Valéria Gomes Fernandes da Silva¹

Bruno Neves da Silva²

Maria Aparecida Alves de Oliveira Serra³

Anny Suelen dos Santos Andrade⁴

Érika Simone Galvão Pinto⁵

Nilba Lima de Souza⁶

¹Universidade Federal do Rio Grande do Norte. Natal, RN, Brasil. ORCID: 0000-0003-1381-8664. E-mail: valeriafernandes7@hotmail.com.

²Universidade Federal do Rio Grande do Norte. Natal, RN, Brasil. ORCID: 0000-0001-9854-4492. E-mail: enfbneves@gmail.com.

³Universidade Federal do Maranhão. Imperatriz, MA, Brasil. ORCID: 0000-0003-0952-9560. E-mail: maa.oliveira@ufma.br.

⁴Universidade Federal do Rio Grande do Norte. Natal, RN, Brasil. ORCID: 0000-0001-7460-5625. E-mail: anny_suelen@hotmail.com.

⁵Universidade Federal do Rio Grande do Norte. Natal, RN, Brasil. ORCID: 0000-0003-0205-6633. E-mail: erikasgp@gmail.com.

⁶Universidade Federal do Rio Grande do Norte. Natal, RN, Brasil. ORCID: 0000-0002-3748-370X. E-mail: nilba.lima@hotmail.com.

Autor correspondente

Valéria Gomes Fernandes da Silva

Endereço: Avenida Senador Salgado Filho, n. 64. Bairro: Lago Nova. Natal-RN. CEP: 59056-000

E-mail: valeriafernandes7@hotmail.com

Telefone: +55(99) 98531-8939

ABSTRACT

Objective: to reflect on the serodifferent relationships to the HIV virus and its challenges based on Arthur Schopenhauer's philosophy of will. Method: this is a theoretical-reflective study carried out from the search for articles and books, in the months of October and November 2021. Results: It is observed that Artur Schopenhauer's conceptual assumptions and philosophy of will are related to the current context regarding the challenges that serodifferent partners experience in their relationships, such as the invisibility of these relationships in the condition of serological difference before society and in health services, prejudice and lack of information about the possibilities that overlap with the concept of suffering and pain, constantly associated with these partnerships. Final considerations: the reflections carried out indicate that the desire of the sexual partners to remain in the relationship in a condition of serodifference to the HIV virus is the matrix force to overcome the challenges and risks peculiar to this form of coexistence. It is believed that the understanding of serodifferent relationships to the HIV virus from a philosophical foundation is relevant in the process of resignifying the infection in society, by health professionals and in the different scopes of the services responsible for monitoring and welcoming these partners.

Keywords: HIV; Health Services; Sexual Partners; Acquired Immunodeficiency Syndrome; Philosophy.

RESUMEN

Objetivo: reflexionar sobre los desafíos vividos en las relaciones serodiferentes con el virus del VIH a partir de la filosofía de la voluntad de Arthur Schopenhauer. Método: se trata de un estudio teórico-reflexivo realizado a partir de la búsqueda de artículos, libros, disertaciones y tesis en los meses de octubre y noviembre de 2021. Resultados: Se observa que los presupuestos conceptuales y la filosofía de la voluntad de Artur Schopenhaouer están relacionados al contexto actual respecto a los desafíos que experimentan las parejas serodiferentes en sus relaciones, tales como la invisibilidad de estas relaciones en condición de diferencia serológica ante la sociedad y en los servicios de salud, el prejuicio y la falta de información sobre las posibilidades que se superponen al concepto de sufrimiento y el dolor, constantemente asociados a estas asociaciones. Consideraciones finales: las reflexiones realizadas indican que el deseo de los compañeros sexuales de permanecer en la relación en condición de serodiferencia al virus del VIH es la fuerza matriz para superar los desafíos y riesgos propios de esta forma de convivencia. Se cree que la comprensión de las relaciones serodiferentes al virus VIH desde una base filosófica es relevante en el proceso de resignificación de la infección en la sociedad, por parte de los profesionales de la salud y en los diferentes ámbitos de los servicios encargados del acompañamiento y acogida de estos asociados.

Palabras clave: VIH; Servicios de Salud; Parejas Sexuales; Síndrome de Inmunodeficiencia Adquirida; Filosofía.

RESUMO

Objetivo: refletir sobre as relações sorodiferentes ao vírus HIV e seus desafios a partir da filosofia da vontade de Arthur Schopenhauer. Método: trata-se de um estudo teórico-reflexivo realizado a partir da busca por artigos e livros, nos meses de outubro e novembro de 2021. Resultados: Observa-se que os pressupostos conceituais e a filosofia da vontade de Artur Schopenhaouer têm relação com o contexto atual referente aos desafios que os parceiros sorodiferentes vivenciam em suas relações, como a invisibilidade dessas relações na condição da diferença sorológica perante a sociedade e nos serviços de saúde, o preconceito e a falta de informação acerca das possibilidades que se sobrepõem ao conceito de sofrimento e dor, constantemente associados a essas parcerias. Considerações finais: as reflexões realizadas sinalizam que a vontade dos parceiros sexuais de permanecer no relacionamento em condição de sorodiferença ao vírus HIV é a força matriz para vencer os desafios e riscos peculiares a essa forma de convivência. Acredita-se que a compreensão das relações sorodiferentes ao vírus HIV a partir de uma fundamentação filosófica é relevante no processo ressignificação da infecção na sociedade, pelos profissionais de saúde e nos diferentes âmbitos dos serviços responsáveis por acompanhar e acolher esses parceiros.

Palavras-chave: HIV; Serviços de Saúde; Parceiros Sexuais; Síndrome da Imunodeficiência Adquirida; Filosofia.

INTRODUCTION

The current reality of people living with the HIV virus, which causes the acquired immunodeficiency syndrome, has been transformed when thinking about the evolution of this infection over the forty years that have passed since its discovery ¹. This evolution has ensured numerous advances and possibilities for an increasingly better quality of life, through treatment policies, strategies to combat and prevent infection made available to these people, which is reflected in their individual and collective context ^2,3,4.

As a result of these achievements, serodifferent affective/sexual relations or mixed serology, characterized by a partner who has HIV positive serology and other negative serology, are increasingly visible in health services, compared to the first years of the epidemic, are visualized in the presence of the positive partner who is accompanied in the service, either by the negative partner through the search for Pre-Exposure Prophylaxis (PrEP) or Post-Exposure Prophylaxis (PEP), or when sexual partners together seek services ^5,3.

Despite the advances in recent decades, regarding the treatment, control and prevention of HIV infection, in other respects, this speed has not been the same success, as is the case, of the stigma and prejudice reported by people living with HIV, especially those who are in different serodifferent relationships ^6,7.

The strongly disseminated thought in society that the serodifferent relationships to the HIV virus are characterized as sick, condemned to death or to live a chronic suffering, in which the transmission of the virus to the negative partner is only a matter of time, show themselves as a challenge to stay in these relationships ⁷. Although demotivating, this reality still reaches important scenarios, such as the health service, in which professionals with outdated knowledge become acquiescent of these stigmas, and weaken comprehensive and humanized care. For the most part, the lack of knowledge and training, as well as the reproduction of stigmatized behaviors, are highlighted as potentiating in the face of misunderstanding and prejudices that surround the partnerships serodifferent to the HIV virus ^8,7.

By establishing a different serodifferent relationship, as in any other type of affective relationship, the intention is to freely live your sexuality moved by the most varied feelings or desires. For the World Health Organization, sexuality is understood from the integral exercise of the human personality, which has the power to connect to people through feelings, thoughts, actions, behaviors, dialogues, intimacy, pleasure, and is not limited to the organic nature, but has the ability to integrate biopsychoemotional aspects from one individual to another ⁹.

This understanding is necessary, because it is part of the idea that serodifferent relationships need to be reflected initially as any relationship established between two subjects moved by the desire to live their sexuality, which is individual and subjective, with another partner, regardless of their serological status ¹⁰.

In this sense, the present study started from the following question: How can serodifferent relations to HIV and its challenges be thought of from the philosophy of Schopenhauer's will? Therefore, the study aimed to reflect on the different serodifferent relationships to HIV and its challenges from the philosophy of Arthur Schopenhauer's will.

The study was structured in two reflective axes. The first was listed concepts departing from the thought of the philosopher Arthur Schopenhauer focusing on his philosophy of will as a representation of the world, and the second presented reflections about the established relationships of philosophical aspects with the serodifferent relations to HIV, focusing on the challenges experienced.

SCHOPENHAOUER AND THE WILL AS REPRESENTATION OF THE WORLD

Arthur Schopenhauer, a German philosopher, was born in 1788, and is dedicated to the studies of philosophy and takes as reference conceptual and reflective bases of Plato, Immanuel Kant and Hindu philosophy ^11,12. It stands out in the nineteenth and twentieth century from its philosophy, which could also be known as metaphysics of the will, in which it is born from his best known and important work "World as Will and Representation" written between the period 1814 to 1818, and published fragmented in four parts, the first published in 1818 ¹³.

The construction of the conceptual basis of the world as will and representation, initially part of one of the great influences that Schopenhauer received, Kant's thought about the attempt to come to the knowledge of things themselves, which, even considering impossible, believed that the starting point would be practical experiences from phenomena, starting from how things are presented in everyday life, that for Kant would be the fundamental and universal knowledge of things ¹⁴.

In this sense, Schopenhauer considers the knowledge of the thing itself, the will itself. For the philosopher will goes beyond a desire, it is related to the cosmic force that drives the experience of all beings, through individuality and subjectivity. His philosophy is known for revealing the appreciation of the will in the face of reason, and, therefore, to highlight it as the essence of all that exists, for it is impossible for man before, from his existence, to escape it ¹⁴.

Thinking of the will as the impulse for the experience of beings, Schopenhauer highlights that man transfers the whole meaning of his existence in objects, understood as anything that stands before the human being. The object carries its importance and cannot be thought without subject and vice versa, because each of them has meaning and existence only for and through the other, this relationship between subject and object, Schopenhauer called the objectification of the will ¹⁴.

The objectification of the will translates the empirical subject who is active in the world, whose essence is felt in the externalization of his actions as an active force, a fact of consciousness that is nothing more than the will ¹⁴. Thus, the consciousness of the individual is responsible for making him perceive as something he wants, that is, as an individual manifestation of the will, which deals with the objects of this desire, the external things of the world through the representation that has them ^14,15.

Representation, therefore, is a fact of consciousness, it is abstract and conscious knowledge of what is perceived of an object, that is, it is accessing the world from the representations of phenomena, which explains one of Schopenhauer's maxims "the world is my representation" 14. Everything that is perceived of the world through will is a representation of the world, however, the world itself is unknown, one only knows the representation that reaches us, that is, phenomena, through will ¹⁴.

The will as the essence of life, it is born from a lack from a state of suffering, because for the philosopher, when the will is not satisfied, suffering settles. When it is achieved, the will does not cease, for one will never reach a state of full satisfaction, assuming that new perspectives to satisfy will arise. Such understanding impels Schopenhauer to affirm that life is a valley of tears, in which he reveals the suffering condition of the human being in an infinite circle of pain and neediness ¹⁴.

This vision reveals that at the same time that the will leads to desire in the human being of life, it also leads to suffering, and that the greater the conscious objectification of the will, the greater its suffering, because the will is irrational and reason appears only as a tool. This thought explains one of the striking characteristics of Schopenhauerian philosophy: pessimism ¹⁴.

Even in the state of submission to the wills, suffering is inevitable, because when the individual reaches the reach of his desires, the feeling will not be of happiness, but of boredom. Therefore, living would be a state of perpetual suffering, in which there is no possibility to be happy ^{14, 16}.

These concepts constitute and substantiate Schopenhauer's basic philosophy, giving way to even deeper and more varied dives that will later influence and propel theories and thoughts of other philosophers, such as Frederich Nietzshe and Sigmund Freud ¹¹.

THE HIV-POSITIVE RELATIONSHIPS AND THE THOUGHT OF SCHOPENHAOER

The relationships serodifferent to the HIV virus face in society the challenges that are to live their sexuality and partnership with the presence of a virus considered incurable ¹⁷. These challenges extend to different reasons, such as the presence of stigma and prejudice present from the beginning of the infection and that lasts until the present day, the lack of understanding of what these relationships really are, the existing preventive care and methods, and how they should be seen ⁷.

These challenges seem to have different origins, however, the Schopenhauerian philosophy invites a reflection in which it is possible to think of these relationships as a manifestation of the will of two subjects who in their individualities and essence decide and allow themselves to live the phenomenon of serodifference in the world. And for this, it is not necessary to think of a reason that explains what for many would be irrational to live, as is the case of being affectively and sexually involved with someone who lives with the HIV virus, because the will exists by itself and it is able to move the human being in the world.

This understanding is necessary because it reflects the idea of freedom in living the choices and desires that is proper to each being ¹⁵. Its importance extends to society in general that needs to normalize the existence of these relationships, not starting from a fictitious idea that the virus does not exist in the face of sexuality of sexual partners and thus neglect care, but seeing these relationships as possible and real, worthy of living all the possibilities that an affective relationship without the virus can, for example, pregnancy ⁵.

Another scenario that deserves this reflection is health services from Primary Health Care (PHC) to Specialized Care Services (SAE), responsible for welcoming serodifferent couples and providing necessary therapeutic care ¹⁸. The correct management of health professionals to deal with these couples is a challenging reality, because it is due to the lack of knowledge and preparation associated with stigmatizing concepts fed in social life and that are reproduced in the services ^19,20. These dilemmas can be enhanced or even born from the lack of understanding about respect for will as the essence of each subject.

In this context, the seronegative individual suffers from misunderstanding and ends up being judged by the choice of remaining by the partner, in situations where the virus has already arisen in an existing relationship, or when he decides to enter into a relationship of this nature. This judgment, much due to the thought of those who see them from the outside because it is not a will that they theoretically would have or would give in to the possibility of involvement with a partner living with HIV. It is at this point that Schopenhauer's philosophy draws attention, because if the will is the essence of the human being, and it is individual and subjective, that is, everyone felt in its own way, then the wills of some should not be judged based on the wills of the others ^14,15.

By analyzing the pessimistic characteristic of Schopenhauerian philosophy, suffering can be reflected from two contexts when referring to serodifference. Based on the thought that the will never exhaust, partners experience the dilemma of even being aware of the importance of using preventive methods, they are encountered with the desire to live free sexual intercourse, without the interference of a protection method, as is the case of condoms ^10,21. Even currently having reached the rate of viral load I=I (Undetectable is equal to Non-transferable) from the treatment with antiretrovirals, there is still the fear of transmission, and the feeling of anguish remains ²¹.

Another important reflection on suffering is the negative view constructed by society on serodifference, which converges to the idea that relations of this nature are condemned to suffering, because as there is no cure, they will constantly live hostages of pain. This characteristic was remarkable in the first three decades of infection, however, current scientific evidence shows that this reality still takes considerable space ²⁰.

In Metaphysics of Love and Death book considered supplementary the work World as Will and Representation, Schopenhauer speaks of love and death as phenomena that cause suffering ¹⁴. When thinking about the metaphysics of love, a parallel is drawn with the experience of sexuality, in which it reveals that sexual impulses are the core of the will of the bodies, moved by love, the driving force of this desire. And even in the face of the existence of the suffering that is inevitable for him, facing it from the dangers that may arise from the satisfaction of the core of his being moved by will is worth ¹⁴.

FINAL CONSIDERATIONS

Schopenhauer's philosophy allows us to reflect the serodifferent relationships to the HIV virus from the will as the essence of the human being that manifests itself in the world. A world, starting from the context of society, sees them in a conflicting and prejudiced way. In addition, it draws attention to the starting point that these relationships should be observed, which strengthens and directs the achievement of a basic understanding necessary in the process of resignification of HIV infection.

The interaction of serodifferent relationships in Schopenhauer perspective both evidences the direction for a better understanding of the experience of relationships of this nature, and brings the reality of the challenges through its pessimistic characteristic about suffering, which time actually presents itself as a reality, time consists only in the reflection of the stigma reproduced in society. Moreover, it is important to consider that, despite all the risks existing in the different serodifferent relationships, the permanence in the relationship has a close relationship with Schopenhauer's philosophy, in which the will to remain in the relationship is the matrix force to overcome the challenges.

In health practices, these reflections point to the need for constant updating and professional training at the same rate as the evolution of policies and strategies to cope with HIV infection occur, since the competent and up-to-date performance of health professionals will be decisive to intensify health education actions in society, and the comprehensive and welcoming care of serodifferent partners, and in the scope of nursing practice this is no different.

Since nursing is the profession that frequently performs the first care and the reception of the individual in the health service, it is indispensable to understand the different serodifferent relationships, both with regard to their clinical and social aspects, and the reflections raised from the Schopenhauerian philosophy enable the nursing professional and the entire multidisciplinary team to develop critical-reflexive thinking beyond clinical reasoning, contributing to the development of care congruent to the specificities of its clientele.

Limitations indicate the scarcity of studies that promote the foundation of the theme in question with a philosophical contribution. Thus, this study assumes an innovative character contributing to support important reflections in the context of health and nursing.

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