Discriminação sofrida em atendimento odontológico por pessoas vivendo com HIV/AIDS: prevalência e fatores associados

Abstract

Prejudice and discrimination suffered by people living with HIV/AIDS during dental care constitute a recurrent public health problem. The literature has pointed to the existence of barriers to the access and retention of these individuals in health services. This discrimination can be related to an interaction between several factors that have the potential to modify the quality of dental care provided to each individual. In addition, the literature has pointed to the importance of understanding the dimension of discrimination in oral health care from the perspective and perception of people living with HIV/AIDS. There is a scarcity of studies in the literature on discrimination suffered in dental care by people living with HIV/AIDS. In view of the above, this study aimed to evaluate the prevalence of this discrimination and the associated factors. A crosssectional study was conducted with 350 active patients receiving care at the Specialized Care Service in the city of Juiz de Fora, Minas Gerais, aged over 18 years. Dependent variables (discrimination in health services and discrimination suffered in dental care) and independent variables (sociodemographic variables, explicit discrimination, characterization of the disease, participant/dentist relationship, and access to dental care) were collected through the application of a structured questionnaire, aiming to identify factors associated with discrimination suffered in dental care by people living with HIV/AIDS. Data were processed using SPSS software, version 20.0. Bivariate analyses and robust Poisson regression were conducted to estimate crude and adjusted prevalence ratios, adopting 95% confidence intervals. The independent variables associated with a p-value ≤0.05 were included in the multiple model, while the variables with a p-value <0.05 remained in the final model. After adjusted analysis, the following remained associated with greater discrimination in health services: age group from 18 to 44 years (PR = 1.13; 95%CI 1.04-1.23), witnessing discrimination in health services (PR = 1.15; 95%CI 1.08-1.23), considering prejudice as a barrier to access to health services (PR = 1.09; 95%CI 1.01-1.17), having one's reproductive rights violated (PR = 1.16; 95%CI 1.00-1.34) and having care denied by a dentist (PR = 1.14; 95%CI 1.01-1.27). The following remained associated with greater discrimination in dental care: age group from 45 to 59 years (PR = 1.11; 95%CI 1.00-1.23), discrimination by family members (PR = 1.21; 95%CI 1.10-1.32), feeling discriminated against in health services (PR = 1.26; 95%CI 1.07- 1.49) and having care denied by a dentist (PR = 1.33; 95%CI 1.11-1.59). The results point to the need for ongoing education of professionals and greater information on patient rights. Furthermore, there are gaps in dental training and care regarding dentists' understanding of the stigmatized face of people living with HIV/AIDS.