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Universidade de São Paulo. Faculdade de Saúde Pública
Access for people with disabilities in Amazonas to public health services: the management perspective
This study aimed to analyze access to health services offered by the Care Network for Persons with Disabilities (RCPD) in the state of Amazonas from the perspective of health managers. A qualitative approach was used, and using a semi-structured questionnaire, interviews were conducted with 25 representatives from the management and coordination of health services in 6 municipalities across 3 health regions of the state. The content analysis of the interviews was based on 5 dimensions of access: access to information, acceptability, availability and accommodation, accessibility costs, and suitability. Critical points were identified in all categories of analysis, highlighting restrictions on access to services for people with disabilities, particularly in rural and remote areas, where geoclimatic conditions strongly influence the logistics and dynamics of individuals’ lives. Furthermore, some managers and professionals have made efforts to optimize access for users, contributing to the greater feasibility of using the available services. Given the results, it is clear that there is a need for adjustments in the planning and implementation of public policies to respond to the different demands of people with disabilities in the different territories of Amazonas.
Copyright (c) 2026 Revista Saúde Sociedade https://creativecommons.org/licenses/by/4.0
The right to psychic integrity of patients under palliative care in defense of the dignity of the human person
The present work aims to demonstrate the importance of protecting the personality rights of patients in palliative care, especially the right to psychological integrity, as a means of corroborating the dignity of the human person. Ensuring a dignified existence for patients diagnosed with diseases with limited possibilities of cure through the provision of essential material resources is a common objective of fundamental human rights, among which the right to integrity is included. In this context, health professionals must be attentive and sensitive to the needs of patients receiving palliative care and their families, which includes listening to their concerns, providing information clearly, and respecting their decisions, in order to ensure that their dignity and psychological integrity are respected until the end of life. Throughout this article, issues will be exposed that permeate the preponderance of the principle of human dignity in relation to people with illnesses that threaten the continuity of life, as well as the right of the patient and family to opt for palliative treatment, from a humanized perspective, as a way of guaranteeing their psychological integrity. The research method used was qualitative, of the bibliographic and documentary review type, based on doctrine and domestic and international legislation.
Daniele Karine Mesquita Casagrande Meneghetti
Factory in the superstructure: the industrial uses of the internet and collective health
This essay reflects on human health in the contemporary world based on economic conditions. To do this, it compares classical capitalism on one side with modern forms of production, distribution, and consumption of goods and services on a global scale. It employs the heuristic procedure of contrasting the productive infrastructure of the 19th century with the technology that enabled the advent of the Internet and its unexpected and multiple applications. Subsequently, it seeks to understand the repercussions of the prodigious transformation of logistical, communicational, and productive means on human affection and feelings. The results of the reflective exercise point to the deterioration of the mental and physical health of a large portion of humanity, but also to emerging properties of the Internet, so to speak, ambiguous and carrying possible lines of escape, potentially promoting collective health.
Access to Specialized Care in the SUS: challenges for the implementation of care-producing regulatory devices
This study sought to identify and analyze the regulatory devices used in the Brazilian Unified Health System (SUS, in the Portuguese acronym) to promote attention in care networks and equitable and timely access to specialized outpatient care (AAE, in the Portuguese acronym). This is a qualitative, multiple case study developed through interviews and focus groups with managers, workers, and users of the SUS, carried out in two municipalities of different sizes in the Metropolitan Region of São Paulo. The conclusions are discussed from three levels of visibility: the complementarity of the Regulatory Center’s access regulation actions with the services; the challenge of reconciling spontaneous and programmatic demand in Primary Health Care (APS, in the acronym in Portuguese); and the need for a less prescriptive and more caring AAE. The results point to the importance of regulatory processes carried out based on services, which approach the needs of users and act in conjunction with regulatory centers. In this sense, reception with qualified listening in APS, which contributes to the knowledge of the people and the production of shared care with AAE, becomes an important regulatory strategy, combined with the use of light and relational technologies, which brings professionals closer to services and enables the organization of care lines.
Representações sociais do viver com HIV/Aids para pessoas trans e travestis
As fragilidades que englobam a expressão da identidade transgênero incorporaram estigmas e sobreposição de preconceitos socialmente construídos para as pessoas vivendo com HIV/Aids. Objetivou-se apreender as representações sociais associadas ao viver com HIV/Aids para pessoas transgênero. Tratase de um estudo qualitativo, exploratório e descritivo, com base na Teoria das Representações Sociais. Os dados foram coletados entre os meses de dezembro de 2019 e fevereiro de 2020. Foram entrevistadas oito pessoas transgênero, sendo sete mulheres e um homem, com idade entre 20 e 60 anos. Foi utilizada uma entrevista semiestruturada, seguida da aplicação de um Teste de Associação Livre de Palavras (TALP). Os dados foram analisados conforme análise de conteúdo temática. O núcleo central de representação foi: o “viver” com HIV/Aids e a possibilidade do autocuidado. Os elementos periféricos relacionados foram: adesão à terapia antirretroviral; preconceito e vulnerabilidade social; arrependimento; morte. Conclui-se que a relação entre a transexualidade e o viver com HIV/Aids implicou pontos negativos, como o medo da morte, arrependimento e aumento do contexto de vulnerabilidade. No entanto, as narrativas apontaram para a atribuição de novos significados a essa experiência, indicando um processo de reestruturação, promovendo a oportunidade de maior cuidado de si.
The power of feminist movement for the democratization of the health field
According to Mario Pecheny, since the return of democracy in Argentina, several advancements in sexual and gender rights have been a consequence of the expansion of the right to health and the establishment of “therapeutic citizenship” that includes individuals as recipients of health policies within the State. This article aims to explore the reverse path and emphasize the contributions and potential of the feminist movement’s struggles in advancing the democratization of health facilities. It constitutes a qualitative study, analyzing 78 in-depth interviews conducted with community members, activists, healthcare workers, and officials from the three participating nodes of the research project titled “Sexual Rights and Accessibility to Health Services: A Comparative Study in Vulnerable Areas of the Metropolitan Area of Buenos Aires, Mendoza, and Santa Fe, during and post-pandemic situations.” We posit that the incorporation of practices guaranteeing abortion within the healthcare system in Argentina, following the enactment of Law No. 27,610 on Voluntary Interruption of Pregnancy, produces democratizing effects that impact the entire healthcare field.
Comprehensive health care, adherence to ART and the political-affective developments of living with HIV/AIDS among Brazilian women
The article addresses considerations emerging from intervention research aimed at understanding the meanings of living and the political-affective consequences of antiretroviral therapy (ART) among Brazilian women living with Human Immunodeficiency Virus (HIV). Adopting the Cartographic Method (Deleuze; Guattari, 1995), interviews and group meetings were used as tools, problematizing the tension between the macropolitics expressed in public policies and care practices in health units and the micropolitics undertaken by each of the women to live better. As a result, women highlighted the challenges they faced in the programmatic, social, family, love, sexual, racial, and gender spheres, developing a critical look at the care received in health services and highlighting the need for health professionals and policies to incorporate the dimension of affection as a means of promoting health. It was concluded that comprehensive care for women living with HIV/ AIDS requires changes in professional practices that allow the intensive resonance of shared affections in the construction of health care, creating relational territories that recognize the tension inherent to subjective differences and strengthen the implementation of Singular Therapeutic Project including families. Brazilian health professionals in Primary and Specialized Care need to experience Continuing Health Education processes to make this possible.
Claudia Valeria Fonseca da Costa Santamarina
Copyright (c) 2025 Revista Saúde Sociedade https://creativecommons.org/licenses/by/4.0
Between law and reality: how integrating referral services andprimary health care can strengthen care for legal abortion
This article analyzes the comprehensiveness of health care in the context of legal abortion in Brazil, highlighting challenges and advances in guaranteeing this right, focusing on Primary Health Care (PHC) and specialized services, such as the Center for Comprehensive Care for Victims of Sexual Assault (NUAVIDAS). It presents how this service operates and innovative aspects in the care provided to cases of sexual violence and legal abortion following violence, such as the adoption of the telehealth model during the pandemic, which expanded access to safe abortion. NUAVIDAS still faces challenges due to the lack of specialized services and weak coordination with primary care. Despite legal support, barriers to the implementation of the right to legal abortion persist, contributing to the maintenance of unsafe abortions and inequalities in access to reproductive health. The article proposes strategies for integration between PHC and specialized services, with the expansion of telehealth and regulation of care flows for greater access and effectiveness in care. Although there has been progress, fully guaranteeing legal abortion requires a strengthened health system, consolidated regulations, and evidence-based public policies, aligned with the principles of the Unified Health System (SUS), within the framework of sexual and reproductive rights and reproductive justice.
Dossier - Comprehensive care for abortion situations in Primary Health Care within the Brazilian Unified Health System (SUS): challenges, perspectives and pathways
Cativar e deixar-se cativar: por um humanismo relacional no encontro entre profissionais de saúde e pacientes
Diante da urgência de resgatar a centralidade das relações de cuidado nas práticas de saúde, fortalecendo atitudes e espaços para encontros intersubjetivos que se apoiam na tecnologia, mas não se resumem a ela, objetivamos delinear contribuições da Teoria Relacional da Sociedade para a conceituação e vivência da relação com o paciente. Neste ensaio, utilizamos o desenvolvimento da amizade entre a raposa e o pequeno príncipe na célebre fábula de Saint-Exupéry como metáfora para refletir sobre concepções e práticas dos profissionais de saúde no encontro com seus pacientes. Partindo da análise das bases culturais de nossas concepções de identidade e alteridade, apresentamos a potencialidade da perspectiva relacional para o desenvolvimento de um humanismo pautado nas relações de cuidado, a partir do qual, sem negar as assimetrias de poder, profissionais e pacientes cativam e deixam-se cativar, transformando-se reciprocamente e podendo constituir uma autêntica alteridade.
Comprehensive care for abortion situations in Primary Health Care: interview with the Brazilian Association of Family and Community Nursing and the Working Group Women in Family and Community Medicine/SBMFC
The development of care pathways is essential to ensure the sexual and reproductive health and rights of women and people who can become pregnant. Given its fundamental features and role within the healthcare network, Primary Health Care is a strategic area to overcome abortion care inequities in Brazil. In this context, we invited ABEFACO and the Women in Family and Community Medicine Working Group of SBMFC to discuss the topic, taking into account the current state of the art and recommendations for developing care pathways. To conduct the written interview, each entity designated representatives with expertise in the field, who received a structured set of questions and instructions, and responded collectively to the proposed questions. The final version, which compiles the contributions from both entities, was approved by the interviewees and the boards of ABEFACO and SBMFC. There is a shared commitment to ensuring comprehensive care in the various abortion situations - both in professional practice and within the organization and delivery of healthcare services - in alignment with the values of the right to health and reproductive justice.
(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.
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.
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.
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