Consultoría sistémica asistida por equinos y procesos de transformación vincular en personas con VIH: un estudio de casos múltiples.

Abstract

Objective: To explore narrative and relational transformations in two people living with HIV who participated in Equine-Assisted Systemic Counseling (EASC), focusing on adherence to antiretroviral treatment. Method: Multiple case study with mixed-methods design and exploratory-descriptive scope, within a systemic-constructivist paradigm. The qualitative component employed categorical discourse analysis with two adult consultants living with HIV, across two categories: ART adherence and relational construction of living with HIV. Relational analysis was operationalized following Miermont across four domains: episteme, beliefs, myths, and rituals. The quantitative component included biological markers (CD4+, viral load), self-reported adherence (CEAT-VIH), and emotional symptomatology, triangulated with the narratives. Results: Problematic narratives were identified in the epistemic domain (reductionist adherence, HIV as obstacle), beliefs domain (guilt-laden stoicism, networks limited by non-disclosure), mythic domain (religious resignation, myth of sin and punishment), and ritual domain (parentification, naturalized discriminatory practices). EASC facilitated embodied metaphors of self-care through equine grooming, incorporated uncertainty as a therapeutic element, and disrupted rigid semantic polarities. Transformations emerged toward self-care as self-love, expanded support networks, and a transition from "being sick" to "a health condition enjoyed in life." Quantitative data showed favorable virological trajectories and reduction of emotional symptomatology to non-clinical levels. Conclusions: This exploratory study suggests that EASC may facilitate narrative and relational transformations in people living with HIV. Findings indicate that adherence involves relational domains not exclusively captured by biomedical markers, and that embodied metaphors constitute a therapeutic mechanism specific to this approach.