The adolescent in a situation of vulnerability to HIV/Aids

Adolescence is the stage of life in which numerous biopsychosocial, cultural and spiritual transformations occur, in which risk behaviors are often underestimated and reflected in other stages of life ⁸.

This is due to the sum of several factors such as inexperience, emotional instability, early initiation of sexual life, multiple partners, not using condoms in sexual intercourse, influences from the media and the need for acceptance in groups can increase vulnerability to HIV/Aids ^(2.10).

Furthermore, when living conditions, housing, schooling, family and social relationships are weakened, they become potential influencers in the development of situations of vulnerability to HIV/Aids ².

Some studies show that adolescents are now able to have broad access to information sources and strategies, as well as public policies on sexual and reproductive health in various spheres of the life cycle. However, even with knowledge about HIV/Aids, some adolescents expose themselves to risk for trusting their sexual partner, for not liking to use condoms, for “thinking” that the partner does not have HIV; persisting in the false idea of invulnerability to sexually transmitted infections ^8,11.

In this sense, vulnerability to Aids stands out for having a complex concept that encompasses several dimensions that involve the state of being/being in danger or exposed to potential harm associated with individual, collective, subjective and adverse situations and contexts, particularities and specificities that vary according to the population addressed ¹².

Souza et al ⁸ highlights that the female population becomes more vulnerable to HIV/Aids, as there is still a large relationship of inequality between the sexes, permeated by stereotyped cultural constructions of domination, inferiority and neglect, which in turn, they deny women the right to exercise their full sexuality.

In addition, this exposure to the virus happens due to some factors such as early sexarche, ease of access to the use/abuse of alcohol and other drugs, low adherence to condoms, associated with greater sexual freedom, emotional instability, lack of information, gender inequity, predominant culture of masculinity and machismo, gender violence and lack of definitions of effective public health policies that have applicability to the existing reality ⁸.

The insertion of adolescents vulnerable to HIV/Aids in primary health care

Primary Health Care has an important role in the identification of existing problems within the community, in the resolution, prevention, promotion and rehabilitation of health. It is, therefore, a gateway for adolescents vulnerable to HIV through early capture, home visits, consultation with the multidisciplinary team, routine monitoring and educational activities ¹³.

The inclusion of adolescents in PHC becomes evident through educational actions such as recreational activity workshops, active methodologies focusing on the clarification of the theme, forms of transmission and prevention. For this, the school becomes the ideal place for providing knowledge and means of learning that contribute to improving health and preventing diseases ^13,14.

The identification of problems as a priority for monitoring and flexibility in the way of working with adolescents can be considered a means of consolidating them in primary care, making them co-responsible for the prevention of HIV/Aids. The diversity of subjects during the service is also necessary to promote involvement with the adolescents, form a bond and identify possible aspects of vulnerability ¹³.

In addition, to facilitate the client's visit to the basic health unit, another means found is the use of the adolescent's health book in order to make him/her participative, not just a passive client in listening ¹³. This booklet, implemented in Brazil by PHC professionals, is an educational material, attractive and practical, which informs adolescents about the main discoveries and changes in this phase of life, addressing relevant issues that gradually make them responsible for their own health ¹⁴.

It is worth noting that professionals often report that this clientele is resistant to seeking primary care, which confirms that assistance is limited. This emerges from the need to encourage action-reflection strategies with adolescents about their threshold of vulnerability, empowerment and co-responsibility, since individuals who do not feel vulnerable to a given disease do not seek to adhere to preventive measures ¹³.

It is essential that the community health workers carry out the capture and orientation of this public, offering a more detailed attention, and that other team members collaborate with the reception, establishing a more open and close dialog with the needs of adolescents, either individually or in groups in the community or schools, through peer education or other participatory methodologies, maintaining a sensitive and free listening of discriminatory principles ¹⁵.

Nursing care for adolescents in a situation of vulnerability to HIV/Aids in Primary Health Care

In PHC, the role of nurses stands out in nursing consultations, home care, educational activities, sexual and reproductive activities, in addition to intermediating in the prevention, promotion, recovery and rehabilitation of health. This complex professional activity seeks to reach the sociocultural, institutional, family, subjective and behavioral processes that generate vulnerabilities to face problems related to HIV/Aids ⁸.

With regard to adolescents in situations of vulnerability, it is observed that nurses use their interpersonal skills to involve this public in the health service, encouraging critical-reflexive reasoning, as well as making them important protagonists of their health ^8,16.

It is noted that the activities carried out by nurses are organized according to the needs of this group, which happens sporadically during the adolescents’ visit to the health unit or when nurses visit schools ¹³.

The nursing consultation should be an opportunity to capture needs, should focus on an intervention through a clinical and educational perspective, seeking to avoid the traditional, vertical and transmitting practice. It should also be a means of exchange and mutual growth for the construction of new values that make assistance more dynamic ¹³.

It is worth mentioning that not all professionals have the skills to work with this public. In order to be a facilitator in this process, nurses also need training for the transmission of adequate knowledge, in such a way as to provide the effective capture of this clientele ^2,13.

This problem is not only related to the receptivity of the nurse's assistance, because during academic training there is no teaching aimed at this approach to adolescents, which becomes a challenge for the professional with regard to care related to vulnerabilities ¹³.

The articulation between the theme in question and nursing care in primary care has an urgency to happen, as this allows overcoming the logic of specialization and fragmentation of care through shared responsibility, where users can be assisted in their community and understood and embedded in their complexity.

Public policies aimed at adolescents in situations of vulnerability to HIV/Aids

Adolescent health care is considered a complex and multifactorial process, since the social context influences behavior patterns and conditions of access to information and health. With this in mind, the Joint United Nations Programme on HIV/AIDS (UNAIDS, as per its acronym) has sought to implement strategies of combined prevention as a way to intervene simultaneously in different prevention approaches (biomedical, behavioral and structural), applied to the individual or community, according to the social context where it is inserted. ¹⁷.

In addition, in 2007, the School Health Program (PSE, as per its Portuguese acronym) was established, which is a strategy for integration of health and education for the development of citizenship and the qualification of Brazilian public policies ¹⁸. Moreover, in 2010, the National Guidelines for Comprehensive Adolescent Health Care were created, which monitor and evaluate actions and programs, as well as contribute to its consolidation as a public health policy ¹⁹.

Associated with this policy, there is the importance of incorporating other public health policies to complement and provide care to adolescents vulnerable to HIV/Aids in a comprehensive/holistic way, since the reception, social policies, sexual, reproductive and education represent some of these axes.

Although public policies and applicable strategies aimed at adolescents exist, they are still in an incipient phase when compared to other policies aimed at other life cycles, such as the health of children, women and the elderly ¹⁵.

The precarious living and health conditions of adolescents also point to their vulnerability, which requires an expanded, comprehensive and non-vertical view of public policies that effectively care for and protect them from HIV/Aids infection ^{(13, 15)}.

The adolescent population is a group with little investment in health, and is not yet a priority for Brazilian public health. The flaw can already be identified in the academic training of health professionals, where there is little or no qualification for specific attention to the needs of adolescents in situations of vulnerability to the acquired immunodeficiency virus ¹³.

Thus, Brazil needs to make more investments in health policies that involve the context of vulnerability in adolescents, in order to solve the main health and social problems identified, considering that inhibiting these gaps reduces vulnerability, and consequently, the number of adolescents infected with HIV/Aids.

And nurses, as members of the health team responsible for conducting public policies and providing assistance to various services, become fundamental pieces for the direction and control of HIV, to intervene in the factors that influence vulnerability, in order to understand the complexity of the adolescent carrier of the virus.

As it is a narrative literature review, the study selection process may present a possible selection and evaluation bias, since this methodology does not require detailed data, which characterizes a limitation of this study. However, this research addresses an extremely relevant topic as it involves all contextual aspects of the adolescents with the acquired immunodeficiency virus, whose scientific publications are still scarce.