NURSING CARE OF HIV-POSITIVE PATIENTS : CONSIDERATIONS IN THE LIGHT OF

This reflective study aimed to discuss nursing care to patients with HIV/AIDS in the light of phenomenology. It deals with the humanization of care of HIV-positive individuals and how nursing professionals should act in order to achieve it. Comprehensive health services provided by qualified professionals that take into consideration users’ emotional, social and cultural aspects can improve patients’ quality of life, treatment adherence and increase life expectancy. The use of phenomenological concepts was essential to understand the relationship between patient and professional practice. The method allowed researchers to identify aspects of patients’ everyday life by sharing their experiences.


INTRODUCTION
AIDS is caused by a human immunodeficiency virus (HIV).Initial cases appeared in the Eighties amongst homosexual males.The growth in the number of cases created stigmas which are still experienced nowadays.HIV-related discrimination is a priority research subject according to the World Health Organization (WHO), since it can be as damaging as the disease itself, particularly in public health. 1hanks to scientific advances AIDS, once lethal, is now classified as a chronic disease.Antiretroviral therapy increased life expectancy and improved the quality of life of people living with HIV/AIDS (PLWHA). 2 The therapy also contributed to raise the rate of treatment adherence.However, treatment abandonment is still frequent, often linked to incorrect use of medications and their side effects, among which lipodystrophy -redistribution of body fat and consequent change of body image. 3he quality of life of PLWHAs is directly related to the biopsychosocial dimension of the subjective experience of our bodies fighting infection, which requires a more comprehensive health care approach. 4he insertion of nursing professionals in the care provided to PLWHAs emphasizes the importance of nursing diagnoses for the planning of interventions.Nurses should be able to deliver humanized, integrated, individualized care, soundly grounded on scientific knowledge, according to the Systematization of Nursing Care (SAE).Thus, nursing actions should aim at the protection and recovery of health, patients' treatment adherence and self-care. 5esearch on the relationship between nursing and the care of PLWHAs in the light of a theoretical framework that supports and reflects such context is still incipient.
This fact originated concerns that can be summed up by the following questions: How can nursing provide humanized and qualified care to PLWHA?How can the National Programme for the Humanization of Care influence nursing care?
Such concerns guided the present study and set the objective of reflecting on the care provided to those patients in the light of Husserl's conception of phenomenology.

METHODOLOGY
This is a reflective study based on phenomenology and the authors' perceptions about the subject matter.They attempted to analyse the literature dealing with nursing care and HIV.The research was divided into two thematic approaches: "humanization of health care"; and "considerations on care in the light of phenomenology".

NURSING CARE OF PEOPLE LIVING WITH HIV/AIDS Humanization of care
This issue emerged from concerns about the humanized care nursing professionals should provide to people living with HIV/AIDS (PLWHA).The Unified Health System (SUS) was referred to, since the Brazilian public healthcare system was established through that institution.
Despite its fair and humanitarian principles, the SUS has significant challenges, such as financing, universal and equitable access to health services, lack of recognition for the health professional and administration obstacles that generate long waiting lists for consultations, demonstrating the disregard for users' right to health. 6,7  2003, the Department of Health launched the National Humanization Programme (PNH).Its objective is to promote changes in health management and care, labour processes, vocational training, and social control; therefore the SUS can truly fulfil its principles and guidelines, dignifying healthcare practices, actions and services. 8umanization of care is a broad issue applicable to all levels of the health system.It seeks to encourage dialogue between managers, workers and users, strengthening their relationship as well as comprehensiveness and equity of care.It also recognizes the importance of getting professionals and users involved in the process because such players trigger changes in management and care processes. 9n order to make care a truly human practice, the body must be considered beyond today's prevalent biological approach, often reductionist and curative.Care is a science but also an art that develops from the interaction between nurse and user.Consequently, fastening the care of the body to the care of the mind, the PNH can point out new approaches to health professionals.
Regarding people with HIV/AIDS, it is through the health service that these individuals manage to have their daily needs seen to and their concerns addressed.People affected by the disease are generally more sensitive and lacking in attention, needing not only therapeutic, but also psychological care.
The PNH intends to offer humanized care to HIV-positive individuals through welcoming services and qualified listening, focussing in problem-solving methods to fulfil their needs and delivering an effective and holistic service according to the principles of comprehensiveness and equity of care.
The PNH is based, therefore, on the partnership between users and health professionals throughout the care process.The strengthening of the programme makes it closer to vo-to build genuine bonds with clients (being cared).Situations and individuals will, therefore, be unique and the welcoming process recommended by the PNH will no longer be seen as a "technique" guided by scientific rationality.According to Heidegger, the proximity between human beings makes them discover their wishes, desires, feelings, anxieties and expectations. 10o think about nursing is to think about caring which consequently requires philosophical reflection in order to expand the knowledge identified through daily human experiences.Phenomenological studies anchor nursing actions addressed to HIV-positive individuals since they enable the researcher to understand the phenomenon AIDS. 13ccording to this perspective, nursing professionals should adopt a humanized and holistic approach regardless of the disease.They should take into account physical health as well as mental health, key to the treatment, especially in PLWHAs because they have to face the stigma created around the disease.
Nursing professionals should welcome HIV seropositive people as any other clients, taking into account their own special needs.Nursing practices should join technical and scientific knowledge to philosophical concepts of care, consolidating and valuing the others as whole beings, keeping in mind humanizing principles. 14onsidering the phenomenological notion that to exist is to take care of being and to take care of being oneself, it is important to emphasize that some HIV-positive individuals are inserted in a context in which they are able to acquire a favourable lifestyle.They are more interested in self-care and appreciate their life story, from diagnosis to all life changes and situations that brought them to that reality.
The internationally recognised Brazilian National Programme on STDs and AIDS supplies since 1996 antiretroviral drugs free of charge to HIV-positive individuals. 15Moreover, the country has HIV/AIDS specialized care services based on welcoming and comprehensive approaches characterized by the involvement between caregivers and patients that enables the establishment of a trusting relationship between the parties.
It is vital to reflect on aspects of nursing practices and the care of PLWHAs.This could contribute to the improvement of interventions that go beyond the disease and the clinical control of situations, overcoming purely biological approaches to nursing. 16t is necessary to offer to the nursing professionals the occasion to reflect on and discuss about their practice beyond its theoretical knowledge.Ethical care prioritizes not only the disease, but also the patients' subjectivity, i.e. their emotional, cultural and social dimensions.

FINAL CONSIDER ATIONS
Nurses are an essential member of the health care team.They should promote the universality, equality and compre-cational training, social control and management, in order to achieve the programme objectives and increase levels of satisfaction among professionals and users.
Humanization of care encompasses several aspects, such as the right to health in all its subjectivity, comprehensiveness and welcoming in order to minimize users' and nursing professionals' anxieties in favour of the care process.

Consider ations about care in the light of phenomenology
Caring as a way of living and interacting with the world accompanies the human race since its beginning. 10It is a transcendental act because it deals with phenomena that go beyond what the eye can see; it extrapolates protocols and technical handbooks; it is guided by harmonious relations and governed by a trusting relationship between caregiver and patient; it emphasizes that the technical dimension should not override the human dimension. 11onsidering the above, the energy field of health professionals can influence the recovery of the patients' energy and may contribute to the improvement or worsening of their health.This fact is demonstrated by quantum mechanics, which considers that there is a relationship between mind and body. 11uring the care process, health professionals should seek their inner balance, harmonizing their life energy before and after shifts for them not to lose energy to the environment or acquire any that may harm their stability, affecting patients' health and the disease process and, consequently, their performance.
Caring has evolved over time and is the essence of nursing.However, it has not always been discussed under ontological and holistic concepts.Although being the subject of many researches that attempt to understand and improve such events, there is still a big gap between the professional -client relationship, as well as lack of appreciation of the existential dimensions of patients. 10he present study is based on Martin Heidegger's phenomenological theories.This German avant-garde philosopher addresses care according to the relocation of the being and the re-establishment of ontology in which phenomenology is, first of all, the human world: Linked only to the existence of man in the world, being understood as the same-being in the world […], therefore, man only exists as being-with-others.:201 To be aware of the extent to which phenomenology may permeate care processes will help nursing professionals (carers) hensiveness of healthcare to HIV-positive individuals based on humanistic, holistic and welcoming principles.Such approach could contribute to higher rates of treatment adherence and to increased quality of life and life expectancy.
The above context could be analysed through a phenomenological perspective that may lead researchers to the study of daily life in the world, of being-in-the-world and being-withothers based upon the identification and sharing of their own experiences.Therefore, it is valid for researchers to use such phenomenological concepts that could support and improve further studies in the health area.