Sexualidade e vulnerabilidade social de pessoas com transtornos mentais atendidas em serviços públicos de saúde mental no Brasil

Abstract

In face of the high prevalence rates of sexually transmitted infections (STIs) and HIV/AIDS detected in people with mental disorders in Brazil, and of the limitations in current preventive approaches generalized and focused on a rational decision, this study had the purpose of understanding the representations of these people about sexuality, focusing on self-care to prevent these grievances. We aimed to help to develop new strategies of attention to health care, with data and reflections, from the perspective of the integrality of assistance. Open and in-depth interviews were carried out with 39 individuals with severe and persistent mental disorders assisted in public mental health services in Brazil, 22 males and 17 females from 18 to 72 years old. Representations about sexuality have been composed of a range of representations such as sex, sexual partners and sexual practices, forming a web of interdependent representations, exposed in their sexual route. They showed large differences between genders, which is closely related to conceptions of masculinity and femininity, which originate behaviors that promote the vulnerability to sexuality transmitted grievances. These representations are strongly based on social norms and on life experiences, although the origins of the scientific discourse had not been identified. Self-care for the prevention of STIs and HIV/AIDS, although recognized as necessary, is carried out with shortcomings and difficulties which occur due to several objective factors and subjective aspects. Among these are: the taboo surrounding the sexuality theme; the feeling of safety with known partners and a good appearance; the fear of having the relationship affected by the use of condoms, represented as an indication of distrust between the couple and also by the little knowledge about STIs and HIV/AIDS and on the use of condoms. The vulnerability of this group with sexuality transmitted grievances worsened with the context of social exclusion where they are inserted, marked by poverty, low level of education, distress, low self-esteem, violence and drug addiction. In addition to making self-care difficult, this context was shown to favor behaviors which contribute to other risky behaviors such as sex for sale. Results showed the need to recognize and promote sexual health as a right also to people with mental disorders and to consider social-cultural aspects involved in sexual experience and in the self-care of this group so that sexual health is available for these people. However, it is not enough if gender stereotypes are not fought against, which have caused so much damage to individual and public health.