We need to use words that we'd use in Brazil, right? A Community-Based Content Validation of a Translated Femicide Risk Assessment Instrument.

The Danger Assessment (DA) is a widely-used risk assessment instrument designed to help women understand their risk of femicide. Currently, no validated tool exists in Brazilian Portuguese. The purpose of this study was to conduct a cross-cultural adaptation of the DA for use in the Brazilian context as a precursor to validation and broader testing among women in Brazil. This study describes a community participatory approach for translation and cultural adaptation of the DA from European to Brazilian Portuguese that engages the target population in the process. Using a three-step process, a final version of the DA-Brazil instrument was developed.

Intimate Partner Violence: Barriers to Action and Opportunities for Intervention Among Health Care Providers in São Paulo, Brazil.

Health care providers (HCPs) who directly interact with women play a critical role in intimate partner violence (IPV) prevention and response. The aim of this study was to identify the structural and interpersonal barriers to IPV response among HCPs working in public health clinics in Santo André, Brazil. Eligible participants included all HCPs providing direct care to individuals at three public health clinics. Participants self-administered an adapted Knowledge, Attitudes, and Practices survey on IPV. Data were analyzed using Epi Info 7 and SAS 9.4. 114 HCPs completed surveys. Less than half of HCPs (41%, n = 34) reported ever having asked a woman about abuse in the past year. HCPs who perceived fewer barriers were more likely to report asking about IPV. The top three reported barriers to asking women about IPV included the following: few opportunities for one-on-one interaction (77%, n = 65), a lack of privacy (71%, n = 60), and fear of offending women (71%, n = 60). Fewer providers who perceived the barriers of lack of privacy asked about IPV (50.8%, n = 33 compared with 84.2%, n = 16; p < .05); less providers who perceived few opportunities for private patient interactions asked about IPV (48.3%, n = 29 compared with 75.0%, n = 18; p < .05). Our results support the need for a systems approach of institution-wide reforms altering the health care environment and avoiding missed opportunities in IPV screening and referring women to appropriate resources or care. Two of the most frequently reported barriers to asking IPV were structural in nature, pointing to the need for policies that protect privacy and confidentiality. Within the Brazilian context, our research highlights the role of HCPs in the design and implementation of IPV interventions that both strengthen health systems and enable providers to address IPV.

"Women fear the law more than abusers": a study of public trust in health and legal response to violence against women in Santo André, São Paulo State, Brazil.

Little is known about how perceptions of government affects women's views of violence against women. This qualitative study examines women's perceptions of violence against women laws and trust in the health and legal sector response in São Paulo State, Brazil. Thirty interviews with female residents of Santo André, 18 years and older, were audio recorded, transcribed, coded, and analyzed for themes using MAXQDA12 software. All women were familiar with at least one federal violence against women law. They expressed widespread lack of trust in the government. They viewed the legal sector as ineffective and felt violence against women laws have little impact, or exacerbate violence. Disdain for the health sector was less prominent than for the legal sector. A generalized lack of trust in government manifests as a lack of confidence in these laws for women seeking support through legal and health sectors. Adoption of legal protections for women is a significant accomplishment. However, health and legal sector violence against women response needs to consider perceptions of government, how violence against women laws are operationalized, and the role of each sector in ensuring women's safety. Violence against women response efforts should include standardized intersectoral procedures including referral to accessible resources and means of screening women who may be at high risk for femicide.

Women fear the law more than abusers: a study of public trust in health and legal response to violence against women in Santo André, São Paulo State, Brazil / As mulheres têm mais medo da lei que dos agressores: um estudo sobre a confiança pública na saúde e a reposta jurídica à violência contra mulheres em Santo André, São Paulo, Brasil / Las mujeres temen más la ley que a los agresores: un estudio de la confianza pública en la salud y respuesta legal ante la violencia contra mujeres en Santo André, estado de São Paulo, Brasil

Abstract: Little is known about how perceptions of government affects women's views of violence against women. This qualitative study examines women's perceptions of violence against women laws and trust in the health and legal sector response in São Paulo State, Brazil. Thirty interviews with female residents of Santo André, 18 years and older, were audio recorded, transcribed, coded, and analyzed for themes using MAXQDA12 software. All women were familiar with at least one federal violence against women law. They expressed widespread lack of trust in the government. They viewed the legal sector as ineffective and felt violence against women laws have little impact, or exacerbate violence. Disdain for the health sector was less prominent than for the legal sector. A generalized lack of trust in government manifests as a lack of confidence in these laws for women seeking support through legal and health sectors. Adoption of legal protections for women is a significant accomplishment. However, health and legal sector violence against women response needs to consider perceptions of government, how violence against women laws are operationalized, and the role of each sector in ensuring women's safety. Violence against women response efforts should include standardized intersectoral procedures including referral to accessible resources and means of screening women who may be at high risk for femicide.

Resumo: Há poucos estudos sobre a maneira pela qual o governo é percebido e como isso afeta as opiniões das próprias mulheres sobre a violência contra mulheres. Este estudo qualitativo examina as percepções das mulheres em relação as leis sobre violência contra mulheres e a confiança delas na resposta dos setores de saúde e direito no Estado de São Paulo, Brasil. Foram realizadas 30 entrevistas com mulheres acima de 18 anos de idade, residentes em Santo André. As entrevistas foram gravadas, transcritas, codificadas e analisadas tematicamente com o uso do software MAXQDA12. Todas as mulheres conheciam pelo menos uma lei federal sobre violência contra mulheres. Elas manifestavam uma desconfiança generalizada em relação ao governo. Consideravam ineficazes as respostas do setor jurídico. Achavam que as leis sobre violência contra mulheres tinham pouco impacto, e que eventualmente exacerbavam a violência. Havia menos desconsideração em relação ao setor de saúde, comparado ao setor jurídico. A desconfiança generalizada em relação ao governo se manifesta enquanto falta de confiança nas leis para mulheres que buscam apoio através dos setores jurídico e sanitário. A adoção de salvaguardas formais para as mulheres representa um avanço significativo. Entretanto, a resposta à violência contra mulheres pelos setores jurídico e sanitário deve levar em conta as percepções em relação ao governo, e de como as leis sobre a violência contra mulheres são operacionalizadas, além do papel de cada setor na garantia da segurança das mulheres. As respostas à violência contra mulheres devem incluir procedimentos intersetoriais padronizados, incluindo o encaminhamento para triagem de mulheres expostas a risco elevado de feminicídio.

Resumen: Se sabe poco acerca de cómo las percepciones sobre el gobierno afectan los puntos de vista de las mujeres sobre la violencia que se ejerce sobre ellas. Este es un estudio cualitativo que examina las percepciones de las mujeres sobre las leyes relativas a la violencia contra mujeres y su confianza en la salud y en la respuesta del sector legal en el estado de São Paulo, Brasil. Se realizaron 30 entrevistas con mujeres residentes de Santo André, de 18 años y edad superior, se grabaron en audio, transcribieron, codificaron y analizaron para los temas usando el software MAXQDA12. Todas las mujeres estuvieron familiarizadas con al menos una ley federal sobre violencia contra mujeres. Ellas expresaron una falta generalizada de confianza en el gobierno. Consideraban al sector legal como ineficiente. Sentían que las leyes sobre la violencia contra mujeres tenían un escaso impacto ante la exacerbada violencia. El desdeño por el sector de salud fue menos prominente que por el sector legal. Una falta generalizada de confianza en el gobierno se manifiesta en una falta de confianza en estas leyes para las mujeres que buscan apoyo legal a través del mencionado sector y el de salud. La adopción de medidas legales para las mujeres es un logro significativo. No obstante, la respuesta sobre los sectores de salud y legal, en cuanto la violencia contra mujeres, necesita considerar las percepciones acerca del gobierno, de qué forma se aplican las leyes, así como el rol de cada sector para asegurar la seguridad de las mujeres. Los esfuerzos para atajar la violencia contra mujeres deberían incluir procedimientos estandarizados intersectoriales que proporcionen recursos accesibles y medios de supervisión a las mujeres que tal vez estén en alto riesgo de feminicidio.

A cross-sectional survey of parental attitudes towards Human papillomavirus vaccination exclusion categories in Brazil.

BACKGROUND: In 1988, Brazil established a constitutional right to health and universal access to health care for all Brazilians through the creation of the Unified Health System (SUS). As part of its efforts to fulfill this right, the quadrivalent Human papillomavirus (HPV) vaccine was introduced into the national immunization program in 2014. The non-discriminatory provision of healthcare goods, facilities, and services is a fundamental part of the right to health. Yet HPV vaccination was limited to females aged 9-13, despite the universal nature of SUS and scientific support for the vaccination of males and older females. The purpose of this cross-sectional study was to describe parental attitudes regarding age- and gender-based HPV vaccination exclusions, as well as parental knowledge of HPV and the HPV vaccine. METHODS: Data were gathered from parents with children aged 9-17 in a health post located in the municipality of Mauá (São Paulo, Brazil) through interviewer-administered questionnaires. We analyzed attitudes regarding HPV vaccination and its eligibility guidelines by comparing parents of HPV vaccine eligible and ineligible children. RESULTS: In this low-income population, the majority of the 219 parents surveyed supported the inclusion of males and females over 13 into the HPV vaccination program; support for the non-discriminatory provision of the HPV vaccine was high among parents - especially if financially accessible. Additionally, there were high levels of knowledge and positive parental attitudes regarding HPV vaccination safety and efficacy among both parent groups suggesting information accessibility - a key component of the right to health and informed decision-making. CONCLUSIONS: Support for the expansion of HPV vaccination for excluded populations exists, and is not based on current eligibility, or differential knowledge and attitudes about the vaccine. Moving forward, careful consideration of gender- based eligibility for vaccination, informed decision-making, and the importance of community participation in health policy development and implementation may be gleaned from the case of Brazil and beyond.