HIV/AIDS in rural areas of Brazil: Cultural implications for health promotion

Background: The real magnitude of the HIV/AIDS epidemic in rural areas of Brazil is unknown. This study investigated social and cultural constructions of HIV/AIDS and implications for prevention activities in rural areas of Northen Minas Gerais State, Brazil. Method: An ethnographic methodology was used including semi-structured in-depth interviews with 52 patients (30 male, 22 female), and participant-observation in patients of the local Montes Claros State University's day clinic for HIV/AIDS and in the patients' homes. Results: Popular construction of HIV\AIDS contributes to the specific vulnerability of those infected by HIV/AIDS. While rural-urban migration is a important vector of HIV transmission in this region, AIDS is perceived as a big city or foreigner disease. All interviewees were infected through homosexual or heterosexual sexual relations. Among this population, there is no perceived association between AIDS and homosexuality. None of the interviewees used condoms routinely. However, they perceived themselves as breaking moral and social rules, AIDS appears as a sort of magical-religious illness, understood as something sent by malignant forces, or by God, as a form of punishment. All patients practiced both catholic or evangelical religions and sects with a common shift towards Evangelism following the diagnosis. The most frequent notion relating to virus transmission was linked to symbolic contact with contaminated objects and persons. Implications: it is necessary to understand local cultural notions that influence HIV vectors of transmission in rural populations. It is also important to understand local cultural construction of the disease while planning prevention programs.