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Universidade de São Paulo. Faculdade de Saúde Pública
(Dis)infodemic during the -19 pandemic and the communicative rationality in health in Brazil: an integrative review
The covid-19 pandemic triggered an infodemic characterized by the massive spread of fake news, harming health in the digital age. This article aims to analyze the links between infodemic, misinformation, and fake news. The method used was an integrative review of scientific articles from 2020 to 2025, combining different Health Sciences Descriptors (DeCS/MESH) such as “Infodemia,” “Covid-19,” “Fake news,” and “Notícias falsas” in the two largest open-access scientific databases in Brazil (BVS and SciELO). The results highlighted challenges in public health communication and strategies to mitigate the effects of misinformation, highlighting the strengths and weaknesses of a communicative rationality in health. It was observed that the infodemic aggravated vaccine hesitancy, generated distrust in institutions, impacted adherence to protective measures, and affected the daily lives of individuals and their practices in the relationship between the offer of care and the demands for healthcare in the country. The need to strengthen digital literacy and public communication policies in the SUS, as well as strategies for Popular Health Education and public participation, was identified. It is concluded that addressing the infodemic requires intersectoral and coordinated actions between government, media, and society, as well as broad discussions on the accountability of digital platforms.
Copyright (c) 2025 Revista Saúde Sociedade https://creativecommons.org/licenses/by/4.0
Training of health professionals for the provision of comprehensive care in abortion situations in public Primary Health Care in Brazil: challenges and innovative experiences
This essay’s objectives are to reflect on challenges in the training of health professionals for comprehensive care in abortion situations in Primary Health Care (PHC) in the Brazilian National Health System (Sistema Único de Saúde – SUS) and to bring to debate innovative training initiatives organized by social and institutional actresses/ actors outside of the traditional training apparatus. In the first part, we dialogue with international literature to explore how training challenges are confronted in countries of the Global North and Latin America, where the practice of abortion has been legalized. Next, we discuss the professional training on abortion in Brazil, focusing on traditional spaces (undergraduate, residencies, and post-graduate). We proceed with the presentation and reflection on some innovative experiences for professional training on comprehensive abortion care, organized by a joint of activist organizations, academic groups, health professionals, professional societies, and the services themselves, mapped from the participation of the authors in forums, organizations, research and activist groups, and selected under the criteria of direct approach to professional training on abortion and/or advocacy actions that have clear or potential repercussion on this training. At the end, we summarize a series of aspects that can strengthen these networks of training for comprehensive care of abortion situations with focus on PHC.
Dossier - Comprehensive care for abortion situations in Primary Health Care within the Brazilian Unified Health System (SUS): challenges, perspectives and pathways
Configurations of care at the end of life: the case of palliative care in Brazil
The socio-anthropological study of palliative care in Brazil has been consolidated over the last two decades, under the umbrella of the sociology of health, death, and dying. Some approaches adopt a macro perspective, aiming to explain the different contours taken by palliative care in each country or even to propose a particular model, while others look at palliative practice at a micro level, in the interactions between individuals at the hospital or at home. This paper analyzes the mechanisms involved in the formation of configurations of care at the end of life, taking palliative care in Brazil as a case. The methodology is qualitative and exploratory in nature, based on an analysis of review papers on the subject, institutional documents, and websites of healthcare organizations. The aim is to establish a range of operational concepts with the purpose of investigating paths of institutionalization and legitimization of health-illness practices at a national and international level. Thus, the aim is to outline a conceptual apparatus useful for explaining the relationships between discursive, practical, and institutional instances in the circumscribed field of palliative care supply models and, possibly, in healthcare systems in general.
Setbacks in sexual and reproductive rights: structural racism and its implications for Black women and girls
Abortion is one of the leading causes of maternal mortality in Brazil. Although permitted in cases of rape, life-threatening conditions for the pregnant person, and anencephaly, multiple barriers hinder access to this right, especially for Black girls and women. Legislative proposals such as Bill 1904/2024 and Resolution 2378/2024 of the Federal Council of Medicine (CFM) pose threats to sexual and reproductive rights (SRHR), further exacerbating the challenges faced by this group. Black girls under 14 are the most affected by sexual violence and suffer additional consequences from the criminalization of abortion. This article discusses the cis hetero normative structural racism and its implications for girls, women, and Black people who gestate, including insufficient access to services and discrimination in healthcare settings. Considering international frameworks such as the Sustainable Development Goals (SDGs) and the recommendations of the Committee on the Elimination of Discrimination against Women (CEDAW) for Brazil, the discussion explores strategies to ensure a more just and equitable scenario. The role of Primary Health Care (PHC) in expanding access to SRHR is highlighted, along with the importance of monitoring the Brazilian state’s responses to international recommendations.
Asexuality and the sexuality dispositif: biopower, sexual normativity and the limits of health
This article analyzes the effects of the medicalization of sexuality on asexual people, understanding them as outcomes of the sexuality aqui é correto dispositif que é um nome, é uma palavra francesa, mas se usa assim em inglês, dispositive é um adjetivo . The research was conducted through virtual ethnography in an online community, in-person observations, and semi-structured interviews. Thematic analysis identified four categories: sex as a norm and foundation of life; pathologization and symbolic violence in healthcare; biomedicine as a normative device; and resistance, activism, and meaningmaking. The findings show that the absence of sexual desire is often interpreted as dysfunction, reinforcing cis-heteronormative standards in clinical settings. Healthcare professionals tend to delegitimize asexual identity, causing embarrassment, misdiagnoses, and silencing practices. On the other hand, digital spaces emerge as territories of resistance, where narratives of recognition and collective care are constructed. It is concluded that the pathologization of asexuality is upheld by exclusionary biomedical epistemologies, highlighting the urgency of critical professional training and the development of health policies that affirm sexual diversity as a legitimate expression of humanity.
Feminist movements and the construction of comprehensive carestrategies for abortion situations in Brazil
This article analyzes the trajectories and strategies developed by Brazilian feminist collectives, Grupo Curumim, Humaniza Coletivo Feminista, and Projeto Vivas, to ensure comprehensive care in abortionrelated situations and to overcome the institutional challenges of the Unified Health System (SUS). It aims to engage in dialogue with these collectives to understand what possible futures can be built to guarantee autonomy and access, through advocacy and harm reduction actions in a context marked by criminalization and stigmatization. The reflection was developed through virtual conversation circles with representatives of the collectives, emphasizing listening, dialogue, and the collective construction of knowledge, in alignment with feminist and decolonial perspectives. The findings highlight practices grounded in welcoming care, information, coordination with health services, and political mobilization, which emerge as feminist and social technologies of comprehensive care. The experiences analyzed reveal both tensions and connections with health services, particularly with Primary Health Care (PHC), whose absence is often noted in care pathways. The study concludes that these collectives broaden the repertoire of abortion care in Brazil and contribute to the formulation of public policies rooted in reproductive justice, autonomy, and dignity.
Fat bodies and obese bodies on digital screens: an analytical look at images propagated by Google
The associations between body and image in terms of image production take on immeasurable contours in digital media, reinforcing the visuality of the body in our scenario. This article aims to study the image production of fat bodies and obese bodies on Google images, considering the similarity of such corporealities in the sociocultural imaginary. This is a qualitative, exploratory study carried out on the Google platform, with reflection inspired by the method of semiotic analysis suggested by Joly (2007). The photographic and public access collection was searched using the descriptors fat body and obese body, and covered the publication period between 2019 and 2022. The images of the fat body show an expression of empowerment. On the other hand, fragmented bodies are linked to a cultural production that associates the fat, so-called obese, body with disease. Analysis of the images reveals their role in perpetuating influential discourses in the collective perception of bodies that can affect health practices, often contributing to dehumanizing approaches to individuals with obesity. It is necessary to re-evaluate and humanize how these pathologized bodies, seen as incapable, are represented and treated in the field of health and in the social context.
Sexual violence against Black girls: the silencing of the racial debate in national scientific production
This article aims to analyse how national scientific production in the field of health discusses the ethnicracial issue in studies on sexual violence (SV) against girls. An integrative literature review was conducted, with thematic analysis of the selected studies. Searches were carried out in three indexed databases, covering the years 2013 to 2022. Fifty-seven articles were selected for analysis, organised into four thematic axes: 1. characterization of SV and the profile of children and adolescents; 2. repercussions and consequences of SV; 3. healthcare for SV victims and professionals’ perceptions; 4. Tthe quality and evolution of SV records, reports, and underreporting. Epidemiological studies predominate, yet not all even include the race/colour variable, despite the observed improvement in information quality during the period. The literature reveals a significant gap regarding racial discussion in SV studies, despite the increase in records involving Black girls. The absence of discussion on the impacts of racism and the lack of specific strategies to address the racial dimension of this issue are evident. The invisibility of violence against Black childhood diminishes the reach of actions to combat SV.
Challenges, opportunities, and persistent inequalities in Indigenous healthcare in Brazil: critical analysis of the scientific production
Enhancing healthcare attention to the Indigenous population is a public health challenge in Brazil. This study aims to systematize and critically analyze the knowledge produced on Indigenous healthcare in the Brazilian context. The chosen method was an integrative review of articles published between 2013 and 2023, in the PubMed/MEDLINE, LILACS, BDENF, and Index Psi databases. Ten studies met the eligibility criteria and were selected. The research followed a qualitative approach and crosssectional design, with a predominant ethnographic focus. The studies present both challenges and prospects, taking into account the efforts of the actors involved in providing care to the Indigenous population to implement a differentiated health policy that addresses the specific needs inherent to their healthcare. Among the main challenges identified in the analyzed studies are: the distance between villages and healthcare services for Indigenous peoples, communication barriers and access to healthcare, deficiencies in the training of professionals responsible for care, inadequate resources, and the persistence of discriminatory attitudes toward the Indigenous communities. The analysed studies demonstrate the need to promote progress towards an intercultural and inclusive care model that takes into account the local realities and cultural specificities of Indigenous peoples, promoting integration in care across various levels of attention.
Human migrations and displacements: concepts for public health. Interview with Enrique Coraza de los Santos
In this interview with Revista Saúde e Sociedade, Professor Enrique Coraza de los Santos, historian and specialist in forced mobility and violence in Latin America, discusses the development of public policies for migrants on this continent. Furthermore, in a very didactic manner, he explains and deconstructs the concepts of forced migration, economic migration, asylum, and exile. He then discusses public policies to address and care for the violence suffered by people on the move, addressing how this violence interrelates with health. This interview contributes to understanding the complexity of the migration issue in Latin America and contributes to reflections on policies to protect and guarantee rights.
Methodological and technopolitical challenges of participation and social control in health
The article aims to explore issues relating to Participation and Social Control, taking as a backdrop methodological and technopolitical aspects experienced in the “Training in Monitoring and Evaluation for Social Control in the SUS” course, a partnership between ENSP/Fiocruz and the ISC/UFMT. The course aimed to strengthen Social Participation in the processes of formulating, implementing, and evaluating public policies through the instrumentalization of technical supporters and representatives of health councils and promoting the development of possibilities for applicability, replicability, and multiplicability of the theoretical-methodological framework. The article contains a section “Methodological Considerations”, exposing reflections involving the process of preparing the text; A “Conceptual Considerations” section, which discusses the concepts of Technopolitics, Participation and Social Control; A section “Problematizations and Challenges”, where considerations are made about the methodological and technopolitical limits and potentialities of the radicalization of Participation and Social Control vis-a-vis training in M&A for health advisors and supporters as multipliers, using mapping and comparison of fieldwork produced by course participants; At last, a “Final Considerations” section of the article.
The liposuction society: lipophobia as an aesthetic driver and a factor of psychological suffering on social media
Aesthetic standards permeate and impose demands on the individual, immersed in the social context, to adapt to the standardization of an ideal body. In this context, lipophobia, considered as an aesthetic and social discourse that imposes negativity on body fat, remains the tonic of a society that establishes, for itself, the thin and “lean mass” indexes as symbols of a healthy. Rooted in the social imagination for a long time, lipophobia finds, in the recent phenomenon of social networks, fertile ground to proliferate as a moralizing maxim. Therefore, the objective of the present work is to investigate the engines that lead not only to the maintenance, but also to the propagation of lipophobia in social networks. From a diagnosis of society and the behavior of subjects immersed in social networks, we seek to address the foundations and motivators of lipophobic discourses, their reasons, their propagation mechanisms, their effects, and also the psychic impacts arising from body aesthetic pressure. By tracing a profile of this liposuction society, we intend to promote debate and discussion about a research locus that has not yet been investigated — social networks — highlighting its importance in the field of public health.
Copyright (c) 2025 Revista Saúde e Sociedade https://creativecommons.org/licenses/by/4.0
Violence against dependent elderly people in the perception of health managers in Brazil
The study aims to understand the experiences of health managers in Brazil regarding the context of violence against dependent elderly individuals at home. This study is a multicentric qualitative investigation conducted in Brazil, involving 16 (sixteen) health managers from primary health care, geriatrics outpatient clinics, and health project coordination for the elderly. The interviews took place from June to December 2019. The study adheres to the principles of hermeneutic dialectics. The results infer that violence is a social phenomenon that impacts everyone, but it has a greater repercussion on elderly people weakened by dependence who require permanent and constant care. In the homes where most of them reside, in addition to suffering from the loss of autonomy, it is quite common for elderly people to be victims of abandonment, neglect, or physical or psychological abuse. We conclude that changes resulting from physical, psychological, and social dependence often intensify violence, encircling the family nucleus and life dynamics.
Ways of (not) providing healthcare to trans women and travestis in the “liquid territory”
From a dynamic space, in constant movement and transformation, here called “liquid territory”, we seek to understand the ways of (not) doing healthcare for trans women and travestis. This is a qualitative, descriptive, and comprehensive-interpretive study, based on the experiences narrated by primary health care workers and trans women and travestis, in Manaquiri, a municipality in the state of Amazonas. The analysis of the narratives revealed three main axes that organized the meanings of care or its absence: “I don’t know”; “I don’t attend to them”; and “So I don’t do anything about it”. This sequence of statements synthesizes the institutional logic that highlights, above all, practices of non-care, marked by silencing, omissions, and denial of the existence of these identities in the daily routine of the services. In conclusion, we emphasize that it is imperative to build inclusive and operational strategies that promote effective health care for trans women and travestis in primary care. These practices must be based on the awareness of the reality experienced by these bodies in different territorial contexts, articulating understandings and affections capable of breaking with the historical cycles of annihilation and opening the main gateway to the services of the Brazilian Unified Health System for trans women and travestis.
The Covid-19 pandemic and the care of vulnerable populations: arrangements and responses produced in the State of São Paulo
In this article, we analyze the care paths developed by two health regions in the state of São Paulo aimed at populations in vulnerable situations, in response to the covid-19 pandemic. This is a multiple case study type investigation, with a qualitative-quantitative approach. Semi-structured questionnaires and 29 interviews were used involving managers and health professionals working in the Regional Health Departments and Municipal Health Secretariats of 6 municipalities in the Health Regions of the Metropolitan Region of São Paulo and the interior. Our analyses showed that invisibilities and a homogenizing perspective on “being vulnerable” persist. Regarding the topic of innovations, we reiterate the challenges faced by managers and health professionals who have experienced the intensification of forces contrary to the construction of care actions, in view of government choices – at the state/federal level. Despite these identified challenges and care actions, the journeys in the municipalities call us to reflect on the need to expand intersectoral action, due to the needs and potentialities present in the territories in relation to the theme of vulnerabilities, especially considering that the initiatives made visible little points to articulations and arrangements different from those produced from the traditional logic of thinkingacting in health.
Comprehensive care for abortion-related situations in Primary Health Care within the Brazilian Unified Health System (SUS): challenges, perspectives, and pathways
This Editorial presents the dossier “Comprehensive care for abortion-related situations in Primary Health Care within the Brazilian Unified Health System (SUS): challenges, perspectives, and pathways”. Abortions are common events in the reproductive lives of women and pregnant people, whether spontaneous or induced. In the absence or weakness of public policies and comprehensive reproductive health care approaches that address abortion situations, risks to health and life are common, becoming a serious public health problem. The centrality of Primary Health Care (PHC) in ensuring access to comprehensive abortion care has been the subject of growing debate in Brazil and worldwide, and is a WHO recommendation. The five articles comprising the dossier present multiple approaches and were developed based on dialogue between researchers and professors from various research and educational institutions, representatives of professional associations, civil society organizations, and feminist collectives from various regions of the country. By promoting a critical analysis of the challenges and potential of PHC, the works contribute to the construction of theoretical and practical frameworks guided by the principles of comprehensive care and reproductive rights, reaffirming their commitment to social and reproductive justice in the context of public health policies.
Editorial - Dossier Comprehensive care for abortion situations in Primary Health Care within the Brazilian Unified Health System (SUS): challenges, perspectives and pathways
Public policies and cisheteronormativity: impacts on the experiences of LGBTI+ parenthood in healthcare
This qualitative study investigated the experiences of LGBTI+ individuals who assume parenthood, as well as the practices of healthcare professionals in providing care to this population. Between November 2023 and February 2024, seven online focus groups were conducted, five with LGBTI+ individuals and two with healthcare professionals. Participants were selected through social media, and the “snowball” method was used to expand the sample. Thematic analysis of the results revealed barriers to accessing equitable and inclusive healthcare, due to a lack of professional preparedness in addressing issues of gender and sexuality, and the cisheteronormative lens present in social relations. The study highlights the erasure of LGBTI+ parenthood in public policies and healthcare practices, as well as the need for further training on sexuality and gender in health curricula. The findings provide insights for promoting more just and welcoming care for this population.
COVID-19 and diabetes: self-care and religion
The first epidemiological studies on covid-19 identified certain “risk groups,” individuals at higher risk of developing severe cases and dying from the disease. Among them are those living with chronic conditions such as type 2 diabetes mellitus (T2DM). For this group with diabetes, glycemic control was identified as one of the main forms of protection against severe cases of covid-19, which should include self-care through medication, diet, and physical activities. However, implementing these measures creates problematic fields in self-care, as well as restrictions and constraints on life and care production. During the pandemic, additional challenges were added to these, further complicating the daily lives of those already living with T2DM. This article presents part of the results from ethnographic research based on semi-structured interviews conducted by phone, analyzing the perspectives of people with T2DM on their self-care experiences during the pandemic. The analysis of the empirical data revealed how the pandemic affected different dimensions of the daily lives of people living with diabetes, with a particular focus in this article on selfcare and religion, revealing the presence of different “worldviews” and “cultural registers”.
A study on access to health and social assistance for children and youth with situations of social vulnerability in the municipality of Porto Murtinho/MS
This article presents the results of research on access to health and social care for children and youth in the municipality of Porto Murtinho/MS. A border that is characterized as a space marked by singularities and diversities, in which people of different nationalities live and travel, and within this context, weaknesses are evident in relation to access to public policies to serve this population, whose dynamics are built from different cultures and identities. This is a bibliographic and field research study; the approach is qualitative and involves issues of access to social public policies in the border region of Porto Murtinho/MS. The results indicate fragility concerning access to these policies, especially for children and youth, generating social vulnerabilities in a stage of life in which protection is necessary, especially in relation to health and social assistance. The results also reveal the social issues present at Brazil’s borders; in the context of the border where the research is taking place, a significant influence of the transformations resulting from the Bioceanic Route is expected, affecting the urban dynamics and the life of the community due to the increase in human traffic, the emergence of new commercial establishments, and other relevant changes.
Gender-based violence and abuse in medical training in Mexico before, during, and after the COVID-19 pandemic: Signs of hysteresis in the medical field?
In this article, we describe the protests that shook the medical field in the years leading up to the COVID-19 epidemic in Mexico. On the one hand, there were protests by the medical profession against different forms of violence related to organized crime in the context of the so-called war on drugs. On the other hand, there were protests by the feminist movement against gender-based violence within the medical field. We point out the need to more systematically investigate the differential course of these struggles, with only the feminist movement appearing to advance toward producing a possible state of hysteresis of the patriarchal habitus within the field. The article begins with a brief conceptual and methodological note. Next, we show the momentum that the two types of protests against violence in the medical field were gaining. We then seek to illustrate how the basic structures of the field, related to medical training (precariat and authoritarianism), operated to the detriment of these protests, but apparently with different effects. We conclude the article with a reflection on the course these struggles have taken since then, asking whether it is possible to speak of a current state of partial hysteresis within the medical field.
Copyright (c) 2025 Saúde Sociedade https://creativecommons.org/licenses/by/4.0
Promoção da saúde mental coletiva mediada por produções sonoras
Apresentação: A busca por respostas e a reflexão contínua sobre como mobilizar esforços para o bem comum na vida cotidiana levaram à inter-relação de três perspectivas. Epistêmica: saúde mental coletiva e sua promoção. Metodológica: pesquisa-intervenção; e estratégica: comunicação e rádio/podcast. Objetivo: Descrever a experiência plurianual de um grupo de professores-pesquisadores universitários na promoção da saúde mental coletiva por meio de produções em áudio. O processo é apresentado em três etapas. Baseado em uma metodologia de pesquisa-intervenção, um processo espiral de idas e vindas entre diferentes áreas do conhecimento, que visa ampliar a construção do conhecimento sobre fenômenos humanos complexos, muitas vezes considerados de forma linear ou dicotômica. Resultados e discussão: 43 episódios de programas de rádio/podcast e 40 cápsulas de áudio. Resultado de conversas dialógicas em grupo, cuja análise subsidiou um segundo momento conversacional em estúdio de gravação com indivíduos profissionalmente ou academicamente reconhecidos, repensando os saberes disciplinares desafiados pela experiência dos primeiros interlocutores. Conclusões: Na promoção da saúde mental, o rádio/podcast pode contribuir para o engajamento individual e coletivo, desencadeando processos de transformação cultural em prol de uma boa vida em comum.
Dossier: Perspectives and approaches between Sociology and Health
Editorial - Dossier on the Sociology of Health
Copyright (c) 2025 Saúde e Sociedade https://creativecommons.org/licenses/by/4.0
The healthcare trajectory of riverside women in reproductive planning at a fluvial Primary Health Unit in Amazonas
This study analyzes the care trajectory of riverine women assisted by the Fluvial Primary Health Unit (UBSF) in reproductive planning, highlighting challenges in access and continuity of care. Using a qualitative approach within a sequential mixedmethods study, interviews were conducted with users, UBSF professionals, and managers from the Municipal Health Secretariat. The results indicate that, although the presence of the UBSF facilitates care in rural areas, barriers such as river seasonality, logistical difficulties, and limited availability of contraceptive methods compromise the effectiveness of reproductive planning. Additionally, the fragmentation of the care pathway and the lack of coordination between healthcare levels hinder access to specialized contraceptive methods, such as intrauterine devices (IUDs) and tubal ligation, forcing users to face costly travel and excessive bureaucracy. The absence of coordination between Primary and Specialized Care exacerbates these difficulties, placing the burden on women to secure their own access to essential health services. This study underscores the importance of differentiated care flows that ensure comprehensive access to reproductive planning for riverine women.
Affections and narratives about obesity in between boxes: a(auto)biographical research in a health education device
This work explores the presence of affects in learning within a continuing health education course designed for Primary Care professionals and focused on improving care for individuals with obesity. The course is grounded in socioanthropological studies of obesity. To achieve this, we examined reports from participant students using a pedagogical tool called the “Box of Experiments,” employed in the course as a device for autobiographical production of formative itineraries. As a theoretical and methodological choice, this work was conducted from the perspectives of biographical studies, complemented by philosophical reflections and insights from the field of social and human sciences in health. The results, categorized into two analytical groups, reflect the emotional impacts present in the transformative process of thinking about obesity facilitated by the course. This is particularly evident when participants engage in critical self-reflection on the subject, encompassing personal experiences, knowledge, health professionals’ training, and care performances. Anguish, guilt, and surprise are affects that surface when students narrate their thoughts on the course’s addressed topics, while enthusiasm, impetus, and readiness for change emerge as affects driving the transformation of these professionals’ practices.
AI, Global Health and Algorithmic Society: Biodata’s democraticuse and regulation
Global health policies within an algorithmic society are developed through tensions between citizenship rights and market interests. In a “global health” timeline, the development of artificial intelligence (AI) has added greater complexity to these policies due to its potentialities and risks. If, on the one hand, the health sector is under the domination of the market’s techno-digital policies, which have undoubtedly brought improvements to the industry through the evolution of AI, on the other hand, one cannot ignore the abusive position of business corporations that feed their algorithmic networks through the mega data flows. In this context, two main points are analysed. The first highlights two ways of using data in the health sector that reflect a democratic and a non-democratic use of the same. While the democratic use emphasizes the potential of AI in the health sector, the non-democratic use reflects the tensions/risks arising from data extraction combined with financial and business logics, with an impact on privacy and security, and transparency. The second, seeking to eliminate or mitigate these main risks, analyzes the axis of governance and regulation of global health data in relation to AI.
Prevents, but does not eliminate: stigma and the use of preexposure and post-exposure prophylaxis in the context of sex work among cisgender women in São Paulo
Over the past four decades, research and activism have shown that reducing stigma must be a central focus of prevention policies. However, stigma remains both a barrier and a driving force behind the acceptability and use of biomedical technologies among cisgender sex workers. This article explores that paradox by questioning the effectiveness of pre- and postexposure prophylaxis in a context shaped by stigma around prostitution and HIV/AIDS. Our analysis is based on in-depth interviews with cisgender sex workers who use these prophylaxes, conducted in 2015 and 2018/2019. We apply thematic analysis to four categories drawn from the Health Stigma and Discrimination Framework: prevention negotiations, representations of HIV/AIDS, motivations for use, and perceptions of PEP and/or PrEP. The findings show that the pursuit of greater autonomy in selfcare drives interest in these technologies. This motivation, however, often aims to navigate stigma and power imbalances within prevention practices. By situating the discussion within Brazil’s STI/AIDS programs over the past decade, we advocate for a renewed focus on structural factors – particularly stigma – as the “first barriers” to prevention in the context of sex work.
Dossier Biomedical HIV prevention and sexuality: mediations and co-productions of bodies, pleasures, and technologies
“Do not defend the indefensible”: elements for a cosmopolitical and antiracist approach to public health at the end of the world
In the context of growing discussions about decolonization in the field of health, this essay aims to present a conceptual framework mobilized by the relationship between cosmopolitical propositions, disputes over care, black feminist poetics, and debates about the end of the world. It argues that there is a strong constraint on the imaginative limits of the field and that this is not a technical, funding, or ideological problem. To enable more forceful reorganizations of democratic struggle today, it seems necessary to dismantle and experiment with possibilities for epistemic-political and administrative reorganization. Based on a larger process of anthropological research with people, networks and territories that, in different ways, experience public health (the state, rights, science and modernity) from a certain distance and with suspicion, this essay offers fertile resources to help in the necessary reformulations of public/collective health and to rethink training processes, knowledge production and, potentially, political-administrative estrategies. The speculative possibility that opens up is to venture to see and recreate with and from multiple diverse perspectives, initially adopting the ontological multiplicity of subjects/worlds/relations to/from health, the epistemic multiplicity, and the multiplicity of praxis and political speculations.
Socio-environmental damages of the Brazilian mining model: a qualitative study on the role of a social movement from the perspective of health promotion
The socio-environmental damages resulting from the Brazilian mining model profoundly impact populations living and working in mining regions. This study examines the actions of the Movimento pela Soberania Popular na Mineração (MAM)—the Movement for Popular Sovereignty in Mining—in response to these damages from a Health Promotion perspective. Through documentary analysis and interviews with key informants, this research highlights three core components of the movement’s efforts: Organization, Training, and Struggle. A central focus of the movement is the advocacy for Mining-Free Territories, a struggle that can be understood through the frameworks of the Social Determinants of Health and the Social Determination of Health.
Social Determination of Health Community
Equity in health of LGBTI+ people: trajectories of struggle in the social movement in Natal/RN
Building policital conditions for the advancement of the Brazilian Health Reform agenda involves thinking about the health necessities of vulnerable populations throughout the process of Brazilian socio-historical formation. Occupation of social control spots and the increasing social power of the LGBTI+ movement made it possible to advance about the notion of equity in the SUS following the creation of the Política Nacional de Saúde Integral de LGBTs in 2012. In this paper, we intend to analyze the history of the LGBTI+ movement in Natal-RN and how the right to health issue was mobilized over time from the perspective of its activists/militants. Data production and analysis occurred through the methodological perspective of Hermeneutics and Dialectics which could organize the narratives shared by the social activists in semi-structured interviews combined with documentary research. The analysis undertaken allowed us to verify at least two cycles in the LGBTI+ movement in Natal, with a central focus on the issue of HIV/AIDS as an articulating element. Furthermore, the right to health has been one of the main mobilizing issues throughout its history, so rebuilding its relationship with the movement necessarily means to rebuild a significant part of its trajectories.
Harm reduction as an ethical-political project: a study on the conceptions of harm reduction in the scientific literature
The objective of this work was to critically analyze the Harm Reduction (HR) conceptions present in the scientific literature in order to think about the possibility of an ethical-political project for HR. The drug-commodity and its consequences are structuring of the capitalist mode of production (CMP), having prohibitionism as a fundamental ideology. HR has historically been taken as a way of dealing with the “issue” of drugs, which considers their consumption as part of human life, with actions primarily aimed at the social, physical, and economic damage caused by use. From this, we analyzed and categorized 50 articles published between 2020 and 2021, based on historical-dialectical materialism and the perspective of totality, identifying four conceptions of HR: abstinentist, instrumental-pragmatic, liberalcitizen, ethicist. In the set of conceptions, the socioeconomic structures and the social dynamics that determine the “issue” of drugs end up being reified or receiving an ethical or epistemic confrontation. We conclude that it is essential to start from the historical accumulation of HR to think about an ethical-political project in exchange with projects and organizations, politicizing the determinations of physical-psychic suffering, the motivations and consequences of drug use, as one of the mediations for confronting and overcoming of bourgeois sociability.