SOCIAL REPRESENTATIONS ABOUT AIDS IN PEOPLE OVER 50, INFECTED BY HIV

Neste trabalho, analisa-se as representações sobre AIDSde 9 pessoas acima de 50 anos, infectadas pelo HIV. Da análise, surgiram representações: ‘AIDSé uma ameaça constante de morte’. Essas foram categorizadas e nomeadas pelas falas dos entrevistados: ‘médico nenhum pensa, primeiro, que a gente pode ter AIDS’; ‘AIDSnão é câncer’; ‘ser velho e estar com AIDSé ser duplamente discriminado’. Os resultados mostram a importância da integralidade dos cuidados pelos serviços de saúde para diminuir o sofrimento psicossocial dessas pessoas.


INTRODUCTION
Reaching advanced age is no longer a privilege for the few.However, concerns are not related to longevity, which many people experience nowadays, but to a good quality of life, aspired by many but enjoyed by few people.
In this search for a better quality of life, the Statute of the Elderly establishes a social policy to value aged people in Brazil.Health, education, law and social science researchers are increasingly interested in different questions about old age, including issues related to HIV/Aids prevention and control.
The National Policy of the Elderly was established on 11/04/94 by Law No. 8.842, and regulated by decree No. 1948, issued on July 03 rd 1996, with a view to attending to this part of the population.Some campaigns to prevent Aids in elderly people have been organized, in line with Chapter IV -Article 10, aimed at guaranteeing that the elderly population receives health care in different care levels of the Single Health System, besides preventing, promoting, protecting and recovering these people's health, through programs and prophylactic measures (1) .
In view of technological and health care advances, elderly people live a new reality in this period of their lives, which they never experienced before.However, when infected by HIV, people over 50 with low education levels tend to manifest the effects of immunodepression more rapidly than younger people as, besides Aids, they are affected by other diseases that frequently appear when old age gets closer.These effects are even more serious in people aged 65 or older.
Moreover, there is disinformation, prejudices and health service access difficulties.This probably contributes to the increase of HIV/Aids cases.Besides, there is the subnotification of cases and the fact that the epidemic is affecting individuals with lower education levels.The researchers observe these factors in their daily work, dealing with questions related to Adult and Elderly Health in health service practice.Besides these general questions, the risk of HIV infection is denied in this group, by health service users as well as by professionals attending the elderly (2) .
In a recent study, physicians from the University of Chicago Hospital reported, for example, that "many professionals who deliver care to elderly persons do not manage to associate Aids with aged persons, as the issue of risk perception does not exist when looking at this population " (3) .
In the absence of vaccines and an actual cure for the syndrome, and despite the increasing number of Aids patients over 50 (4) , there is a lack of systemized knowledge about this group, mainly in terms of quality of life and coping with the disease, including these people's representations about the event of HIV in their lives.

METHODS
We carried out a qualitative study, focusing on the expression of participants' subjectivity, using social representations theory.In the analysis, we sought the central and peripheral nuclei (5) , for which social representations are "elements structured around a central nucleus and peripheral nuclei, to systemize knowledge in the attempt to study the object in further depth".Qualitative research extracts results like opinions, attitudes, feelings and expectations, which together constitute the social expression of the specific group under study, in a certain society and at a specific time, in short, how practices influence representations (6) .

Theoretical Framework
All individuals develop in a social reality, with needs and cultural meanings that mould their values and are expressed in daily life, through social representations that are constructed in common sense, in interactions, ideologies and people's ways of life.
Based on Moscovici (8) , Forgas (7) points out that the notion of social representation refers to a set of From the perspective of the dynamics of becoming familiarized with the non-familiar, social representations involve two processes: objectification (transformation of something abstract into something almost physical) and anchorage (fastening) (8) .
In order to access these representations, the Central Nucleus Theory is proposed, elaborated on the basis of the hypothesis that the organization of a representation presents a particular characteristic: not only the elements of the representation are ranked, but all representations are organized around a central nucleus, constituted by one or more elements that give meaning to the representation.This theory suggests that the essential character of a certain representation can be discovered in further detail.
Thus, representations guide the action, that is, the way individuals look at reality determines their way of being in the world.This presupposes that ways of prevention or care after the infection are central in the subjectivity of people who experience HIV/Aids when they are over 50.This experience is loaded with beliefs and values that organize their behavior towards the disease.
In daily life, people very often only perceive the risk and severity of a disease when they are affected by it and "while there was no risk, not even of getting ill, because of the disease, the risk is now visualized as a death risk".Thus, their attitudes towards a severe illness, even if it is a pandemic, are not always accompanied by the perception that they are susceptible to infection.This sometimes leads to negligence of prevention modes.

Research subjects
We interviewed nine HIV/Aids seropositive patients who were hospitalized at a public hospital in Goiânia, Goiás, between August and December 2003.
The number of interviewees had not been defined a priori.Two participants were 52 years old, three 60 years old and four 64 years old.The saturation of themes addressed by the patients was adopted as the criterion to interrupt data collection.The interviewees preferred to be interviewed at the institution they were hospitalized in and at the two support services for Aids patients in the state capital.

Ethical aspects
All participants received a free and informed consent term, containing information about the study and conditions for participation, in accordance with Decree 196/96 by the National Health Council (9) .None of the interviewees refused to participate.They were willing to talk about themselves, provided that their identities were protected by the use of codes for analysis and presentation of results.
Participants were informed about the research objectives and their voluntary participation, that their anonymity would be preserved and that they had the right to withdraw from the study at any time, without any pressure or harm to the care they received by health and social support services.
It should be reminded that sociological research is, in the first place, a way of systematically expressing people's views and life history.In this context, it is fundamental to deeply respect their statements, in data collection and analysis.

Information collection
Information was obtained through oral, faceto-face discourse, using open and in-depth interviews, which were audio-taped.The tapes were coded and stored by the researchers, and will be destroyed after the publication of the results.

Information analysis
Based on the logics of the subjective trajectory (10) , we attempted to deconstruct and reconstruct discourse by analyzing the narratives, in order to extract the analytic categories.
After the literal transcription of the participants' testimonies, these were read and reread on the basis of social representations theory, horizontally reading each interview.We looked for information about representations with a view to a first empirical categorization, through the themes addressed by the subjects themselves.
Soon after, all segments that coincided around a same discourse object were grouped, and each group received a provisional name, with a view to the second empirical categorization.
Based on the empirical categorization, we carried out cross-sectional reading of the interviews by organizing the contents in thematic blocks.We considered the regroupings of each interview and compared them with the conjunctions and disjunctions in the set of interviews.
In this sense, analysis involved the following steps (11)(12) : close transcription of audio-taped interviews; vertical reading; elaboration of a 'paragraph' that summarizes the subject's discourse; horizontal analysis; nomination of sequences; first categorization; search for central and peripheral elements of representations according to their density in the discourse structure; elaboration of a hierarchical scheme of representations; in-depth analysis, including readings of other authors about the observed representations.

RESULTS AND DISCUSSION
The study group consisted of four heterosexual women and five men, between 52 and 65 years old.Two men presented themselves as heterosexual, while three affirmed sexual relations with men.All participants were poor and had not finished basic education.
The group included single and widowed persons, as well as people without a stable partner.
Sexual exposure was predominant (eight participants), while one person believed contamination occurred through this route, but was not sure because of a history of drugs use.Hence, the group was in accordance with the epidemiological profile of Aids in Brazil, as described in Ministry of Health statistics (4) , which reveal a higher number of sexuallycontaminated patients.HIV can infect men and women of all ages, skin colors and social conditions, religions and nationalities.As described by epidemiology since the 1990's, sexual behavior is the main transmission route.
As to condom use, the interviewees confirmed that they did not use this before their infection by HIV.
Through these people's reports, identified in the text as E1, E2..., we attempted to discuss, in this study, how the existence of HIV/Aids is represented by the subject who has the disease.Social Representations Theory was basically chosen because of the search for the central nucleus and peripheral system, that is, of what is fixed, 'hard', but not immutable, and what is mobile and flexible and, therefore, can be changed more quickly, in representations about the disease experience.This allowed for the identification of these representations, also discussing how they are reflected in these persons' daily life (6) .
The peripheral system of representations about HIV concepts, assertions and explanations originated in daily life, in the course of communications between individuals, which are equivalent, in our society, to traditional societies' myths and systems of beliefs, which can be considered a contemporary version of common sense.The informal conversations and the force of arguments found in the heat of afternoon discussions give "speakers" at the same time an encyclopedic competence about the discussion themes: As group conversation advances, speech gets regularized and expressions become more precise.Each participant becomes eager to transmit his/her knowledge and keep a place in the circle of attention surrounding people who are well informed.Each person obtains information and continues in the running, getting familiar with the unknown.
After I took the test, the prejudice came: my family discovered, all of the neighbors discovered [...] Stupid people![...]Then, they already started to discriminate against me, to cast me aside (E1).Now that I'm old, even more, who will want to be close to me? (E4).This shows that interactions related to the existence of HIV infection are more based on suspicion and closure than on confidence and disclosure.Aids is a threat of solitude and isolation, as the interviewees frequently indicate the need for affective and material support from family and friends and the time they most need these, but without any certainty that this will actually occur.When they start the aging process, people fear and experience social forms of discrimination, which is aggravated by knowing about the infection Social representations about... Brasileiro M, Freitas MIF.Rev Latino-am Enfermagem 2006 setembro-outubro; 14(5):789-95 www.eerp.usp.br/rlae didn't show.I couldn't imagine either that I had it.(E7).The subjects' experience makes them represent the physician as the person who does not know what they have and neither refers them correctly to define the diagnosis.The patient, on the other hand, does not suppose (s)he is infected, or does not want The comparison between Aids and cancer also appears to indicate difficulties related to the fear of being discovered and having one's sexuality disclosed.The nuclei closest to the center These representations are part of the more peripheral system, presented above, and preserve the age-related specificity, but are based on the same aspects as representations about aids in the general population.-Being old and having aids means being discriminated twice Nobody wants me anymore, nobody wants to come close to me.Everybody who saw me said: 'look at that: he has HIV!' One shows it to the other, you know?It was like that at first and, now, I don't care at all... (E2);