Concept analysis of vulnerability to HIV / aids in female sex workers

The aim of this study was to analyze the concept of vulnerability to the Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome among female sex workers. The eight stages of the model proposed by Walker and Avant were followed, which are: concept selection; purpose of the conceptual analysis; identification of all possible uses of the concept; determination of the defining attributes; identification of a model case; identification of an additional (contrary) case; identification of antecedents and consequences; and definition of empirical referents. The 36 selected studies show that the concept elaborated for vulnerability to these infirmities in female sex workers involved social, economic, prior health, individual, direct, accessibility and administration aspects besides aspects related to partners. The antecedents were education/illiteracy; financial necessity; Sexually Transmitted Infections. The consequences were social isolation, Infection with the Human Immunodeficiency Virus and other Sexually Transmitted Infections. The study makes a contribution to strengthen the body of scientific work on nursing, by supporting the development of technology aimed at this population for the prevention of these infirmities. Descriptors: HIV; Women; Sex Workers; Concept Formation; Nursing Research. 1 Nurse, Master of Nursing. Student of the Doctorate Program in Nursing at the Federal University of Rio Grande do Norte. Natal, RN, Brazil. E-mail: claudia.freirearaujo@gmail.com. 2 Nurse. Student of the Master’s Program in Nursing, at the Federal University of Paraíba. João Pessoa, PB, Brazil. E-mail: milenna_minhaqui@hotmail.com. 3 Nurse. João Pessoa, PB, Brazil. E-mail: lopes_brenda@outlook.com. 4 Nurse. João Pessoa, PB, Brazil. E-mail: thaynaadds@hotmail.com. 5 Nurse, Doctor of Health Sciences. Adjunct Professor at the Federal University of Rio Grande do Norte. Natal, RN, Brazil. E-mail: rirosendo@hotmail.com. Received: 09/27/2017. Accepted: 07/16/2018. Published: 12/31/2018. Suggest citation: Patrício ACFA, Ferreira MAM, Rodrigues BFL, Santos TD, Silva RAR. Concept analysis of vulnerability to HIV/aids in female sex workers. Rev. Eletr. Enf. [Internet]. 2018 [cited ____________];20:v20a38. Available from: https://doi.org/10.5216/ree.v20. 49546. Patrício ACFA, Ferreira MAM, Rodrigues BFL, Santos TD, Silva RAR. Rev. Eletr. Enf. 2018;20:v20a38. doi: 10.5216/ree.v20. 49546. INTRODUCTION Vulnerability to HIV/AIDS infection remains a challenge to public organs and society, as it is related to intrapersonal and interpersonal choices. The Human Immunodeficiency Virus (HIV) permeates various contexts, it being noteworthy that in Brazil, in the last five years, there has been an annual average of 40 thousand new cases. There is a real epidemic of the disease in key populations in Brazil. Among the affected groups are female sex workers, among whom the prevalence of HIV is 5.3%. Since the beginning of the AIDS epidemic in Brazil, 882,810 cases have been registered, with the North-East accounting for 15.4% of the cases, with an annual mean of 8.8 thousand. In Paraíba, the number of notified AIDS cases between 1980 and 2017 registers a total of 8,102, occupying fifth place in the North-East region. Sex workers have an estimated prevalence of HIV/AIDS 15 times higher than the incidence for the general female population. Prostitution involves, besides the emotional and sexual exchange, material, work and financial means. Vulnerability in the female context is strongly defined by the relationship that a woman maintains with her sexuality and with herself, which has been marked by subordination to male desire. This phenomenon promotes a situation of risk of exposure to HIV/AIDS: as female sex workers are outside the institutions, they are rarely reached and have restricted access to formal education and health services, and to social care organs. It is noteworthy that female sex workers become more vulnerable to HIV infection, as sex is an inherent part of their professional activity, working directly with multiple partners with unknown sexual histories. It is necessary for these women to have knowledge and empowerment and apply them in an attempt to minimize HIV infection. Within this epidemiological context in which AIDS is presented, female sex workers tend to be part of this reality for being a social group executing sexual activity as a form of subsistence, using licit and illicit drugs. Often, this sexual activity is performed without the use of a condom, so it may encompass individual, social and programmatic vulnerabilities, such as low levels of education, restricted access to health care services and social stigma. Studies indicate that sex workers are more susceptible to acquiring HIV/AIDS, although it can be observed that there are gaps in the literature in relation to the concept of vulnerability applied to this population, justifying the present study. In light of the above, it is emphasized that there is a necessity for conceptual analysis of vulnerability to HIV/AIDS in female sex workers, promoting clarification of concepts that are useful for the practice of health care, especially nursing, as the organization of this knowledge may contribute to supporting strategies of health promotion for this population, demonstrating the relevance of the present study. Moreover, conceptual analysis is intimately related to the evolution and expansion of Nursing knowledge. It can be highlighted that concepts are meanings attributed to determined phenomena or words, which may vary in accordance with the chosen theory and the context used. Furthermore, it is necessary to consider that each concept possesses attributes consisting of characteristics that compose the concept. There are also the consequences of concepts, which determine applicability and what may happen when they are used. The concepts facilitate and standardize understanding. Patrício ACFA, Ferreira MAM, Rodrigues BFL, Santos TD, Silva RAR. Rev. Eletr. Enf. 2018;20:v20a38. doi: 10.5216/ree.v20. 49546. In this perspective, the objective of this study consists of analyzing the concept of vulnerability to HIV/AIDS in female sex workers. METHOD This is a Concept Analysis of vulnerability to HIV/AIDS in female sex workers, following the model proposed by Walker and Avant, which is subdivided into eight stages. First stage: concept selection The chosen concept was Vulnerability to HIV/AIDS in female sex workers. Second stage: purpose of the conceptual analysis This stage refers to the purpose of the conceptual analysis, which, in this case, is identification of the concept of vulnerability to HIV/AIDS in female sex workers, enabling its refinement or update for the context of this demographic framework. This analysis, focused on female sex workers, will contribute to the deployment of strategies directed at closing the gaps that are encountered, promoting minimization of HIV/AIDS infection through the implementation of programs, public policies and partnerships with the association of female sex workers, considering the attributes, characteristics and particularities involved in vulnerability to HIV/AIDS in these women, working on the findings, individually or as a group, so as to prevent or minimize the installation of vulnerability. Furthermore, it will allow the academia to know the concept of vulnerability in this context, instigating new studies that consider the aspects involved in vulnerability. Third stage: identification of all possible uses of the concept In this stage, bibliographic research was carried out in the form of a review of the literature, which can be found described in the eighth stage of this study. In addition, searches were conducted in the dictionary and other scientific sources covering the concept of vulnerability. The identification of the possible uses of the concept enables finding how the concept is being used and applied, it being recommended to research beyond literature from the healthcare area, searching in books, dictionaries and encyclopedias. Fourth stage: determination of the defining attribute The frequency with which each attribute was mentioned in the studies was found, with subsequent definition of the most frequent for better understanding of the concept. Defining attributes are words or expressions appearing repeatedly in the literature that demonstrate the essence of the concept, constituting characteristics that express the concept, avoiding biases in the understanding of its nature. Patrício ACFA, Ferreira MAM, Rodrigues BFL, Santos TD, Silva RAR. Rev. Eletr. Enf. 2018;20:v20a38. doi: 10.5216/ree.v20. 49546. Fifth stage: identification of a model case This occurs through the confection of a case based on reality, which transmits defining characteristics and attributes that represent the concept. Defining characteristics are demonstrated through the presentation of a fictitious case, which is constructed based on the results found in studies from the integrative review, and on care experiences and prior knowledge. Sixth stage: identification of an additional (contrary) case The elaboration of a case that manages to be at the frontier between what is real and what does not apply to the concept is determined as additional case . In the present study it was chosen to present a contrary, fictitious case, elaborated by the author. The contrary case is understood as that which determines inapplicability of the concept. Seventh stage: identification of antecedents and consequences Antecedents correspond to events or incidents that occur before the existence of the concept; therefore they cannot be an attribute of the concept. The consequences are the events that occur as a result of appearance of the concept. As such, a word cannot be considered to simultaneously be an attribute, a consequence and an antecedent. The antecedents and consequences were obtained through the studies from the integrative review. For this, the informat