Living invisible: HTLV-1-infected persons and the lack of care in public health.
BACKGROUND
Human T-cell lymphotropic virus type 1 (HTLV-1) infection is intractable and endemic in many countries. Although a few individuals have severe symptoms, most patients remain asymptomatic throughout their lives and their infections may be unknown to many health professionals. HTLV-1 can be considered a neglected public health problem and there are not many studies specifically on patients' needs and emotional experiences.


OBJECTIVE
To better understand how women and men living with HTLV-1 experience the disease and what issues exist in their healthcare processes.


METHODS
A qualitative study using participant observation and life story interview methods was conducted with 13 symptomatic and asymptomatic patients, at the outpatient clinic of the Emilio Ribas Infectious Diseases Institute, in Sao Paulo, Brazil.


CONCLUSIONS
The interviewees stated that HTLV-1 is a largely unknown infection to society and health professionals. Counseling is rare, but when it occurs, focuses on the low probability of developing HTLV-1 related diseases without adequately addressing the risk of infection transmission or reproductive decisions. The diagnosis of HTLV-1 can remain a stigmatized secret as patients deny their situations. As a consequence, the disease remains invisible and there are potentially negative implications for patient self-care and the identification of infected relatives. This perception seems to be shared by some health professionals who do not appear to understand the importance of preventing new infections.


CONCLUSIONS
Patients and medical staff referred that the main focus was the illness risk, but not the identification of infected relatives to prevent new infections. This biomedical model of care makes prevention difficult, contributes to the lack of care in public health for HTLV-1, and further perpetuates the infection among populations. Thus, HTLV-1 patients experience an "invisibility" of their complex demands and feel that their rights as citizens are ignored.
Federal University of São Paulo, São Paulo, Brazil. zihlmann@usp.br
Karina Franco
KF
Zihlmann
Augusta Thereza
AT
de Alvarenga
Jorge
J
Casseb
D000328:Adult; D058070:Asymptomatic Diseases / Q000523:psychology; D001938:Brazil / Q000453:epidemiology; D005260:Female; D015490:HTLV-I Infections / Q000453:epidemiology* / Q000523:psychology* / Q000635:transmission; D015368:Human T-lymphotropic virus 1 / Q000302:isolation & purification; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D057545:Social Stigma