Introduction

The Human Immunodeficiency Virus (HIV) has become a relevant issue for public health, given the increase in its incidence, which reaches 1.7 million new infections according to data provided by the Joint United Nations Programme on HIV/AIDS (UNAIDS), representing a health challenge worldwide¹.

For public health, the challenge is to achieve effective prevention strategies and to address the different human dimensions involved in individuals, such as biological, psychological, and/or social dimensions².

To better understand these conditions, it is necessary to recall historical data since HIV appeared on the world scene in the late 1970s, being identified in Chile in the early 1980s, linking its diagnosis with homosexuals -or those who were part of sexual dissidence-, and those who were drug users or engaged in the sex trade. The difficulty of effective treatment linked HIV with death from acquired immunodeficiency syndrome (AIDS), and in addition to the above, the social imaginary was generated that HIV was a health problem that only affected a particular sector of the population, while its diagnosis was a death sentence.

From this context, besides the concerns for the physical deterioration and mortality caused by the progression of HIV in the organism. Also, there was a need to address aspects such as the fear and social rejection associated with living with the virus since it threatened the welfare of individuals who suffered from it.

Although timely and effective treatment currently allows people living with HIV to have a life expectancy like the population average. The mortality rate due to AIDS has decreased. Now, there is greater availability of treatments with fewer adverse effects, and other prevention strategies such as pre-exposure prophylaxis (PrEP), among other factors that favor their quality of life and well-being, it is evident that social stigmas continue to be present today^3,4.

Such stigmas can be defined as attitudes, feelings, beliefs, and behaviors that arise from prejudice and lead to discrimination against a person, affecting their social, work, and family dynamics and, in turn, creating a barrier to access to health services. It then becomes a relevant issue in the health care approach, considering the comprehensiveness of care, a principle declared in Chile as part of its health care model^5,6.

When social stigmas come from health workers, aspects such as empathy, which are necessary to establish care relationships from a humanized perspective, are affected, generating a need to consider their presence as a lack of ethical aspects of deontological type⁷.

People with HIV were socially stigmatized by the professionals who participated in the COVID-19 vaccination process throughout Chile, which led the Ministry of Health to grant guidelines to facilitate their access and guarantee their confidentiality, following pressure from social organizations and non-governmental institutions working on HIV-related issues^8-10.

The same situation was experienced in the main vaccination center located in southern Chile. For this reason, it was considered necessary to address it as a research topic, which led to establishing a general objective: To analyze the social stigmas concerning the care of people living with HIV by students, health professionals, and administrative staff in the context of COVID-19 vaccination in a vaccination center located in southern Chile.

Materials and methods

Results

Concerning the participants' profile, most of them were between 18 and 29 years of age (75.4%), from urban areas (88.1%), predominantly female (76.2%), and with cis-gender and heterosexual identity (86.5%); had some religious practice (68.2%), and most of them were students in health careers (71.4%) in their second to the fourth year of their respective training programs.

67.5% reported that they did not know anyone close to them living with HIV; however, 54% did refer that they had addressed users with this health condition. There was a 68.3% lack of training about HIV, and most (88.1%) considered that people with HIV experience discrimination (Table 1).

When analyzing the information according to classification, 71.4% presented a low level, 27.8% a medium level, and 0.8% an important level of stigma, the latter evidenced in a health professional.

Most of the surveyed population demonstrated some level of stigma (85.7%, n=108), and among those who showed no stigma (14.3%, n=18), the majority corresponded to students of health careers, reaching 15 subjects.

In the individual evaluation of the questionnaire responses, it was possible to identify that there is still a lack of knowledge about various aspects of HIV and its transmission. It is noteworthy that 13 people (10.3%) stated that "they would only care for people with HIV/AIDS because of ethical or professional commitment," and 2 (1.6%) responded that "they agree with the rejection of people with HIV/AIDS."

The analysis between the participants' profile variables and the level of stigma was significant for those who have cared for people living with HIV in the work or training context (p=0.008). No relationship was evident between the level of stigma and the other variables (p≥ 0.05) (Table 2).

Discussion

Since most participants were students in the health area, characteristics such as age and female gender predominance have been evidenced in research conducted in this type of population^12,13.

The results on the perception of people living with HIV as being outcast or discriminated against coincide with research that has shown the presence of social stigmas and discrimination on the part of professionals and students in health careers^7,14.

Regarding training about HIV, its contribution to improving professional-user interaction has been demonstrated, and at the same time, making possible the construction of public policies which recognize aspects of promotion, prevention, and follow-up, including the existing social esteem towards this type of population¹⁵.

For these reasons, the training deficit is an aspect that needs attention from both health institutions and those that train human resources in health, especially if we consider that this is a relevant issue given its prevalence worldwide, nationally, and particularly in the Los Lagos region in Chile¹⁶, where the investigation was developed.

Stigma and having had experiences of care for people living with HIV was a factor that promoted a low level of stigma; however, this is an aspect that requires further exploration to identify the factors that lead to support, generate, or mitigate social stigmas that create barriers to care^17,18.

The fact that most of the participants expressed some level of social stigma is relevant, and a small number of subjects showed that there was evidence of being in favor of rejection towards people living with HIV. In addition, they considered that their care would be provided only because of the professional duty that it entails. These aspects can make it difficult to establish therapeutic links necessary to develop empathic and genuine care, which are part of humanization and one of the principles of the integral health care model, from which the patient is considered the center of care^6,19-21.

The need to develop training that addresses knowledge related to HIV not only as a biomedical issue is evident since it should also include topics related to ethical aspects of health. These should enable reflection and recognition of these, not only from their correspondence with the legislative-regulatory duty to be but also as a deontological aspect necessary to establish horizontal human relationships in the context of care, to achieve the welfare of those who experience situations that affect their health²².

The incorporation of gender aspects is another relevant issue in training, where the concept of intersectionality²³ is relevant, considering cultural diversity and processes such as migration, which has been remarkable in recent years in Chile, together with the results of research in which the expression of social stigmas towards people due to race and ethnicity, and/or for identifying themselves as women, have become evident^24,25,26,27.

Conclusions

It is necessary then, that the HIV approach as a subject of education and training responds to the complexity of this phenomenon. In addition to its biomedical nature, it is necessary to recognize its history and the experiences of the people who suffer from it, to identify and address aspects such as social stigmas, and to incorporate paradigms like the biopsychosocial and spiritual, with a gender perspective, to contribute to the provision of care from a holistic perspective.