help to minimize the impact of disclosure of seropositivity and the associated stigma.
It is not uncommon for these women to perceive themselves as victims and share the prejudices related to people with HIV / AIDS. The idea of having been “tricked” 39 by the partner points out that adherence to gender norms related to sexuality, romantic love or conjugality was not enough to guarantee the stability of the life of a wife and mother advocated by those same norms.
- 42 However, reports of maltreatment in health services during the performance of anti-HIV testing are frequent. -HIV
- and after the diagnosis of the woman’s serological status.42Although gender
- stereotypes and limited living conditions compromise female sexual autonomy and enhance women’s exposure to HIV /
AIDS, the stigma related to AIDS (abortion and work) contributes to making gender inequalities that make them vulnerable to infection invisible. Facing the stigma related to HIV / AIDS in women implies micro and macro-structural changes, and cultural interventions, capable of impacting the deconstruction of gender stereotypes and expanding female sexual autonomy.
The cover-up operated by the stigma makes it difficult for women to prevent HIV, delays the search for diagnosis and promotes the negative consequences of late diagnosis. In addition, it interferes with the post-diagnosis quality of life, given the difficulties in publicizing the serological condition and the isolation and restriction of the social support network.
This work aimed to demonstrate that gender stereotypes and specific stigmas result from social inequalities and contribute to producing norms and prescriptions of conduct, with impacts on health. From three strongly stigmatized situations involving women, prostitution, induced abortion and HIV infection,
it was discussed how the stigma operates in reducing these women’s access to health resources and services, resulting in violations of rights and, consequently, an increase from the vulnerability of women to illness and death. In these three situations, we sought to demonstrate the ways in which stigma covers social and gender inequalities, masking the power games that articulate around the control of women’s sexual autonomy.
- Stigma thus appears as an effective instrument in these games, compromising the exercise of more just, equal and healthy human relationships. It is worth
- remembering that the stigma of prostitution works synergistically with the stigma related to abortion and AIDS, favoring discrimination against infected women, women prostitutes,
women who have abortions and, above all, those belonging to both groups. The relationship between vulnerability, stigmatization processes and the axes of social and gender inequality suggests that expanding access to health in the three cases presented (prostitution, abortion and AIDS) implies structural and cultural interventions, in the micro and macro spheres,
Capable of fostering women’s autonomy
and guarantee their sexual and reproductive rights. Such a task is difficult and complex but not impossible. Management, legislative and other actions that directly or indirectly affect health, alongside the daily practices of health services, can contribute to unveiling the axes of inequality production that give rise to and feed a given stigma, aiming at its deconstruction and overcoming, in the way of greater social justice.
- The vulnerability to HIV of prostitutes, due to stigma and social exclusion, it can be seen in most
- countries, where this group has higher rates of HIV / AIDS infection than other women.23 At the same
- time, the global mapping of the most effective actions in reducing vulnerability HIV among sex workers shows the relevance
of actions such as the recognition of prostitution while working, the reduction of s forms of the expansion of prevention and health care practices and the empowerment of these professionals, through the performance of organizations and social leaders in partnership with local governments
Faced with fear of being discriminated against, women tend not to share the diagnosis. Non-disclosure contributes to the perpetuation of stigma and interferes with quality of life and treatment adherence. Stigma covers the complexity of the processes that reduce the autonomy of women in relation to their sexual, loving and reproductive trajectories, such as the romantic idealization of relationships, the lack of involvement of men with prevention in the sexual sphere, sexual coercion and the diverse forms of violence.Bez kategorii