Gender norms – set of social prescriptions constitutive of the sense of masculinity or femininity -8 affect subjects of both sexes, determining patterns of behavior, performance in daily life and exercise of sexuality. For women, gender norms associate the practice of sex with love and reproduction, creating the assumption of motherhood as the ultimate desire of all, treated with priority over other alternatives for individual fulfillment.
like prostitutes, who refuse a pregnancy, like women who cause an abortion, or who have HIV, often without breaking any rules but “inheriting” “the mark of deviation related to AIDS, are especially affected by processes of stigma and its consequences for health.
Aspects of access to health
arising from gender stereotypes and specific stigmas, among prostitutes, women who have abortions and women living with HIV, based on a critical analysis of recent research conducted in the country. It is intended to contribute to the reflection on the relationships between gender, stigma and health, aiming to encourage more inclusive and equitable care practices.
Women, prostitution and health It is estimated that one percent (1%) of the Brazilian female population between 15 and 49 years old (almost half a million people) is involved in commercial or transactional sex activities.9 According to a survey conducted in 2010, with 2,523 prostitutes in ten Brazilian cities, 10 about half of these professionals are up to 30 years old. age, never married, did not complete elementary school and has been in the profession for less than six years.
- The main place of work is the street, followed by bars or clubs. Approximately half of them charge R $ 50.00 or less per program, performing, on average, 15 programs per week. About 20% of these women have not had a gynecological examination in the past three years and of these, half report never having gone
- to the gynecologist; approximately 40% of the total of women interviewed did not seek health services the last time they had a sexual health problem.
Even during the duration of the Integrated Plan to Combat the Feminization of AIDS and other Sexually Transmitted Diseases (STDs), which allocated specific funds for HIV prevention projects among women, prostitutes were less contemplated.21 Furthermore, throughout the HIV epidemic / aids, the projects developed for prostitutes, in general, used methodologies currently recognized as ineffective in reducing the prevalence of infection in this group, as is the case with peer education.22
Ethnographic studies of prostitution
reveal variations in the motivations and conditions of female sex work, although they confirm the effects of stigma on women who prostitute themselves.11 Expressed in moral, medical and legal discourses and practices, the stigma is concretized in situations of violence and vulnerability that affect their lives.
- 12 The apartment of health service prostitutes is not a recent phenomenon. One of the first Public Health actions in Brazil was the organization of maternal
- and child care services, aiming to reduce the mortality of children and mothers during pregnancy and childbirth.13 They were not services for women “from the
- street” because, until the implantation of the SUS, the health care model required a working relationship.
However, the universalization of health care and the implementation of the Comprehensive Health Care Program for Women (PAISM) in 1986, aiming to expand the offer of health care for women to in addition to reproduction, this scenario has not substantially changed.13 Based on a concept of integrality aimed at expanding offers, PAISM has not privileged any specific group of women. Although the text of the National Policy for
Comprehensive Health Care for Women -14 successor to PAISM as of 2004, makes explicit the recognition of the different health needs of women, no strategy was devised to expand access to health for prostitutes. Perhaps it was not a lapse but an understanding that prostitutes were included in the effort to offer quality health care to all women, at any stage of life.
This absence violates the principle of equity
without which the universality of the right to health as defined in the Brazilian Constitution cannot be guaranteed.15 It is possible to assume that the invisibility of the specific demands of women prostitutes corresponds to a posture of the Brazilian State of laissez-faire in approaching the theme, of not criminalizing prostitution but the activities associated with it.
- Such a posture leaves women who work as prostitutes in a situation of extreme unprotection, as they cannot demand hygienic and safe working conditions. In
- other words, under the guise of respecting the right of women to prostitute, there is, in fact, a lack of
- assistance to their needs for comfort and safety at work, which makes it difficult to cope with situations of violence and the stigma they are subjected to. .
The same can be considered in relation to health. The work of satisfying male sexual desires and fantasies for a fee brings specific health demands that are not restricted to the development of condom use skills with clients. The other aspects of sexual and reproductive health, and general health, should be considered in view of the precarious conditions in which sex work is performed16 and the need to facilitate access to health services.
The opening hours of the units, the routine of life and the fear of being poorly attended, due to the stigma, keep prostitutes away from health services, causing them to be at increased risk for various conditions such as depression, 17 induced abortion, 18 hepatitis B19 and others. Although the Brazilian response to HIV /
AIDS has increased access for prostitutes to prevention and care services, the prevalence of infection in this group is approximately ten times higher than among other women.20 Although prostitutes are present in AIDS policies since its inception, the volume of actions directed at them has been repeatedly smaller, in comparison with actions directed at other population groups at greater risk of infection..Bez kategorii