1 St udy ext ract ed fr om t he Mast er ’s Thesis. Funded by t he Br azilian Council of Technological and Scient ific Developm ent - CNPq/ PI BI C; 2 PhD in Nur sing, Adj unct Pr ofessor at t he Bahia Federal Univer sit y College of Nur sing, e- m ail: lilian.enfer m agem @bol.com .br ; 3 M.Sc., Pr ofessor at t he Technology and Sciences College; 4 Under gr aduat e st udent at t he Bahia Feder al Univer sit y College of Nur sing, PI BI C gr ant holder ; 5 Physician at t he Car e Ser vice t o Vict im s of Sexual Violence - VI VER
D isponible e n ca st e lla no/ D isponíve l e m língua por t ugue sa SciELO Br a sil w w w .scie lo.br / r la e
W OMEN VI CTI MS OF SEXUAL VI OLEN CE: ADHEREN CE TO CHEMOPREVEN TI ON OF HI V
1Nor m élia Mar ia Fr eir e Diniz2 Lílian Con ceição Gu im ar ães de Alm eida3 Bár bar a Cr ist ina dos S. Ribeir o4
Valér ia Góes de Macêdo5
D i n i z NMF, Al m e i d a LCG, Ri b e i r o BCS, Ma cê d o VG. Wo m e n v i ct i m s o f se x u a l v i o l e n ce : a d h e r e n ce t o
ch em opr ev en t ion of HI V. Rev Lat in o- am En fer m agem 2 0 0 7 j an eir o- fev er eir o; 1 5 ( 1 ) : 7 - 1 2 .
Th i s st u d y a i m e d t o i n v e st i g a t e t h e a d h e r e n ce o f w o m e n v i ct i m s o f se x u a l v i o l e n ce , t o AI D S
chem opr event ion t r eat m ent . A quant it at ive st udy w as car r ied out at a car e ser vice t o vict im s of sexual violence in Salv ador ( Bahia, Br azil) . St udy par t icipant s w er e 172 w om en. Dat a w er e collect ed t hr ough int er v iew s w it h for m s and consult at ion of pat ient files. The r esult s show ed t hat 45. 4% of t he abused w om en w er e t eenager s
and 40.7% of t he at t ended w om en w er e r aped. Only 54% of t he w om en w er e advised t o use ant ir et r ovir als t o pr ev en t HI V. Adh er en ce t o t r eat m en t occu r r ed in 5 7 . 4 % of cases an d discon t in u it y cor r espon ded t o 4 2 . 6 % . Non- adher ence t o t r eat m ent w as at t r ibut ed t o psy chological or em ot ional disor der s and non- under st anding of t he est ablished t r eat m ent . Ther efor e, it is im por t ant t hat pr ofessionals pay car eful at t ent ion in or der t o per ceive
t he condit ions t hat m ight incr ease w om en’s v ulner abilit y t o t he infect ion.
DESCRI PTORS: w om en ; v iolen ce; ch em opr ev en t ion
MUJERES VÍ CTI MAS DE LA VI OLÊNCI A SEXUAL: ADHESI ÓN A LA QUI MI OPROFI LAXI A DEL HI V
La finalidad de est e est udio fue invest igar si las m uj er es víct im as de violencia sexual adhier en o no al uso de m edicam ent os par a pr evención del HI V. Fue r ealizado un est udio cuant it at ivo en un ser vicio de at ención a per sonas sexualm ent e violent adas, ubicado en Salvador ( Bahía, Br asil) . Par t icipar on del est udio 172 m uj er es. Lo s d at o s f u er o n r eco p i l ad o s a t r av és d e en t r ev i st as d i r i g i d as y co n su l t a a l o s ar ch i v o s. Lo s r esu l t ad o s
d em ost r ar on q u e el 4 5 . 4 % d e las m u j er es v íct im as d e v iolen cia er an ad olescen t es y q u e el 4 0 . 7 % d e las m u j e r e s a si st i d a s f u e r o n v i o l a d a s. Só l o e l 5 4 % d e l a s m u j e r e s f u e a co n se j a d o a u sa r m e d i ca m e n t o s ant ir et r ov ir ales par a pr ev ención del VI H, El 57. 4% de ellas adhir ió al t r at am ient o y el 42. 6% no lo cont inuó.
Aquellas que no adhir ier on al t r at am ient o alegar on dist ur bios psicológico y / o em ocional o no com pr ensión del t r at am ien t o in st it u id o. Por lo t an t o, es n ecesar ia u n a m ir ad a at en t a d e los p r of esion ales p ar a p er cib ir las condiciones que im plican un aum ent o en la v ulner abilidad de las m uj er es a la infección.
DESCRI PTORES: m u j er es; v iolen cia; qu im iopr ev en ción
MULHERES VÍ TI MAS DE VI OLÊNCI A SEXUAL: ADESÃO À QUI MI OPROFI LAXI A DO HI V
O est udo t ev e com o obj et iv o av aliar a adesão de m ulher es v ít im as de v iolência sex ual ao t r at am ent o de quim iopr ofilaxia do HI V. É um est udo quant it at ivo que t eve com o lócus o Ser viço de At enção a Pessoas em
Sit uação de Violência Sexual em Salvador ( Bahia) . Par t icipar am do est udo 172 m ulher es. A colet a de dados foi r ealizad a at r av és d e en t r ev ist a com f or m u lár io e con su lt a aos p r on t u ár ios. Os r esu lt ad os m ost r ar am q u e 45,4% das m ulher es v iolent adas er am adolescent es e o est upr o acom et eu 40,7% das at endidas. Apenas 54%
d as m u lh er es t in h am in d icação p ar a o u so d e an t i- r et r ov ir ais p ar a a p r ev en ção d o HI V. Hou v e ad esão ao t r at am en t o d e 5 7 , 4 % e a t ax a d e d escon t in u id ad e cor r esp on d eu a 4 2 , 6 % . A n ão- ad esão f oi at r ib u íd a aos t r anst or nos psíquicos e/ ou em ocionais e à não com pr eensão do t r at am ent o inst it uído. Por t ant o, há necessidade d e u m o l h a r a t e n t o d o s p r o f i ssi o n a i s a f i m d e p e r ce b e r a s co n d i çõ e s q u e i m p l i ca r ã o n o a u m e n t o d a
v u ln er abilidade das m u lh er es à in fecção.
I NTRODUCTI ON
S
ex u al v i o l en ce i g n o r es cu l t u r al b ar r i er s, social classes, socioecon om ic lev els an d in d iv id u allim it at ions. I t can occur in t he pr iv at e as w ell as in
t he public spher e and affect s m en and w om en of all
ages, w it h w om en being t he gr eat est v ict im s.
V i o l e n c e a g a i n s t w o m e n , c a l l e d g e n d e r
v i o l en ce, r ep r esen t s a sev er e v i o l a t i o n o f h u m a n
r i g h t s an d i s cap ab l e o f cr eat i n g co u n t l ess h eal t h
p r ob lem s, am on g w h ich : f ear, lack of cr ed ib ilit y in
t h e l eg al sy st em an d si l en ce, t u r n i n g v i ct i m s i n t o
accom plices of t h eir aggr essor s.
I t should be highlight ed t hat violence r ecor ds
do n ot r ev eal t h e r ealit y as, in Br azil, t h er e ar e n o
global dat a abou t t h is ph en om en on : it is est im at ed
t hat com plaint s are filed in less t han 10% of cases( 1).
For a lon g t im e, v iolen ce w as con sider ed a
police m at t er. Now adays, due t o t he dim ensions it has
a ssu m e d , i t h a s a l so t u r n e d i n t o a p u b l i c h e a l t h
p r ob lem . Wom en in v iolen ce sit u at ion s f ace sev er e
healt h problem s. Psychological disor ders, for exam ple,
include repeat ed night m ares, anguish, flight , avoiding
m em or ies about t he t r aum at ic event , w het her in t alks
or by avoiding t o r em em ber t hought s, places, people;
i n c r e a s e d e m o t i o n a l e x c i t a t i o n , a n g e r, l a c k o f
concent rat ion, st at e of aler t , get t ing scar ed easily and
n er v ou sn ess( 2 ).
W i t h r e sp e ct t o p h y si ca l a sp e ct s, w e ca n
m en t ion sk in in j u r ies, p r eg n an cy, ab or t ion , sex u al
infect ion, t ears and cont am inat ion by HI V. Ot her effect s
of aggr ession ar e chr onic diseases and dr ugs use.
Thus, as a result of t he t raum a, sexual violence
i s ca p a b l e o f p r o v o k i n g p sy ch o l o g i ca l d i so r d e r s,
physical diseases ( such as body inj uries for exam ple) ,
sex ually t r ansm issible diseases and Aids.
I n r e s p o n s e t o t h e p r o b l e m s a n d
r eper cu ssion s of sex u al v iolen ce t o people’s h ealt h ,
i n 1 9 9 9 , t h e Br azi l i an Heal t h Mi n i st r y l au n ch ed a
m a n u a l a i m e d a t ca r e st a n d a r d i za t i o n . Co n d u ct s
st a n d a r d i z e d b y t h e Mi n i st r y i n cl u d e t h e u se o f
ant ir et r ov ir als t o pr ev ent HI V infect ion.
D i sse m i n a t i o n a n d k n o w l e d g e a b o u t t h i s
pr act ice is st ill incipient in healt h ser v ices and in t he
p op u lat ion . How ev er, sin ce 2 0 0 1 , a r ef er r al cen t er
ex ist s in Salv ador w h ich deliv er s car e t o v ict im s of
sex u al v iolen ce an d of f er s ch em opr ev en t ion .
This st udy is j ust ified by it s epidem iological
an d social im por t an ce, as it pu t s f or w ar d qu est ion s
t hat have received lit t le at t ent ion unt il now and need
f u r t h er r ef lect ion , r ev ealin g or, bet t er, u n v eilin g t h e
space of v iolence in t he field of fam ily r elat ions, i. e.
t he hom e envir onm ent , w hich is gener ally consider ed
as a place of affect ion an d lov e, bu t w h ich act u ally
h ost s at r ocit ies an d aggr ession s.
I n t his cont ext , t his st udy’s gener al aim w as
t o a s s e s s f e m a l e v i c t i m s o f s e x u a l v i o l e n c e ’ s
ad h er en ce t o HI V ch em op r ev en t ion t r eat m en t , an d
it s specific obj ect ive w as t o ident ify fact ors influencing
fem ale sexual violence vict im s’ non- adherence t o HI V
ch em op r ev en t ion t r eat m en t .
METHODOLOGY
This descr ipt ive, explor at or y and quant it at ive
st u dy w as car r ied ou t at a Car e Ser v ice f or People
living in Sexual Violence Sit uat ions, locat ed in Salvador
( BA) , Brazil, bet ween Oct ober and Decem ber 2003. A
sy st em a t i c sa m p l e w a s sel ect ed . Ou r co r p u s w a s
con st it u t ed b y all f em ale ch ild r en , ad olescen t s an d
adult s w ho r eceiv ed car e dur ing t his per iod, t ot aling
172 wom en ( children, adolescent s and adult s) vict im s
of sexual violence at t ended at t he service, 60 of whom
were vict im s of Violent I ndecent Assault ( VI A) and 112
of rape, eit her associat ed wit h VI A or not .
Sex ual v iolence is consider ed as an act t hat
obliges a per son t o h av e sex u al, ph y sical or v er bal
cont act or t o par t icipat e in ot her sex ual r elat ions by
f o r ce, i n t i m i d at i o n o r an y o t h er m ech an i sm s t h at
annuls or lim it s per sonal w ill( 3).
Accor d in g t o t h e Br azilian Pen al Cod e, t h is
coercion can be expressed in different w ays, including
r ap e, at t em p t ed r ap e, sed u ct i o n , v i o l en t i n d ecen t
assault and obscene act( 3).
D at a w er e co l l ect ed t h r o u g h d o cu m en t ar y
analysis and int erview s. The lat t er w ere only held w it h
w om en w ho did not adher e t o t r eat m ent .
Dat a w er e obt ained fr om inst it ut ional r ecor ds,
w hich m ade it possible t o ident ify t he pat ient files and
v er i f y d a t a , t h r o u g h t h e i d en t i f i ca t i o n o f v i ct i m s,
sexual violence, aggr essor s and HI V chem opr event ion
t r eat m en t ad h er en ce.
All et h ical an d legal aspect s det er m in ed by
Nat ional Healt h Council resolut ion 196/ 96( 4) w er e t aken
in t o con sider at ion an d t h e pr oj ect w as appr ov ed by
t he Et hics Com m it t ee at t he Pr ofessor Edgar Sant os
Un iv er sit y Hospit al.
S e x u a l v i o l e n c e , a d h e r e n c e a n d n o n
dependent v ar iables, and sociodem ogr aphic dat a and
gy n ecological h ist or y as in depen den t on es.
RESULTS AND DI SCUSSI ON
St udying violence r equir es int egr at ion am ong
sect or s, as t h e com p lex it y in v olv ed d oes n ot allow
t r eat m ent by one single discipline. Violence is, above
all, a social issue and, as such, it is not only st udied in
healt h, but also in ot her ar eas, due t o it s disast r ous
consequences for w om en’s qualit y of life.
I n t h i s st u d y, t h e sam p l e ch ar act er i zat i o n
r ev eal ed cer t ai n p ar t i cu l ar i t i es, su ch as t h e l ar g e
n u m b e r o f s e x u a l v i o l e n c e c a s e s a m o n g f e m a l e
children and adolescent s and occurrence in t he hom e
en v ir on m en t .
The non- pr ivat e aspect of t he dom est ic spher e
lies in t he fact t hat it shelt er s t hings t hat should be
h id d en f r om h u m an ey es: t h e d ist in ct ion b et w een
w hat should be public or pr ivat e is est ablished t hrough
t he differ ence bet w een w hat should be ex hibit ed and
w hat should r em ain hidden( 5).
Man y ch ild r en , ad olescen t s an d ad u lt s ar e
vict im s of violence, but t he dat a below do not r eveal
all cases of v iolence t hat occur r ed in fam ily nuclei in
Salvador. Thus, w e infer t hat t hese dat a do not show
t he act ual r ange of violence, alt hough t hey suggest a
p r eoccu p y in g scen e.
I n t r afam ily v iolen ce is r oot ed in t h e cu lt u r e
and hist ory of civilizat ions and has becom e increasingly
unv eiled. I t has r eceiv ed gr eat er at t ent ion since t he
1 9 9 0 ’ s a n d , h e n ce , co n st i t u t e s a t h e o r e t i ca l a n d
pr act ical k now ledge ar ea under const r uct ion( 6).
Sam p le ch ar act er izat ion
We u se d t h e a g e r a n g e d i v i si o n cr i t e r i o n
est ablished by t he St at ut e of t he Child and Adolescent ,
consider ing people under 12 as childr en, bet w een 12
and 18 as adolescent s and 19 or older as adult s.
The r esult s evidenced t hat t he age gr oup m ost
affect ed by sexual violence is bet w een 12 and 18 year s
old ( 4 5 . 4 % ) , f ollow ed b y ch ild ( 3 2 . 6 % ) an d ad u lt
v ict im s ( 2 2 % ) .
Ot h er st u d ies h av e alr ead y m en t ion ed t h e
r elat ion bet w een violence exper iences and young age.
Acco r d i n g t o t h e sa m e a g e cl a ssi f i ca t i o n cr i t er i a ,
sexual violence affect ed 37.7% of childr en, 31.3% of
adolescent s and 31% of adult s( 7). These dat a confir m
t h at som e g r ou ps ar e m or e v u ln er able t o v iolen ce,
including y oung w om en( 7- 8).
This vulnerabilit y is j ust ified by relat ions t hat
could be char act er ized by confidence and pr ot ect ion
b u t w h i ch , h ow ev er, ar e u sed as a su b t er f u g e f or
v iolen ce. Th u s, in t h e h om e en v ir on m en t , in m ost
cases, t hese childr en and adolescent s going t hr ough
v iolence sit uat ions const r uct a social ident it y t hat is
r epr odu ced acr oss dif f er en t gen er at ion s.
Violence is discussed as a phenom enon t hat
appears in different social layers, t hat is, t here exist s
an equalit y level am ong sexual violence vict im s, w hich
is repeat ed across difference generat ions in t he sam e
fam ily, and can be called int er generat ionalit y( 6).
What skin color is concerned, w e believe t his
is a r elev an t v ar iab le w h en d iscu ssin g v iolen ce as,
alt h ou gh w e h av e dist in gu ish ed bet w een t h e color s
b l a ck a n d m u l a t t o , i n l i n e w i t h t h e i n st i t u t i o n a l
cl a ssi f i ca t i o n cr i t e r i o n , t h e Br a zi l i a n I n st i t u t e o f
Geogr aphy and St at ist ics ( I BGE) est ablishes t hat t he
t er m “ b lack p op u lat ion ” cov er s b ot h t h e b lack an d
m ulat t o populat ions t oget her, accor ding t o t he t er m s
a d o p t e d t o n a m e r a ce s a n d e t h n i c g r o u p s i n t h e
Br azilian p op u lat ion( 9 ). Based on t h is cr it er ion , w e
found t hat 7 7. 3% ( 3 9. 5% black ; 37. 8% m ulat t o) of
t he v iolence v ict im s w er e black s.
How ev er, t hese dat a do not pr event us fr om
af f i r m i n g t h at sex u al v i o l en ce w as m o r e f r eq u en t
am on g black w om en , as t h ese ar e n ot on ly w om en
but also black , t hus suffer ing because t hey ar e m or e
discr im in at ed again st , dev alu at ed, liv in g in u n equ al
gender condit ions and v iolence sit uat ions.
A st u dy car r ied ou t in Salv ador ( BA) f ou n d
t h at 4 6 . 5 % o f w o m en w h o su f f er ed so m e k i n d o f
v iolence consider ed t hey w er e black( 1 0 ). How ev er, in
a st u d y r e a l i ze d i n Sã o Pa u l o , 4 7 . 8 % o f w o m e n
d ecl a r ed t h ey w er e w h i t e. Th i s d i f f er en ce ca n b e
j ust ified by r egional et hnic char act er ist ics( 11).
As t o t h e g y n ecolog ical v ar iab le, w e f ou n d
t h at t h e ser v ice clien t s u sed con t r acept iv e m et h ods
an d w er e alr eady sex u ally act iv e bef or e t h e sex u al
v i ol en ce.
I t sh ou ld be h igh ligh t ed t h at 1 8 . 7 % of t h e
w om en w er e vir gins and had t heir fir st sexual cont act
dur ing t he v iolent act , w hich r aises t he possibilit y of
sk in t ear s an d lacer at ion s, in cr easin g HI V in f ect ion
r isk s an d t h e n eed t o im p lem en t r isk m in im izat ion
c o n d u c t s . Th i s f a c t j u s t i f i e s t h e n o n - u s e o f
cont r acept ive agent s, as t hese w om en had not st ar t ed
Wh en v i r g i n w o m en ar e v i ct i m s o f sex u al
violence, t his ent ails, am ong ot her problem s, a higher
r isk of HI V cont am inat ion, as t he per for at ion of t he
hy m en inj ur es genit al m ucosa int egr it y( 12).
Sevent y per cent of violence vict im s w er e not
using any cont r acept iv e m et hod: t his ev idences t heir
v u ln erabilit y t o pr egn an cy.
Ev e n i f s o m e w o m e n u s e d e m e r g e n c y
c o n t r a c e p t i o n , i n l i n e w i t h H e a l t h M i n i s t r y
r ecom m endat ions, som e of t hem got pr egnant aft er
t h ey w er e v iolat ed, as t h e m edicat ion is n ot 1 0 0 %
effect ive and m any w om en at t ended t he ser vice m or e
t han 72 hour s aft er t he event , i.e. aft er t he deadline
det er m ined t o adm inist er t he m edicat ion.
I n case of pr egn an cy, t h e w om en h av e t w o
p ossib le op t ion s: eit h er t h ey accep t t h e p r eg n an cy
r esu lt in g f r om t h e r ap e an d liv e w it h t h e su f f er in g
t his can ent ail, or t hey choose t o hav e an abor t ion,
w h ich is of f er ed in h ealt h ser v ices b u t is n ot w
ell-st r uct ur ed y et and can also cause suffer ing.
Sex u al v iolen ce
Wit h r espect t o t he sex ual v iolence v ar iable,
at cer t ain t im es, w e found an associat ion w it h ot her
f or m s, su ch as Violen t I n d ecen t Assau lt w it h Or al
co i t u s ( VI AO) ; Vi o l en t I n d ecen t Assau l t w i t h An al
coit us ( VI AA) and bot h com bined w it h r ape.
Ta b l e 1 - D i s t r i b u t i o n o f s e x u a l v i o l e n c e c a s e s
accor ding t o age gr oups
t h e p r e d o m i n a n c e o f r a p e a m o n g a d u l t s a n d
adolescen t s, w h ile VI A pr ev ails am on g ch ildr en .
Th e s t u d y b y D r e z e t t e v i d e n c e d t h e
p r e v a l e n ce o f VI A a m o n g ch i l d v i ct i m s o f se x u a l
v i ol en ce, cor r esp on d i n g t o 7 0 . 4 % i n t h i s st ag e of
life( 13). As t o t he dist r ibut ion of aggr essor s accor ding
t o t h e v ict im s’ dif f er en t age r an ges, w e f ou n d t h at
s e x u a l a g g r e s s i o n a g a i n s t c h i l d r e n w a s m o s t
f r e q u e n t l y c o m m i t t e d b y n e i g h b o r s ( 3 2 . 1 % ) ,
a c q u a i n t a n c e s ( 1 7 . 9 % ) , f a t h e r s ( 1 4 . 4 % ) a n d
st epf at h er s ( 1 2 . 5 % ) .
Am ong adolescent s, 27.9% of violence cases
ar e pr act ices by acqu ain t an ces, 1 9 . 1 % by u n k n ow n
p e r so n s a n d 1 3 . 2 % b y st e p f a t h e r s. Am o n g a d u l t
w o m e n , 6 0 . 4 % o f s e x u a l v i o l e n c e c a s e s w e r e
com m it t ed by unknow n m en. This show s t hat childr en
a n d a d o l e s c e n t s a r e m o r e v u l n e r a b l e t o f a m i l y
v i ol en ce.
Th u s, it sh ou ld b e h ig h lig h t ed t h at , in t h e
i d e n t i f i e d r a p e ca se s, t h e a ssa u l t e d w o m e n a r e
ex posed t o high HI V infect ion r isk s, consider ing t hat
a st udy car r ied out at t he out pat ient clinic of a t eaching
hospit al in São Paulo evidenced het erosexual relat ions
as t he m ain for m of HI V/ AI DS exposur e, r epr esent ing
83.5% of cases( 14).
As t o t h e n u m ber of aggr essor s, t h e st u dy
sh ow ed t h at , in 8 9 % of cases, t h e sex u al v iolen ce
was com m it t ed by one single aggr essor. Dat a indicat e
t h at p sy ch olog ical seq u elae ar e m or e sev er e w h en
sex u al abu se is per pet r at ed by m u lt iple aggr essor s
and also t hat , t he lar ger t he num ber of aggr essor s,
t he higher t he r isk of cat ching STD and HI V( 13).
S e x u a l v i o l e n c e i n v o l v i n g c h i l d r e n a n d
ad olescen t s occu r r ed in t h e p h y sical an d sy m b olic
t er r it or y of t he fam ily st r uct ur e, w her e m en ar e alm ost
t ot ally dom inant . The dist r ibut ion of sex ual v iolence
accor d in g t o t h e p lace of occu r r en ce d em on st r at ed
t h at t h e ag g r essor ’s h ou se w as t h e p r ef er r ed sit e
( 29.6% ) , follow ed by t he vict im ’s house ( 16.2% ) and
bushes, am ong ot her public places ( 13.4% ) ; in ot her
w or ds, violence can happen anyw her e, w het her public
or pr iv at e.
I n t he dom est ic spher e, aggr essor s w it h blood
o r p a r e n t h o o d b o n d s p e r p e t r a t e se x u a l v i o l e n ce
t hr ough a pr ocess of dom inion and pow er, est ablished
b y s o c i a l r u l e s . Th i s c a n b e c a l l e d i n t r a f a m i l y
v i o l en ce( 1 5 ). Th e se cu r i t y o f t h e h o m e a l l o w s t h e
aggr essiv e t o ex er cise pow er in w ell- k now n t er r it or y,
w h e r e d o m i n i o n a n d d e l i m i t a t i o n o f s p a c e a r e
ch ar act er ist ics t h at au t h or ize v iolen ce, w h ich t u r n s e
m i r C l a u x e
S Child Adolescent Woman Total
n % n % n % n %
e p a
R 7 12,5 41 60,3 22 45,8 70 40,7 A
A I V + e p a
R 3 5,4 5 7,3 4 8,4 12 7,0
O A I V + e p a
R - - 4 5,9 11 22,9 15 8,7
O A I V + A A I V + e p a
R - - 4 5,9 11 22,9 15 8,7
A I
V 46 82,1 14 20,6 - - 60 34,9
l a t o
T 56 100 68 100 48 100 172 100
Ta b l e 1 s h o w s t h a t 4 0 . 7 % o f w o m e n i n
differ ent age gr oups w er e vict im s of r ape, i.e. 60.3%
o f a d o l e s c e n t s , 4 5 . 8 % o f w o m e n a n d 1 2 . 5 % o f
c h i l d r e n . I n s o m e c a s e s , t h i s a g g r e s s i o n w a s
associat ed w it h ot her for m s, such as VI AO in 22.9%
of w om en ov er 1 8 ; VI AA in 8 . 4 % of w om en in t h e
sam e gr oup and t he t hr ee for m s t oget her in 2 2 . 9 %
of t hese w om en.
V I A w a s m o s t f r e q u e n t a m o n g c h i l d r e n
( 82.1% ) and affect ed 20.6% of adolescent s. No cases
filin g a com plain t in t o a difficu lt decision . We fou n d
t hat m ost aggr essor s w er e bet w een 20 and 40 year s
old. This qualifies adult indiv iduals as per pet r at or s of
sex u al v iolen ce.
Few cases of alcohol use occur r ed am ong t he
aggr essor s in com par ison w it h ot her st udies on t his
t h e m e . We f o u n d t h a t 5 7 . 3 % o f t h e m h a d n o t
consum ed alcoholic bev er ages w hen t hey com m it t ed
t h e v iolen ce. How ev er, it is com m on f or v ict im s t o
a sso ci a t e sex u a l v i o l en ce w i t h d r u g s u se: h en ce,
alcohol, as a legal drug, is also insert ed in t his cont ext .
A st udy of 150 fem ale college st udent s w ho had been
vict im s of r ape show ed t hat 84% affir m ed t hey knew
t he aggr essor and 73% t hat he w as under t he influence
of dr ugs or alcohol( 16) .
Ad h er en ce t o ch em op r ev en t ion
What t he adherence t o HI V prevent ion variable
is concer ned, w e found t hat ant ir et r ov ir als had been
in dicat ed t o on ly 5 4 % of w om en w h o at t en ded t h e
service in order t o prevent HI V( 17). The analyzed crit eria
include t ype and risk degree of t he aggression; whet her
it w as a r ape or a v iolent indecent assault ; w het her
genit al inj ur ies and fissur es occur r ed; if pier cing and
cut t ing m at er ial or sy r inges, et c. w er e used; t y pe of
sex ( oral wit h ej aculat ion, anal or vaginal) ; if t he vict im
react ed t o t he violence or not , as som e of t hese fact ors
can pot ent ializes t he risk of infect ion.
H e n ce , 4 6 % o f t h e w o m e n u se d n e i t h e r
chem opr event ion, because t hey did not at t end t o t he
a b o v e m e n t i o n e d c r i t e r i a , n o r e m e r g e n c y
con t r acep t ion .
A m o n g w o m e n w h o s t a r t e d t r e a t m e n t ,
adher ence lev els cor r esponded t o 57.4% , i.e. 42.6%
of w om en w ho init iat ed t r eat m ent did not cont inue.
Ta b l e 2 - D i st r i b u t i o n a cco r d i n g t o a d h e r e n ce t o
ch em opr ev en t ion u se per age gr ou p
l e a d i n g t o n o n a d h e r e n ce i n cl u d e m e n t a l a n d / o r
em o t i o n al d i so r d er s ( 4 0 % ) , l ack o f u n d er st an d i n g
a b o u t co r r e ct m e d i ca t i o n u se ( 3 0 % ) , se co n d a r y
collat eral effect s ( 20% ) and lack of financial resources
t o r et u r n t o t h e ser v ice t o r eceiv e t h e m ed icat ion
( 10% ) . We did not m anage t o cont act 56. 5% of t he
w om en w ho st opped t r eat m ent t o find out about t he
r eason t hat m ade t hem giv e up.
Tight ening t he r elat ion bet w een pr ofessionals
an d p at ien t s is an ex cellen t alt er n at iv e t o im p r ov e
t r eat m ent adher ence, as t he t eam could have w or ked
on all of t he m ot ives t hese w om en alleged t o abandon
t r eat m en t .
Pu b lic p olicies sh ou ld b e h eld accou n t ab le,
so as t o cont r ibut e w it h financial r esour ces t hat can
g u a r a n t ee t h e a d eq u a t e r ea l i za t i o n o f t r ea t m en t ,
pr ov iding at t he v er y least t r anspor t t ick et s t o allow
t h e w om en t o r et u r n t o t h e ser v ice t o p ick u p t h e
m ed icat ion .
Dr ezet t ’s st u dy in dicat ed gast r ic in t oler an ce
as t he m ain cause of t r eat m ent discont inuit y ( 80% ) .
Only one case of lack of under st anding about t r eat m ent
( 6.7% )( 12) w as r epor t ed.
Th u s , i n t e r a c t i o n b e t w e e n h e a l t h
p r o f e s s i o n a l s a n d v i c t i m s o f s e x u a l v i o l e n c e i s
e s s e n t i a l t o i n c r e a s e a d h e r e n c e t o H I V
c h e m o p r e v e n t i o n . Th i s r e q u i r e s t h e c o n t i n u o u s
a ssessm en t o f ca r e w i t h a v i ew t o t h e p er i o d i ca l
ident ificat ion of cases of abandonm ent , in t he sear ch
for v iable alt er nat iv es t o r educe HI V infect ion r isk s.
FI NAL CONSI DERATI ONS
Th e r esu lt s ev id en ced t h at sex u al v iolen ce
a f f ect s w o m en i n d i f f er en t a g e g r o u p s, w i t h h i g h
in ciden ce lev els am on g adolescen t s.
Violence st udies show t he black r ace as t he
m ain t ar g et of ag g r ession s. Black w om en p lay ed a
significant r ole in t he sam ple. Et hnic, socioeconom ic,
cult ur al and gender fact or s cannot be suppr essed in
discu ssion s abou t v iolen ce.
U s i n g f o r c e t o i n t i m i d a t e w a s c o m m o n
p r act ice: h en ce, sex u al v iolen ce ap p ear ed as r ap e,
violent indecent assault , violent indecent assault w it h
oral coit us and violent indecent assault w it h anal coit us.
Th e act g en er ally in v olv ed on e ad u lt ag g r essor. I n
so m e ca se s, t h i s p e r so n w a s a n a cq u a i n t a n ce o r
r elat iv e ( f at h er, st epf at h er, u n cle or br ot h er ) of t h e
v ict im , w h ich ch ar act er izes in t r afam ily v iolen ce.
* Six cases of t r eat m ent w er e suspended on t he doct or ’s or der
I n com par ison w it h t he st udy by Dr ezet t , in
w h ich 7 5 . 8 % of w om en ad h er ed t o t r eat m en t an d
discont inuit y rat es am ount ed t o 24.2%( 13), dat a in Table
2 sh ow low adh er en ce lev els in ou r st u dy. Reason s t
n e m t a e r
T Child Adolescent Woman Total
n % n % n % n %
e c n e r e h d
A - - 6 46,1 25 64,1 31 57,4 e
c n e r e h d a -n o
N 2 100 07 53,9 14 35,9 23 42,6
l a t o
Recebido em : 17.11.2005 Apr ovado em : 19.9.2006
Adherence t o HI V chem oprevent ion t reat m ent
was low, as all wom en should adhere t o t he t herapeut ic
schedule wit h a view t o reducing HI V infect ion risks.
Tr eat m en t aban don m en t can be j u st ified by
cou n t less sit u at ion s: t ak in g a pill t o pr ev en t HI V is
a c c o m p a n i e d b y a s e r i e s o f t h i n g s , s u c h a s
r e m e m b e r i n g t h e v i o l e n c e a n d m a k i n g p u b l i c
som et hing t hat w ould be pr ivat e. Ot her r easons include
econom ic difficult ies t o go t o t he ser v ice t o pick up
t he pill and lack of under st anding about t r eat m ent .
The t eam should w or k w it h and per iodically
a sse ss t h e se m o t i v e s, w i t h a v i e w t o i m p r o v i n g
ad h er en ce lev els.
Th i s s t u d y c o n t r i b u t e s t o t h e e d u c a t i o n
pr ocess for w or king w it h fam ilies, t o t he ext ent t hat it
sh ow s in t r af am ily v iolen ce as a n at u r alized p ar t of
socially const r uct ion int er gener at ional r elat ions. Thus,
p r o f e s s i o n a l s f r o m d i f f e r e n t a r e a s c a n h a v e a
d if f er en t iat ed look w it h a v iew t o car e d eliv er y t o
subj ect s and fam ilies in v iolence sit uat ions.
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