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Conteúdo (article):

INTERAÇÃO SOCIAL DE MULHERES BRASILEIRAS QUE PROFESSAM RELIGIÃO PROTESTANTE COM A EXPOSIÇÃO AO HIV/AIDS

SOCIAL INTERACTION OF PROTESTANT BRAZILIAN WOMEN WITH EXPOSURE TO HIV/AIDS

INTERACCIÓN SOCIAL DE MUJERES BRASILEÑAS QUE PROFESAN RELIGIÓN PROTESTANTE CON EXPOSICIÓN AL VIH/SIDA


Carla Marins Silva
Antonio Marcos Tosoli
Lloyd Goldsamt
Heloisa Gonçalves Silva
















Resumo
Objetivou analisar o processo de interação social de mulheres brasileiras que professam a religião protestante com a exposição ao HIV/AIDS, segundo os significados por elas atribuídos. Estudo qualitativo, interpretativo, com 24 entrevistas por videoconferências. Análise apoiada no Interacionismo Simbólico e Grounded Theory. As mulheres significam exposição ao HIV/AIDS como falta de métodos preventivos tradicionais, de ensinamentos cristãos e condenação do outro. Resgatam memórias de tabu, sentidos de doença grave e normas religiosas protetivas. Avaliam sua exposição como baixa e tentam agir desde os ensinamentos cristãos com o casamento, preservativos para controle de natalidade e orientando outras pessoas. Interpretam negativamente a pouca abordagem de algumas igrejas, os preconceitos contra pessoas com HIV e a impulsividade das pessoas fora do meio cristão. Procuram viver o melhor dos dois mundos, cristão e não cristão, buscando conhecimentos. Categoria central: Recomendando cuidado do corpo, templo do Espírito Santo, com uso de preservativos em situações não condizentes com a vida cristã. Conclui-se que o modelo representativo evidencia distanciamento das mulheres com a exposição ao HIV/AIDS como “doença do outro”, sugerindo potencial das instituições religiosas como promotoras de saúde.
Palavras-chave: HIV. Síndrome da Imunodeficiência Adquirida. Religião. Saúde da Mulher.

Abstract
The present study aimed to analyze the process of social interaction of Brazilian women who profess the Protestant religion with exposure to HIV/AIDS, according to the meanings attributed by them. This was a qualitative, interpretative study with 24 videoconference interviews, analyzed based on Symbolic Interactionism and Grounded Theory. These women define the exposure to HIV/AIDS as a lack of traditional preventive methods, Christian teachings, and a condemnation of the other. They recall memories of taboos, meanings of serious illness, and protective religious norms. They assess their exposure as low and try to act on Christian teachings with marriage, condoms for birth control, and the mentoring of others. They interpret negatively the limited approach of some churches, the prejudice against people with HIV, and the impulsiveness of people outside the Christian environment. They seek to live the best of both worlds, Christian and non-Christian, constantly seeking knowledge. Core category: Recommending care for the body, the temple of the Holy Spirit, through the use of condoms in situations that are not conducive to a Christian life. In conclusion, the representative model shows that women distance themselves from exposure to HIV/AIDS as a “disease of others”, suggesting the potential of religious institutions as health promoters.
Keywords: HIV; Acquired Immunodeficiency Syndrome; Religion; Women\'s Health.


Resumen
El objetivo de este estudio fue analizar el proceso de interacción social de las mujeres brasileñas que profesan la religión protestante con exposición al VIH/SIDA, de acuerdo con los significados atribuidos por ellas. Se trata de un estudio cualitativo, interpretativo, con 24 entrevistas por videoconferencia. Análisis sustentado en el Interaccionismo Simbólico y la Teoría Fundamentada. Las mujeres se refieren a la exposición al VIH/SIDA como la falta de métodos preventivos tradicionales, las enseñanzas cristianas y la condena del otro. Rescatan recuerdos de tabúes, sentidos de enfermedades graves y normas religiosas protectoras. Califican su exposición como baja y tratan de actuar a partir de las enseñanzas cristianas con el matrimonio, los condones para el control de la natalidad y guiar a otros. Interpretan negativamente el poco acercamiento de algunas iglesias, los prejuicios contra las personas con VIH y la impulsividad de las personas fuera del ambiente cristiano. Buscan vivir lo mejor de ambos mundos, cristiano y no cristiano, buscando el conocimiento. Categoría central: Recomendar el cuidado del cuerpo, templo del Espíritu Santo, con el uso del preservativo en situaciones no coherentes con la vida cristiana. Se concluye que el modelo representativo evidencia el distanciamiento de las mujeres de la exposición al VIH/SIDA como una "enfermedad del otro", sugiriendo el potencial de las instituciones religiosas como promotoras de salud.
Palabras clave: VIH. Síndrome de Inmunodeficiencia Adquirida. Religión. Salud de la Mujer.

 
Introduction
Human Immunodeficiency Virus (HIV) affects a significant portion of the global population, although new cases have been decreasing worldwide1. However, in Brazil, between 2020 and 2023, cases increased by 24.1%, particularly in the North and Northeast regions2. In this context, between 2007 and June 2024, 541,759 cases of HIV infection were reported in Brazil through SINAN, with the highest concentration occurring in the Southeast region2.
Given this epidemiological scenario, women represent around 53% of all people living with HIV and 44% of new infections in 2023 worldwide1. In Brazil, in 2022, new infections in women, aged 15 to 49 years, accounted for 78.3% of all infections in women, while cases among women, aged 50 or older, rose from 11.4% in 2012 to 20.3% in 20222.
Female vulnerability is a major global health challenge, considering nuances and worldviews embedded in different beliefs and cultures, in addition to gender issues. Relating the religious issue and its connection to female vulnerability to HIV makes it important to consider the religious profile of Brazil and the stereotypes marked by moral judgments. In this sense, from a gender perspective, the naturalization of a sexist idea that cisgender and heterosexual women live in stable monogamous relationships makes vulnerabilities invisible, placing these women in a false scenario of protection3.
Moreover, despite the transformations related to sexual rights, in religious norms, especially Christian, issues related to sex are associated with marriage and human reproduction, which can be understood as a form of oppression or control of the expression of sexuality4. This phenomenon highlights the power and influence of these ideas on the sociocultural factors that can promote female exposure to HIV/AIDS as well as characterize AIDS as a disease of the other5.
Furthermore, this scenario is amplified in women\'s relationships with their intimate partners, revealing the persistence of gender inequalities. In the context of protective measures against HIV/AIDS exposure, women trust their partners and expect actions to preserve their lives, revealing the importance of knowing their partner and the couple\'s intimacy as a form of "control" over exposure5.
Simultaneously, most of these religions promote conservative behaviors to reduce vulnerability6. Being religious and frequently attending religious services are associated with lower chances of acquiring STIs and a lower self-assessed risk of contracting HIV/AIDS, especially for adherents of Christianity7. A protective association between religion and spirituality in HIV prevention is evident8.
Thus, it is important to consider the Brazilian religious landscape. According to Global Religion9, deviating from the global average of 61%, approximately 89% of all Brazilians believe in God or a higher power that allows them to overcome such crises as diseases, conflicts, and disasters. Additionally, 76% follow some form of organized religion, mainly Christian (70%). Despite this demographic importance, there are gaps in scientific knowledge that underpin strategies for controlling the epidemic.
Therefore, the present study aimed to analyze the social interaction process of Brazilian women who profess the Protestant religion with exposure to HIV/AIDS, based on the meanings they attribute to it. For this, we relied on Symbolic Interactionism, a framework for observing human behavior by understanding the meaning of everyday life in which individuals interact10.
The three premises of Symbolic Interactionism are: 1) human beings act in relation to things based on the meanings that these things represent to them; 2) the meaning of things originates from the social interaction that the individual establishes with others; and 3) these meanings are manipulated and modified by an interpretative process during social interactions10.
Therefore, it is understood that the meanings that religious women attribute to exposure to HIV/AIDS are constructed throughout their experiences and perceptions of the past, which are reinterpreted in the present, in a dynamic and continuous process. Through interactions, they set goals, apply appropriate perspectives, take on the roles of others in the situation, pinpoint and define the objects of the situation, and observe themselves within the situation. From there, they determine the course of action in relation to the objects, including other individuals. Subsequently, they act openly, which is social action, interpreting their own actions in light of the actions of others, as well as interpreting the actions of others, a fact that determines the construction of meanings. At the same time, other individuals give meaning to this action, according to their perspectives and definitions; define a course of action; and act openly. Finally, the women review perspectives, redefining the situation and their course of action in relation to HIV/AIDS11,12,13.

Method
This work is a qualitative, interpretive study, based on the theoretical and methodological assumptions of the classical approach to Grounded Theory14. The criteria of the Consolidated Criteria for Qualitative Research Reports (COREQ) were respected for the presentation of the methodology.
Grounded Theory deals with the understanding and interpretation of social reality and socially constructed meanings. A theory emerges from the analysis of qualitative data through the comparison of incidents, the proposition of concepts, and the formulation of hypotheses, which, when compared with more incidents, deepen their theoretical properties. This procedure is called constant comparative analysis14,15.
According to Grounded Theory, initially, there is no prior definition of the number of participants, and the constitution of the sample groups is defined during the study by constant comparative analysis15,16. The total number of women was determined according to the criterion of theoretical saturation14. According to Glaser and Strauss16, saturation occurs when the collection of new information no longer allows for elucidations concerning the object of study or adds properties to a category16.
The sampling was carried out by snowball sampling, in which the initial participants (seeds) with the necessary profile for data collection found in the population. These "seeds" indicate other people with the desired profile. This process occurs successively17. In this study, the "seed" was collected through social networks. Through an exchange of messages, the Informed Consent Form was sent, and an online meeting was scheduled for a recorded interview via videoconference, using the Google Meet® application. The online format allowed for the recruitment of women from different locations in Brazil. Each participant indicated other potential participants, and so on.
Twenty-four semi-structured interviews were conducted with women, aged between 20 and 61 years, who profess the Protestant religion. The script consisted of two parts: the first, with characterization data (age range, education, marital status, weekly attendance, role performed, and time of participation in the religion) and, the second, with a trigger question (what does exposure to HIV/AIDS mean to you?) and topics that were introduced in the interview (individual, social, and relational exposure to HIV/AIDS, condom use, sexuality, and religious affiliation).
During data collection and analysis, memos were recorded, which, according to Glaser14, are the researcher\'s methodological and theoretical notes. The data were analyzed according to the assumptions of IS10 and the stages of the classical approach to Grounded Theory14,15, such as open, selective, and theoretical coding in inductive, comparative, and emergent forms.
Using the ATLAS.TI 9 software, quotations were selected, codes were created, and groups of codes were created to identify the core category. The study respected ethical aspects and was approved by the Research Ethics Committee (Comitê de Ética em Pesquisa – CEP) of the University of São Paulo (USP).

Results
To form the first sample group, Brazilian women, residents of the city of São Paulo, over 18 years of age, who professed the Protestant religion, were selected. Women diagnosed with HIV/AIDS and/or with speech impairments or psychiatric disorders were excluded. Thus, this group consisted of six women, married, highly educated, belonging to the aforementioned religion since birth or who had professed it for at least 5 years, with high frequency of church attendance and with roles in ministries or pastoral work.
A comparative analysis of the data identified the influence of Christian teachings on the thinking and acting in the world of the first sample group. In this comparison, the role of marriage as protection, the informed discourse on exposure to HIV/AIDS, and traditional forms of prevention without using them stand out. Another point is the participants’ standpoint as "representatives" of the Church. At this stage of analysis, the following question arose: Do women who attend church only once a week for worship have the same discourse and behavior?
Group 2 was then set up with six women who attended church only once a week, as listeners and only playing musical instruments during the service. These women were married, highly educated, and had been practicing the Protestant faith for more than five years. At this stage of the analysis, there was greater openness in discussing the topic and criticism of the Church’s rigid positions and lack of a specific approach.
Considering that the participants in groups 1 and 2 have many years of religious affiliation, the idea arose to compare the data with participants who have professed the religion for less than 5 years. Therefore, a third sample group was set up with 4 participants, each with less than five years in the evangelical religion, with no alterations in the phenomenon.
A fourth group was then set up with young, single women, with the addition of the idea of filtering between church teachings and "worldly" teachings, with actions according to their conclusions. Next, the fifth group consisted of young married women, maintaining the same idea.
However, up to this group, all the women interviewed had high levels of education. Hence, women with low levels of education, regardless of age or marital status, were sought for the sixth sample group. These women reported memories of having close people or acquaintances who died of AIDS and, therefore, were afraid of exposure.
Given this intentional process of theoretical sampling, it is important to highlight that no differences were found between the groups that could interfere in the comparative data analysis process.

CATEGORY 1: MEANING OF EXPOSURE TO HIV/AIDS WITH DISTANCING.
The participants interpret exposure to HIV/AIDS with detachment from a scientific perspective, under the gaze of religion and condemnation from other individuals. They thus define the non-use, by individuals, of traditional preventive measures and the failure to adopt care in the context of relationships.
Influenced by church doctrines, for them, exposure to HIV means a lack of care on the part of individuals in not knowing the person with whom they have affective and sexual relationships, and a lack of boldily care due to promiscuity and a lack of Christian teachings from birth, in addition to considering it a death sentence for other people and synonymous with danger and fear.

CATEGORY 2: REFLECTING ON THE EXPOSURE OF OTHERS
When questioned about HIV/AIDS exposure, women enter the situation and recognize the social objects involved. They then recall memories from the past, the meaning of exposure, and religious norms. They recall the taboo related to sex and related topics within the family and attribute the limited information about sexuality, diseases, and prevention to the ignorance, shame, or fear of their parents. They report that, when there was dialogue, the recommendations focused on caring for the body through chastity and choosing partners. They report that the topic of "HIV exposure" was primarily addressed in educational settings, among friends, healthcare professionals, and the media, that is, outside the family.

Reflecting on the meanings of illness and the exposure of others.
For the participants, it is a serious and frightening disease, reminiscent of cases of close or famous people who died of AIDS. They understand it as a cultural, social, and family issue with prejudice. Despite this, they reflect on the amount and ease of access to information available today. They point to the greater vulnerability of certain groups, such as sex workers, homosexuals, and drug users. However, they emphasize the importance of not excluding these people and that AIDS is not the end of life.

Retrieving religious norms as protection.
For these women, sexual relations are something divine, an intimate act of surrender, trust, and union with their spouse. They report that the church preaches marriage and care for the body, the temple of the Holy Spirit, with sex only after marriage. Moreover, Christians need to be more careful, as they are more visible in God\'s eyes. The participants affirm that the fear of God favors appropriate behaviors and, therefore, the care of the body, life, and mind, in the pursuit of a life of holiness.
In this sense, caring for the body demands restrictions on behaviors that are inconsistent with the Christian life, such as the use of drugs and alcoholic beverages, promiscuity, and not dancing to certain musical rhythms.
The use of condoms and contraceptives is not explicitly prohibited and is seen as a choice for the couple, usually focused on birth control.

CATEGORY 3: LOOKING AT YOURSELF IN RELATION TO DISTANT EXPOSURE TO HIV/AIDS
After defining the meanings of HIV exposure and recognizing social objects, they define the situation for themselves based on their experience within the Christian community, where, regardless of how long they have professed the religion, they report following Christian teachings and taking care of their body, mind, and soul to be temples of the Holy Spirit.
After defining the situation for themselves, the women determine their course of action in relation to social objects. Thus, based on the application of past experiences, perspectives from reference groups, considerations about the future, and putting themselves in the other\'s place, they assess their exposure to HIV as low.
To determine the course of action, they evaluate possibilities and intervening conditions, review perspectives, and define the course of action considering HIV/AIDS distant from their realities, since they do not have intimate relationships with people with HIV, do not have behaviors considered deviant and believe in the fidelity of their partner, or do not have sexual partners because they are single and saving themselves for marriage.

CATEGORY 4: APPLYING CHRISTIAN TEACHINGS FOR SELF-PROTECTION AND THE PROTECTION OF OTHERS
By seeking action and interaction strategies, they act openly, trying to apply Christian teachings to their lives. In fact, considering the explanatory theoretical model, these are actions based on strategic and tactical reflection according to the Christian environment in which they live.
For them, a religious background is a criterion for choosing a husband as a form of security, including sexual relations only after marriage. They therefore do not feel the need to talk to their husbands about exposure. They use good quality condoms for birth control and comfort but indicate that they do not need to use condoms as protection against diseases.
Another form of protection is the performance of premarital diagnostic tests and regular medical routines after marriage. Assessing their exposure as low, they openly guide other people in specific ways according to the audience, dividing people between those from the Christian environment and those outside this environment.
For family members or church brothers and sisters, they provide guidance on sexuality without encouraging its practice and bodily care based on Christian teachings, including chastity and sex as worship to God. However, outside of Christian groups, acquaintances or work colleagues often recommend traditional prevention methods. They discuss famous media cases and comment on medical routines and diagnostic tests as a responsibility to care for one\'s body. Furthermore, they advise undergoing procedures in reputable clinics to protect against other forms of transmission and try not to judge the choices of others.

Interacting with the actions of others and interpreting them in relation to HIV/AIDS exposure.
Social interaction, built from social action and interpersonal interaction with the Protestant church and the individuals around them, makes them social objects for one another. Through communication, using social and cultural symbols, participants learn about bodily care in an approach that is different from science or public health policies. They report that the church does not prohibit or interfere in Christians’ choice to use condoms, but they also do not address the topic in the Christian community.
At this point, they engage in mental action, using the self and justifying that the church does not address this topic frequently because, in theory, relationships are monogamous and cases are rare in the Christian community. However, they consider churches that are uninformed or too rigid in their approach to their congregation to be a challenge.
For them, people infected with HIV do not normally announce their health condition to the Christian community. Despite this, interpreting these actions, the participants understand the context of fear and prejudice of people with HIV, and value non-exclusion for guidance on self-care and care for others.
They interpret this as meaning that people living in contexts outside the Christian church act impulsively without believing in the possibility of an infection like HIV, even with access to information. According to them, non-Christians tend to have behaviors considered deviant, such as promiscuity, premarital sex, and drug use, in addition to trusting their partners.

Interpreting one\'s own actions in relation to HIV/AIDS exposure in light of the actions of others.
At this stage, these Christian women seek to interpret their own actions in light of their own interpretation of society and the actions and interpretations of the actions of others. They believe they have learned this throughout their lives and are aware of the risks. They consider themselves open-minded and willing to talk about any subject. Thus, they prefer to guide their children on sexuality and disease prevention rather than having them learn from people outside the Christian group.
However, they do not feel the need for traditional methods of prevention or to debate with their husbands about disease prevention or the use of condoms, as they are of the same religion and follow Christian teachings. They trust that their husbands do not have extramarital affairs.

Considering it important to provide guidance on the best form of protection according to self-assessment of risks.
Based on their interpretation of others\' actions and their own, the women reassess their perspectives, believing that the topic should be addressed everywhere possible in order to break taboos and reduce exposure. People should be informed enough to self-assess risks in order to choose the best form of HIV prevention. The participants believe that guidance on condom use is essential in complicated, insecure, unreliable, and violent relationships, even within marriage. For them, it is a matter of public health, regardless of religion, to keep up-to-date with diagnostic tests in an attempt to care for themselves and others.

CATEGORY 5: Trying to live the best of both worlds without losing the essence of being Christian
After reviewing their perspectives, they redefine their situation and course of action. The participants seek to live the best of both worlds, the Christian and the non-Christian, seeking knowledge to guide others appropriately and free from prejudice, participating in or leading health actions in the church, filtering the approaches of the church and the world to choose their actions, and preserving themselves by seeking a life of holiness, without excluding people with HIV/AIDS.
Considering that presented above, Figure 01 shows the representative diagram of the explanatory theoretical model, which is constructed from the comparative analysis of the data from this study, in which the core category is presented as "Recommending care of the body, the temple of the Holy Spirit, with the use of condoms in situations inconsistent with Christian life".
Discussion
The representative model highlights the participants’ detachment from HIV/AIDS exposure, bringing the idea of "someone else’s disease." This issue is not new, as studies conclude that women recognize vulnerability factors in other women, but without considering themselves to be at risk of exposure5,18.
This detachment can be illustrated by the meanings attributed to HIV/AIDS exposure based on basic theoretical knowledge about the subject learned in the educational curriculum and not through lived experience. Despite this detachment, in the fight against the AIDS epidemic, knowledge about HIV and its forms of transmission is still considered one of the pillars for reducing stigma and promoting positive behaviors19. In fact, research conducted with young Brazilians showed an association between a lack of knowledge about the subject and increased exposure20.
This detachment can also be discussed based on the strong influence of religious teachings on the participants’ worldview, through the attribution of meanings to HIV exposure in a conservative manner, relating non-Christian behaviors to exposure. These meanings have also been attributed by women who profess Afro-Brazilian religions5, who link this exposure with attitudes seen as immoral and/or promiscuous, especially those of women who are not in a stable relationship.
The relevance of this discussion in the Christian context is highlighted by symbolic constructions about HIV/AIDS as a form of divine justice for sexualities deemed deviant21, which consolidates the syndrome as a disease of the other, this other being that which society rejects and disqualifies as a moral individual22.
The meaning attributed by the participants as condemnation of the other has persisted since the beginning of the epidemic, evidencing the maintenance of stigmas that generate fear and prejudice23. Considering that people act according to the attributed meanings, one can think of weaknesses regarding actions to combat the epidemic due to the stigmas involved in their symbolic constructions.
When entering the situation and defining the situation for themselves, the participants retrieve memories from the past, bringing up family taboos, little information on the subject, and reproducing conservative recommendations for bodily care. One study conducted with young people20 showed that limited parental education is an obstacle to accessing up-to-date information and discussing issues related to sexuality with their children, as are myths and taboos. Despite so much progress, this lack of preparedness to address these issues is still a reality24,25. Another difficulty can be added, which is the belief that discussing sexuality could encourage young people to engage in early sexual activity.
Simultaneously, family members expect or delegate this responsibility to formal education, as demonstrated in the present study, where access to information occurred outside the family environment. However, educational institutions are also not pedagogically prepared to act in the collective construction of what constitutes healthy sexuality. Nevertheless, even when included in the pedagogical planning, educational institutions suffer from negative reactions from families, generating gaps in knowledge and a decrease in preventive actions25.
It is in the context of stigmas and stereotypes that the participants recall known cases of people who have become infected and died of AIDS. In so doing, they ratify the ideas of transmission through so-called deviant behaviors and death/suffering. This negative image, linked to fear and the certainty of death, has been present since the beginning of the pandemic and persists to this day26. Despite this, even in the participants’ statements, this stereotyped image of AIDS and of certain behaviors or vulnerable groups, there is a concern for a discourse without judgment or exclusion.
The other point to be discussed is the progress in combating the epidemic and the improvement of access to Antiretroviral Therapy (ART)27. In this sense, the participants in this study talk about the ease of access to information about HIV and forms of prevention in contemporary times, when compared to the beginning of the epidemic, stating that the lack of information can no longer be considered a vulnerability factor.
It is correct to think that individuals’ interaction with social networks is a widely used form of political mobilization28. However, regarding the level of information and protection practices of young people concerning sexual and reproductive health, the dissemination of the internet and social networks does not seem to have had the same impact29. The existence of what is called silencing about AIDS stands out, that is, the syndrome and forms of prevention are topics that only appear in the media on specific occasions, such as Carnival and World AIDS Day29.
This silencing is embedded in a political context that weakens actions to combat the epidemic30. In this sense, a wave of moral and religious conservatism, as well as strong political movements, begins to question such issues as gender, sexuality, and diversity within public policies that directly affect the policy to combat AIDS31 and the Health in Schools Program, for example31.
From a conservative perspective, participants bring religious norms as protection when defining the situation for themselves and their life context. This corroborates another study3, in which the meanings attributed to sexual relations are related to marriage for procreation and marriage as a way of preserving the body. In the context of protective measures against HIV/AIDS exposure, women trust their partners and expect actions that preserve their lives. They also report the importance of knowing their partner and having intimacy to "control" exposure5.
In addition to marriage, they report a series of expected behaviors for individual salvation, based on the pursuit of a life considered by them to be holy. Thus, living in God implies preserving the body and protecting against exposure to HIV/AIDS.
Another idea brought up by the interviewees was God\'s spiritual care and the gift given to human beings to build useful knowledge to preserve the body. For them, man created diagnostic tests for HIV and condoms for birth control. Even outside the religious context, they tend to use these strategies as a form of protection5,32. There is also the concern that children follow this Christian path of preserving the body33.
A study conducted with young students who profess Protestant religions34 shows that the greater the regularity in religious activities, the less likely they are to use condoms. But they were more likely to remain chaste than young Catholics and young people without religion. Furthermore, they significantly agree on "sex only for love" and disagree on "love without fidelity".
In light of the above, it is suggested that action plans geared toward prevention demonstrate gaps in the approach to the population or in how academically the fight against the epidemic is conceived. Thus, the representative model of this article highlights the importance of including other elements in this fight and of questioning the directions of the contemporary Brazilian government for the control of HIV/AIDS.
Despite the advances, it is agreed that the focus of current interventions is responding to biomedical and technocratic interests, foregoing the perspective of human rights35. It is essential to highlight the challenges that the new scenario of the epidemic presents with the reemergence of the stigma of AIDS as a necropolitical instrument36.
This is also part of the medicalization process, which is not enough to fill the identified gaps. One example to illustrate this would be that, in the present study, the participants never mentioned the new drug strategies as a method of prevention, corroborating a study29 that shows a great lack of knowledge among young people about new technologies, such as PrEP and PEP.
Taking this into account, the advance in the discussion presented here lies in the idea that health care is not conceived outside of society, and, therefore, it must be considered that a large part of the Western population professes Christianity and that the meanings attributed/processes of social interaction must be included in clinical actions and the fight against the AIDS epidemic.
It is not enough to carry out one-off campaigns targeting key populations. It is necessary to coordinate actions that integrate various sectors of society, including religious institutions. The participants affirm that churches should take a stand and address this and other issues as a way of caring for the community, breaking taboos, and reducing exposure.
Churches are considered to play important roles in communities around the world, especially in areas with limited resources and insufficient access to healthcare. One study37 shows the importance of integrating health promotion actions in a culturally appropriate manner.
A study conducted in the United States with religious leaders38 assessed the acceptability of partnerships aimed at HIV prevention, screening, and treatment actions in Hispanic/Latino communities due to their cultural competence and the trust of the faithful. The results show openness to activities in partnerships and identify possible faith-based solutions to break down barriers.
Research conducted with women who profess Afro-Brazilian religions5 also suggests that addressing the topic without taboos create by religious institutions can contribute to reducing exposure to HIV/AIDS and is an integrating space for health practices. Contemplating the integration of religious beliefs and public health knowledge/practices aligns with the participants’ line of action, in which they seek to live the best of both worlds, the Christian and the non-Christian, for bodily care and to guide others.
Thus, the present study’s data show coherence among the worldview, Christian teachings, and preventive actions of the participants, especially since, currently, governmental preventive actions recommending the use of condoms occur only on certain occasions29 and without keeping pace with the changes in the phenomenon39. Furthermore, the participants speak of the importance of (self-)assessment of risk, which is also present in the clinical anamnesis protocols, including in the current debate on post-exposure prophylaxis (PEP) based on the assessment of the risk of the scenario of exposure40. Finally, our study serves to validate the core category of the present study, which is "Recommending care of the body, the temple of the Holy Spirit, with the use of condoms in situations inconsistent with Christian life".

Final Considerations
The substantive theory of the social interaction process of Protestant women with HIV/AIDS exposure shows that the meanings attributed to HIV/AIDS exposure by women who profess the Protestant religion are related to common-sense knowledge stem from the beginning of the pandemic, from school education, and from a strong influence of religious beliefs. Furthermore, in a behaviorally conservative manner, they distance themselves and focus on the exposure of other people. Therefore, they recommend that people, in situations inconsistent with Christian life, should use condoms for bodily care in relation to HIV/AIDS. In addition, the data suggest a strong potential for religious institutions as promoters of health, by preaching bodily care, in conjunction with health institutions.
Given the above, understanding the theoretical model of the interaction process of women who profess the Protestant religion with HIV/AIDS exposure allows us to accept that a woman\'s experience based on her beliefs is capable of mobilizing knowledge and ways of acting in the context of AIDS, based on the meanings she attributes to HIV/AIDS exposure. Understanding these meanings emphasizes that it is a much broader and more complex phenomenon than formal awareness methods for HIV/AIDS prevention. In fact, the individualities, uniqueness, and complexity of women who profess a Christian faith must be respected.
This study faced some key limitations during the research process. For example, conducting the interviews remotely made it more difficult to connect with the participants due to the difficulty in capturing their nonverbal language. Another limiting factor was that, despite the effort to recruit women from all regions of Brazil, the participants are predominantly from the Southeast region. Regarding the topic, there is a possibility of social desirability bias due to the stigma and prejudice surrounding the research questions, in which participants may respond in a socially acceptable way.
It is expected that this study can contribute to health promotion strategies for this specific population group, stimulating dialogue and reflection on the topic. In addition, it aims to contribute to the improvement of existing practices in health services and to propose other actions and practices directed at women\'s health in an intersectoral context, including religious institutions.

Funding
National Council for Scientific and Technological Development (CNPq) – universal call for proposals – MCTIC/CNPq Call No. 28/2018 – Universal/Band A - Up to R$ 30,000.00.
This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001.
References
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