Approaching Sexually Transmitted Infections in a Nursing Undergraduate Curriculum^*

Abordaje de las Infecciones de Transmisión Sexual en un Currículo de Grado de Enfermería

ABSTRACT

Objective:

To identify the approach to sexually transmitted infections in the undergraduate nursing course at a federal university in southern Brazil.

Method:

Socio-historical research with a qualitative approach, and use of oral and documentary sources. Thirteen professors participated. Data collection took place between December 2018 and April 2019. Data analysis was thematic.

Results:

Three categories of analysis emerged: the teaching of sexually transmitted infections based on Brazilian public policies; sexually transmitted infections and their teaching strategy in an undergraduate nursing course; and the trajectory of approach to sexually transmitted infections in an undergraduate nursing course. The undergraduate course is based on public health and education policies, and the subject “Sexually Transmitted Infections” was created in the course at the end of the 1970s. The content is not mandatory, being associated with the area of public health and evidenced in the fields of practice and educational activities.

Conclusion:

The teaching of sexually transmitted infections has been in line with public health and education policies. It gains a greater teaching focus with the emergence of AIDS.

DESCRIPTORS
Curriculum; Education, Nursing; Sexually Transmitted Diseases; Acquired Immunodeficiency Syndrome; History of Nursing; Nursing

RESUMEN

Objetivo:

Identificar el abordaje del tema relativo a las infecciones de transmisión sexual del curso de grado de enfermería en una universidad federal del sur de Brasil.

Método:

Investigación socio histórica con abordaje cualitativo y uso de fuentes orales y documentales. Participaron 13 docentes. La colección de datos ocurrió entre diciembre de 2018 y abril de 2019. El análisis de los datos fue temático.

Resultados:

Surgieron tres categorías de análisis: la enseñanza de las infecciones de transmisión sexual fundamentada en las políticas públicas brasileñas; las infecciones de transmisión sexual y su estrategia de enseñanza en un curso de grado de enfermería y la trayectoria del abordaje de las infecciones de transmisión sexual en un curso de grado de enfermería. El curso está fundamentado en las políticas públicas de salud y educación, y la asignatura “Infecciones de Transmisión Sexual” fue creada en el curso al final de la década de 70. El contenido no es obligatorio, está relacionado a la salud pública y tiene más evidencia en los sectores de práctica y actividades educativas.

Consideraciones Finales:

La enseñanza de las infecciones de transmisión sexual ha acompañado las políticas públicas de salud y educación. Gana más destaque como asignatura con el surgimiento del VIH/SIDA.

DESCRIPTORES
Curriculum; Educación en Enfermería; Enfermedades de Transmisión Sexual; Síndrome de Inmunodeficiencia Adquirida; Historia de la Enfermería; Enfermería

RESUMO

Objetivo:

Identificar a abordagem da temática relativa às infecções sexualmente transmissíveis do curso de graduação em enfermagem em uma universidade federal do sul do Brasil.

Método:

Pesquisa sócio-histórica com abordagem qualitativa, e uso de fontes orais e documentais. Participaram 13 docentes. A coleta de dados ocorreu entre dezembro de 2018 e abril de 2019. A análise dos dados foi temática.

Resultados:

Emergiram três categorias de análise: o ensino das infecções sexualmente transmissíveis pautados nas políticas públicas brasileiras; as infecções sexualmente transmissíveis e sua estratégia de ensino em um curso de graduação em enfermagem; e a trajetória da abordagem das infecções sexualmente transmissíveis em um curso de graduação em enfermagem. O curso de graduação é pautado nas políticas públicas de saúde e educação, e a disciplina “Infecções Sexualmente Transmissíveis” foi criada no curso ao final da década de 1970. O conteúdo não é obrigatório, sendo associado à área da saúde pública e evidenciado nos campos de prática e atividades educativas.

Conclusão:

O ensino das infecções sexualmente transmissíveis vem acompanhando as políticas públicas de saúde e educação. Ganha maior foco de ensinamento com o surgimento da aids.

DESCRITORES
Currículo; Educação em Enfermagem; Doenças Sexualmente Transmissíveis; Síndrome de Imunodeficiência Adquirida; História da Enfermagem; Enfermagem

INTRODUCTION

Sexually Transmitted Infections (STIs) are spread through sexual intercourse without using a condom, by an infected person, as well as by contaminated non-sterilized sharp instruments and through pregnancy, due to cross-contact from mother to child. Many individuals are unaware that they have STIs, which makes this issue a worldwide public health problem due to its easy contamination and gradual increase. STIs are evidenced mainly in the young population(¹). They are among the most common acute conditions in the world as there are more than 30 infections that can be sexually transmitted. Global incidence data from 2012 indicated an estimated 357.4 million new cases of curable STIs in the world, in the age group of 14 to 49 years, most of them in developing countries(²).

The former National Department of Sexually Transmitted Diseases, AIDS and Viral Hepatitis, now called Department of Chronic Diseases and STIs, as well as state and municipal STI/AIDS programs, seek to expand universal and free access to condoms and thus increase the practice of safe sex, a strategy aimed at reducing STI rates(³).

Among the STIs, it is important to point out that, since the advent of AIDS in the 1980s, this disease has specific policies. Aiming at the control and prevention of this epidemic, government authorities and the Brazilian civil society are organized to expand knowledge and use of new technologies seeking to improve the quality of life of HIV-positive individuals, investing in prevention and care measures(⁴).

Nursing, as a health profession, has a fundamental role in identifying the population’s care needs. In health care, there are weaknesses around the theme of sexuality that are associated with personal and contextual factors. Health professionals realize it is still a sensitive and delicate topic belonging to the private sphere(⁵).

The teaching and learning process is mediated by teachers and students, either in basic education or in higher education(⁶). Regarding nursing, according to the National Curriculum Guidelines (DCN), professionals shall be able to learn continuously, both in their training and in their practice. It emphasizes that health professionals shall be committed to education and training of future generations of professionals, and stimulate and develop academic/professional mobility(⁷).

Nurses, as health educators, need to keep themselves routinely updated in their field of work, especially in the approach to STIs in primary health care, taking into account that poor care in the community can negatively contribute to the chain of transmission of diseases. Learning to use the STIs syndromic approach during the undergraduate nursing course is essential for the training of these professionals and their performance in the network(⁸).

Considering the importance of this theme in the nursing field, the object of this study was to seek the participation and contributions of professors about the teaching of STIs in an undergraduate nursing course at a federal university in southern Brazil. The teaching staff, in the teaching-learning process, is responsible for creating spaces and opportunities that enable professionals’ technical training, making them socially committed, which is consistent with one of the objectives of higher education institutions. Thus, it is part of the faculty’s responsibility to assist in the students’ social, cultural, and scientific improvement, which requires creating opportunities for interactions that lead them to reflect on social contexts, as well as develop critical thinking when solving problems(⁹).

Undergraduate nursing courses in the Brazilian reality, through Opinion no. 163/72, had as a common professional trunk the coverage of some disciplines, among them the so-called “Nursing and Communicable Diseases”. This subject has become mandatory in the basic curriculum of the nursing course according to Resolution No. 04/72 of the Federal Council of Education(¹⁰–¹¹). Currently, some higher education nursing institutions still maintain this discipline specifically in their curriculum; in others, the theme is included in as a transversal competence. The educational focus related to STIs, and especially HIV/AIDS, in nursing higher education institutions, can not only lead to the prevention of contagion among the students themselves, but also serve in the construction of knowledge so that future nurses are able to guide the population to have a healthy life(¹²).

During the undergraduate course, nursing students get into contact with the most diverse health-disease problems, and this knowledge acquired during the training process will guide their intervention behaviors in the most incident problems. This way, being prepared since the undergraduate course to recognize risk factors, prevention methods, and possible nursing interventions will help in the development of the STI area of knowledge. The study aims to identify how sexually transmitted infections were approached in the undergraduate nursing course at a federal university in southern Brazil.

METHOD

Type of Study

This is a socio-historical study with a qualitative approach, using oral and documentary sources. Socio-historical studies consider the participants historical, defined, identified by a culture as creators of ideas and consciousness that, by producing and reproducing social reality, are at the same time produced and reproduced by it(¹³). As a historical part of the research, it was decided that the study would start in 1977, when the subject “Nursing and Communicable Diseases” was included in the course curriculum. The final cutout from 2019 was selected to allow an analysis of the approach to this content over time.

Population

Thirteen professors from an undergraduate nursing course at a federal university in southern Brazil who are part of the trajectory related to the teaching of STIs at the institution participated. Of the 13 professors, 11 belonged (or belong) to the nursing department and 2 belonged (or belong) to the public health department.

The course in question was created as a Nursing School in 1969 and was an annex to the Medical School, a situation changed in 1970 by virtue of the implementation of the university reform. Nurses come mostly from the state in question, but many come from the entire southern region of the country. The region covered by the course has one of the highest epidemiological rates of HIV/AIDS in Brazil, which makes teaching about STIs in the undergraduate nursing courses in the region even more important.

Since its creation, the course has undergone 8 properly registered curricular reforms. It is active and accredited by the Ministry of Education. Since its last curricular reform (2011), it has been organized in 10 semesters, or phases. To be admitted, the student do a selection test – vestibular. As for the number of vacancies, 75 vacancies are offered annually, 38 in the first semester and 37 in the second semester, with other 6 vacancies for Afro-Brazilians, Quilombolas, and native Brazilians. The course load consists of 4,980 class hours, distributed in 35 subjects, with 1,264 class hours of supervised internship, 120 class hours of complementary activities, and 72 class hours of optional subjects(¹⁴).

Selection Criteria

The study included professors linked to the educational institution who somehow made the provision of teaching on the subject effective or historically marked the course through their expertise in the subject of study. The number of participants was defined by data saturation, that is, achievement of the objective and understanding of the studied phenomenon. As an exclusion criterion, lecturers or health professionals who were not linked to the institution.

Data Collection

The interviews took place between December 2018 and April 2019, with the aid of a semi-structured script. Participants were reached through the name indication technique called snowball. The interviews took place according to the availability of the participants, and in places of their choice. They lasted approximately 40 minutes, were recorded and transcribed in full, and later validated by the participants through an electronic address, so that they could be used in full or in part.

The documentary sources were characterized by “Official Catalogues” produced by the institution, which included departments, teaching staff, disciplines, syllabuses and course load - the oldest being found in 1971 and the most recent in 2002. The current “Political Pedagogical Project” of the course and three teaching plans for disciplines obtained from the personal files of the professors were also part of it. These were used in this study to provide internal and external criticism of the participants’ testimonies(¹⁵).

Data Analysis and Treatment

Analysis of the data obtained through the interviews was based on the operative proposal by Minayo(¹⁶), which covers two moments: the first, related to the fundamental determinations of the research, mapped in the exploratory phase of the investigation; the second, called interpretive, is the starting point and the ending point of the investigation, represented by the encounter with empirical facts. The interpretive moment consists of the ordering and classification of data, final analysis, and report. For the elaboration of the categories, registration units were developed and incorporated according to the professors’ similar answers. Subsequently, the analysis categories were created. This study contemplates three categories: the teaching of sexually transmitted infections based on Brazilian public policies; sexually transmitted infections and their teaching strategy in an undergraduate nursing course; and the trajectory of approach to sexually transmitted infections in an undergraduate nursing course.

Ethical Aspects

The participants signed the Free and Informed Consent Form. They were identified by the letter C, corresponding to “coordinators” and P, for “Professors”, followed by a sequential number. Ethical aspects were respected according to the recommendations of Resolution no. 466/12 of the National Health Council, and the study was approved by the Human Research Ethics Committee under Opinion No. 3.027.667 of 2018.

RESULTS

Oral sources are described in Chart 1. As documentary sources were used as support and proof of oral sources, that is, to carry out internal criticism of the sources (evaluating the authenticity of the information). The “Official Catalogues” produced by the university made it possible to verify the staff, disciplines, and syllabi of each period, and the adherence of participants to the research. The course’s current pedagogical political project was used to visualize the theme in the current curriculum. Subject teaching plans provided by the professors interviewed showed how the topic was approached, in line with their reports.

Chart 1.
Identification of oral sources – Florianópolis, SC, Brazil, 2021.

Teaching Sexually Transmitted Infections Based on Brazilian Public Policies

The course professors pointed out that the teaching of STIs to nursing students has always been guided by current public policies and that this is a potential of the course. They also provide nurses with the role of formulators and influencers of these policies.

I saw it very strong in primary care, because we already had important policies in Brazil. There was a space then, which was the sixth phase, which gave a lot of attention to adult health, but it was still focused by some teachers. There was concern that it would be worked, for example, in children, with the vertical transmission of AIDS and everything else in Brazil in the 2000s. (C4)

Public policies guide education, then you have science itself, which will have models there, so you take what is strong nowadays, it is the society of family doctors, which has protocols, which many nurses follow. Then you will have books, articles from nursing professionals themselves, about STIs and AIDS, so you have a scientific, political and ethical field that is articulated, but you have to think, there is the WHO (World Health Organization), PAHO (Pan American Health Organization), the MS (Ministry of Health), or the training institution adequates itself to induce this teaching. (C5)

One of the major concerns of the course, which is a strong characteristic of the undergraduate course, is this anchoring in public policies, as an important element in nursing education. This political character of nursing education, which is working on public policies. (C3)

The course has always had this concern, not to leave out these contents, because they are super important. What happens in the development of the teaching plan is that a little is lost if you are not following what is being done. (C2)

There is a concern of the course to address the topic, and, in a way, an approach to primary care where there is the association and implementation of public policies. When translated into teaching itself, education policies and health policies will underpin nursing education.

Sexually Transmitted Infectionsand their Teaching Strategy in an Undergraduate Nursing Course

When asked about the theme and about its position in the nursing course curriculum, they point out that the theme is something peripheral, that there are still barriers related to teaching. These obstacles are associated with moral behaviors and end up influencing teaching and bringing the topic closer to the student-teacher relationship.

In curriculum proposals; it never appears as a transversal theme. It is a specific theme linked to some disciplines, it has always been like that. It has always been dealt with in certain disciplines, in a very specific context, which is that of public health care, from the perspective of prevention. (C3)

It was included in the fourth phase of primary health care that dealt with women’s health. Sexually transmitted diseases were never the main focus, but it was in the disciplines until some point. When I was active, it had a focus of importance like the other themes, and with the advent of AIDS, it was even more important. (C2)

The professors demonstrated in their speeches that in the 1980s there was a specific discipline to deal with the theme and that, later on, it gains strength and is disseminated among the different phases of the course. In this decade, more specifically from the time of AIDS epidemic, the importance of an approach in the nursing curriculum is highlighted. Note that the topic is considered a specific subject of public health, being the responsibility of the public health department.

In the 1980s we had separate subjects and even today we have the famous “communicable diseases” separated. I think the trend was having transversal content that should be resumed at each stage. (C4)

It’s very clear for me that this is a public health issue, which nursing incorporated, but it was not the responsibility of the nursing department. I may be wrong that the issue of STIs was seen as a matter of public health (…) the issue of the so-called STDs (…) At that time there was vaccination, immunization, prenatal care, gynecology, a huge sign written STD. (P1)

When we made the reforms, we discussed the importance of having this content in the course (…) I took the students to the Department of Public Health, to see how the tuberculosis program was, there was already a specific program for this area, so we stayed there, did a mini internship, because the workload was small, but at least they knew what was being done (…). In the subject of communicable diseases, then it was absorbed by the internal medicine nursing. (C1)

In the 1970s and 1980s, the theme was specifically associated with the public health department. These professors had active participation in teaching about STIs at the undergraduate nursing courses. Many activities proposed by the Public Health Department were the precursors to the dissemination of the theme among nursing students at that time.

In the current curriculum of the course at this institution, which corresponds to the year 2011, teaching is presented in a discipline that emerged from the need to address human sexuality, being linked to women’s health. There is a concern to treat the theme as something transversal, which can be understood as the responsibility of the other and, finally, no one uses this approach to the theme in an effective way in teaching.

The discipline of sexuality was born with two credits on the human sexual health response in the area of women’s health. Then it grew and became a transversal theme. I have no chronological recollection of when it stopped being an isolated subject. (P1)

We only work when we are going to carry out educational activities related to sexually transmitted diseases. One or another subject has the content of sexually transmitted diseases, which is gonorrhea, syphilis, HIV. We still have a long way to go. (P5)

The topic does not currently have a single space for discussion. Epidemiologically, it is pointed out that, in the region where the university is located, there is an increase in syphilis rates and that there seems to be a certain trivialization of the topic. The professors say that the students participate in the reflection on the themes, through theoretical-practical activities carried out in the different places and health institutions in which the course operates. This is a constant in the undergraduate course, as it is also the role of the future nursing professional to act in the prevention of STIs.

It seems that it is regressing in many aspects, even we know that AIDS has been growing among young people (…) there is a certain trivialization, because AIDS can be treated. Florianópolis is a municipality that already has decentralized care for people with HIV in primary care, this is very recent, it is a 2015 ministry proposal. We do internships in these places; theoretically, we should be addressing these issues because the nurse who does all the counseling, guidance regarding the use of antiretroviral drugs, all these actions are the nurse’s (…). At the moment, there is an increase in syphilis in our state. It is one of the states that had a high rate of neonatal syphilis. (P3)

Currently, attention to STIs and AIDS is inserted in the various health facilities, where students work throughout the entire undergraduate teaching process. Thus, the professors place the need to address, in the curriculum, the contents considered a priority for nursing education.

Path of Approach to Sexually Transmitted Infections in a Nursing Undergraduate Course

The theme in the undergraduate course, in the view of the professors, has been treated in a prescriptive way, working a lot on prescriptive methods and thinking little about educational actions that could help in lowering the rates. It is noticed that the theme in the 1970s was undervalued in the nursing department, being linked only to the public health department, focused on immunizations and guidelines in general, covering topics such as hepatitis and syphilis. In the curriculum corresponding to the year 2004, it is pointed out that the topic of STIs and AIDS ended up being integrated into the area of women’s health and left the hospital focus, being disseminated to primary care.

The teaching of syphilis and venereal diseases in general was in the public health area totally separate from the hospital area. We went for practical activities at Nereu Ramos. We studied hepatitis, tuberculosis, but STIs were very few, it was more when we went to the public health department. The issues related to vaccines, treatment, guidance were more common, but nothing that we could get in touch. (C2)

When discussing what primary care is, STI can be addressed in children and adolescents, in women, in adults, in primary care (…). For example, HIV/Aids was already a topic that had been discussed, but focusing on hospitalized patients with HIV/Aids; later it was expanded. The 2004 proposal had the tonic of giving visibility to transversality and totally changing the role and importance of primary care in the curriculum. (C4)

There is a curricular path where the topic of STIs was approached in the logic of syphilis and gonorrhea, with the teaching of HIV being introduced in the institution in the late 1980s, closely associated with the public health department and its professors. Regarding teaching in the disciplines of the undergraduate nursing course, it was stated that it depends on the awareness and approximation of some professors to the subject.

In the field of mental health, the drug user, who comes with more strength, which has the CAPS AD (Psychosocial Care Center for Alcohol and Drugs), will be discussed, in harm reduction, it is implicit to STIs, and transsexual people will be discussed in some subjects. Theoretical teaching is given, certainly in the basic disciplines, pharmacology itself will think about medicines, or mechanisms of action, pharmacokinetics. (C5)

It arises in the issue of breastfeeding because students deal with breastfeeding, so it appears more as information. Milk transmits HIV, prevent yourselves, handle breasts with a glove for your protection, do not allow and guide cross-breastfeeding. (P1)

They instituted the international AIDS day, so we always used it… because the discipline had 3 parts, the woman, the child and the community (…) We did the educational activity with the students of the second phase, in agreement with the position, I went to the education sector of the State Health Department, in January, to collect material, folders, condoms (…). We set up a white tent at the front, and there they were handing out condoms among other things. (P6)

The insertion of the theme in the undergraduate course has a trajectory that is closely associated with the public health department and its educational actions, as well as educational activities aimed at primary care in the municipality where the university is located. Each professor engaged in disseminating information on the subject has a method, such as fixed actions on days already established with the basic unit, and nursing processes with people who have been diagnosed with HIV. The theme also appears closely associated with the context of sexuality, in actions aimed at teenagers in schools, or in the curricular subject of the course called “Body, Gender, and Sexuality”.

DISCUSSION

Historically, undergraduate nursing courses were built intertwined with public education and health policies. This study highlights STI intertwined in its early days with public health in its teachings and in its health promotion actions. In the 1970s and 1980s, the theme was involved in the obligatory nature of the discipline “Nursing and Communicable Diseases”. From the perspective of the discipline at that time, the authors state that the importance and need for educational action by nurses in the care of patients with contagious diseases led the discipline “Nursing in Communicable Diseases” to include, as one of the central objectives of the program, to enable students to instruct patients, family members and community groups about communicable diseases and their ways of prophylaxis(¹⁷).

The subject called “Nursing and Communicable Diseases” was included in the institution’s curriculum in 1977, continuing until 1981, with two credits, with the syllabus comprising (a) characteristics of a hospital to care for patients with communicable diseases; (b) hospital-health unit integration for the prophylaxis and treatment of communicable diseases; (c) identification of the nursing problems of patients with communicable diseases; (d) hospital, outpatient’s, and home nursing care”(¹⁸).

In this teaching-learning process in nursing, as well as in other courses in the health area, it has been noticed that education with a biomedical focus is not enough. In this study, it is evident that the topic of STIs was little addressed in undergraduate nursing course, being associated with specific actions of the public health department more related to immunizations and general information about syphilis, gonorrhea and hepatitis.

A study on the approach to teaching the subject “Nursing and Communicable Diseases” places themes such as vaccination calendars, health surveillance applied to the control of STIs, viral hepatitis, HIV/AIDS, syphilis, among others, as the basic structure of the subject. It also presents as the objective of the discipline to interpret the occurrence and confrontation of communicable diseases, and to develop nursing practices aimed at health surveillance(¹⁹).

During the 1970s and 1980s, the actions of this discipline were closely associated with the public health department and its actions in the teaching of the undergraduate nursing course. The professors at the time contributed to the theme introducing the most recurrent communicable diseases to the students, and promoting activities at the headquarters of the public health department.

With the AIDS epidemic, from the 1980s onwards, there has been a transition of knowledge, where the focus becomes the epidemic and its development, as it was little known at the time, and covered with stigma and prejudice. HIV/AIDS epidemic had three distinct phases in its characterization. In the area of health, when dealing with issues related to HIV/AIDS, the progression of the epidemic, changes in the profile of people affected, and economic variables brought concerns and required redefinitions (the first phase known as the “risk group” specifically associated with HIV-infected male homosexuals with a high level of education). Later, known as the concept of “risk behaviors” due to the high levels of contamination among injecting drug users and sex workers. Finally, the third and current one is understood as vulnerability, indicating the complexity involved in the disease for the entire population, being associated with the concept of social well-being adopted by the State(²⁰–²²).

Brazil’s response to the AIDS epidemic is associated with the context of the Brazilian Public Health System (SUS) and, since its inception, there has been a great movement for humanization in the provision of care and prevention, given the appropriation of technological advances and the extension of treatment for all people with HIV(²³). During SUS’s implementation over the years, a greater connection of health practices aimed at the promotion and not just the prevention of diseases is perceived. Health education and training and nursing studies bring the need to produce objective and clear knowledge about STIs, their risks and probabilities, as well as strategies for the development of skills in the future professional to understand risks and vulnerabilities(²¹).

It is important to place the concern with nursing training in the context of the SUS, demanding strategies from the Ministries of Health and Education that articulate and improve the training process so that students can act in the different Brazilian social and health realities. Thus, it is essential that educational institutions improve training for the proper management of STIs, and pay attention to the particularities of vulnerable social groups under which researches show the growth and impact of this problem. Social responsibility, in the context of health and of the organization of public health and educational policies, that makes education and the right to health possible in an equitable way. It should be highlighted that although the participants in this study present the possible fields of contact with the theme, few of them associate or represent SUS in their speeches in the management of STIs.

Associating public education and health policies reflects in teaching methodologies on direct care and direct observation in the fields of practice, where public policies are instituted and developed. When thinking about education and health, it is necessary to understand the importance of the university in its extension activities with the community and society, providing the construction of practices and interdisciplinary actions to respond to situations of vulnerability(²⁴). The role of professors of undergraduate nursing courses in the teaching-learning process requires some important characteristics, such as the ethical position in defense of life, promotion of citizenship, respect for knowledge, emancipation of the human person, search for dignified and egalitarian actions, among other aspects(¹²).

After the 1980s, the theme STI is implemented according to the choice of a teacher and their interest in theorizing it in classes or in the various scenarios of theoretical-practical activities, not necessarily being included in the teaching plan as something programmatic in a specific discipline, appearing during the course in a situational manner, assuming that not all students will have the same experiences.

Professors “are important for the training of individuals, especially if they are sensitized and motivated to contribute to education on STI in a critical and reflective way, which also implies sensitizing and educating nursing undergraduates about values in humanized care for the individuals”(¹²).

The study states that it is a challenge for higher education institutions to train health professionals with a humanist profile who are qualified to work in comprehensive health care, characteristics that are essential to the services of SUS, also considering the National Curriculum Guidelines(²⁵). University teaching requires that professors have specific knowledge on their training area, and that they act based on the pedagogical foundations of the teaching-learning process. Teaching is considered an activity that requires preparation and dedication, and has to provide tools capable of motivating student learning(²⁴).

Students appear as important representatives of educational actions that are linked to the training process and the local reality of basic health units. These activities are shown as important tools for approaching the theme of STIs and for managing them. Thus, professors mediate the relationship between the student and the professionals of the health units to raise important epidemiological problems that require intervention. Among the topics of importance, there are themes associated with STIs, with specific content on HIV and sexuality.

A study on the knowledge disseminated by undergraduate nursing students about STIs points to primary health care as the main scenario. It also states that health promotion actions are being intensified and being more comprehensive as the student progresses through the stages of the undergraduate course(²⁶).

From an international perspective, a study carried out in Canada reports that nursing practice focused on STIs has evolved over the years, encompassing different perspectives of care, especially because it is related to a problem that involves several factors - representations, practices, and behaviors related to sexuality. In the area of health care, nursing care can involve health education, comprehensive and complete assessment, counseling, immunizations, tests, treatment, active search for partners and support for users in decision-making(²⁷). There is a scarcity of literature on the experiences and attitudes of nursing students and professors when caring for people with HIV, as well as alternative teaching activities to address, for example, the stigma of HIV. Even though more than 30 years have passed since the first diagnosis of HIV/AIDS, there are still negative attitudes in the world associated with people with HIV. It is known that they are exposed to discrimination, stigma, negative attitudes and behaviors on the part of health professionals in health environments(²⁸–²⁹).

A study carried out in Turkey points out that interventions aimed at improving the knowledge and attitude of nursing students towards HIV/AIDS since graduation are required to prevent negative attitudes, stigma, and discriminatory behavior in healthcare environments. This behavior will bring significant results for both students and people with HIV(³⁰). Another study in Israel demonstrates that medical school curricula focus on the pathological issues of HIV infection and its effects on the host. The authors also state that there are no specific programs dedicated to addressing issues of stigma in relation to these specific populations of patients(³¹).

The teaching of STIs, in general, in the researched undergraduate course, is presented as something related to situations found in the health scenarios where students are inserted, in some specific classes that are related to reference professors on the subject and their awareness in spreading information about the theme, as well as in classes of the disciplines of basic nursing education, disconnected from the disciplines offered by the institution’s nursing department. The commitment to this content appears associated with some professors’ practical professional experiences; the theme also seems very close to some clienteles and places, such as primary care in basic health units, schools, or even direct care to patients with HIV.

CONCLUSION

The course’s approaches to the theme were historically developed in accordance with the global epidemiological framework and the health reality of the southern region of Brazil, being directly linked to the professors of the public health department in the 1970s and 1980s. The focus of the approach was a preventive one, through visits and educational actions aimed at the promotion, prevention and guidance of some specific STIs such as syphilis and hepatitis, which are closely associated with the Sanitary Reform movement and the strengthening of the Brazilian public health. Gradually, the potential of teaching STIs by nursing professors becomes evident, especially since the advent of AIDS, the very implementation of the SUS, and the progression of public policies aimed at this health problem, demonstrating the need for health professionals’ adaptation. Over the years, this content was gradually assumed by the nursing department professors, offering the student situational and specific teaching opportunities in the fields of theoretical-practical activity aimed at education and health promotion in the community in general.

A critical issue identified and that should be a warning to educators is that the topic is still associated with reference professors or professors that are sensitive to the topic to the point of including it in their classroom programs or theoretical-practical activities. The content is offered in the disciplines of basic education or transversally in disciplines of the undergraduate nursing course. This situation is configured as a major weakness in undergraduate courses. Also, it can be minimized through scheduled regular curriculum assessments to assess the mandatory and necessary contents for the training of undergraduate students.

Conducting this research in a region of Brazil with large epidemiological indices of STIs, combined with the need for professionals to know how to intervene in the health reality where they work, shows that knowledge on the subject is an important tool in the prevention of STIs.

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• Financial support The support of the National Council for Scientific and Technological Development (CNPq) for the development of this study.

Publication Dates

• Publication in this collection
  10 Sept 2021
• Date of issue
  2021

History

• Received
  21 Jan 2021
• Accepted
  17 May 2021