{"id":947,"date":"2021-11-22T11:59:00","date_gmt":"2021-11-22T11:59:00","guid":{"rendered":"https:\/\/mihealth.418staging.co.uk\/?p=947"},"modified":"2024-06-13T15:48:57","modified_gmt":"2024-06-13T14:48:57","slug":"impacto-do-ipv-na-adesao-a-arte","status":"publish","type":"post","link":"https:\/\/mihealtheurope.org\/pt\/impact-of-ipv-on-art-adherence\/","title":{"rendered":"Viol\u00eancia entre parceiros \u00edntimos, ades\u00e3o \u00e0 terapia antirretroviral e sa\u00fade da mulher"},"content":{"rendered":"

No in\u00edcio deste ano, os meus colegas e eu public\u00e1mos um artigo sobre a forma como a experi\u00eancia de viol\u00eancia por parceiro \u00edntimo (VPI) afecta negativamente a capacidade de manter elevadas taxas de ades\u00e3o \u00e0 terapia antirretroviral (TARV). Para este estudo, foram recolhidas amostras de 410 mulheres seropositivas que estavam a receber TARV h\u00e1 pelo menos seis meses em 12 hospitais p\u00fablicos do Qu\u00e9nia. Ap\u00f3s o check-up de rotina, perguntou-se \u00e0s mulheres que aceitaram participar no estudo se o seu atual parceiro alguma vez tinha sido f\u00edsica, sexual ou emocionalmente abusivo para com elas (tal como definido pelo m\u00f3dulo sobre viol\u00eancia dom\u00e9stica do Inqu\u00e9rito Demogr\u00e1fico e de Sa\u00fade). Tamb\u00e9m lhes foi perguntado se os seus parceiros alguma vez tinham demonstrado um comportamento controlador, como limitar o seu contacto com amigos e familiares.<\/p>\n\n\n\n

H\u00e1 muito que a VPI foi identificada e provada como um fator de risco para a infe\u00e7\u00e3o pelo VIH entre as mulheres. Isto deve-se ao facto de as mulheres que sofrem de VPI terem mais probabilidades de serem expostas a comportamentos sexuais de risco, actos sexuais violentos, sexo for\u00e7ado e<\/p>\n\n\n\n

raramente est\u00e3o em posi\u00e7\u00e3o de negociar a utiliza\u00e7\u00e3o do preservativo. Tamb\u00e9m raramente acedem aos servi\u00e7os de sa\u00fade. A literatura recente tamb\u00e9m sugere que, em pa\u00edses com elevada preval\u00eancia de VIH, os homens violentos t\u00eam maior probabilidade de serem seropositivos, aumentando assim o risco para as mulheres. Por isso, infelizmente, n\u00e3o foi surpreendente verificar que 76% das mulheres entrevistadas tinham sofrido alguma forma de VPI do seu parceiro atual. Esta taxa de preval\u00eancia \u00e9 mais elevada do que a m\u00e9dia nacional do Qu\u00e9nia, 46%.<\/p>\n\n\n\n

Quando comparada com a taxa de ades\u00e3o ao TARV nos \u00faltimos 30 dias, as mulheres que tinham sofrido VPI f\u00edsica, VPI sexual ou comportamento de controlo eram mais propensas a declarar ter tomado entre 0 e 94% das suas doses de ARV. As mulheres que nunca tinham sofrido VPI relataram maioritariamente uma ades\u00e3o de 100%<\/p>\n\n\n\n

taxas. Os profissionais de sa\u00fade que entrevistaram as mulheres apresentaram algumas explica\u00e7\u00f5es para este facto. Uma delas \u00e9 o facto de, durante os confrontos violentos, algumas mulheres serem perseguidas ou obrigadas a fugir de casa e, por isso, n\u00e3o poderem levar consigo a medica\u00e7\u00e3o. Al\u00e9m disso, o facto de terem acabado de se refugiar pode dificultar-lhes a manuten\u00e7\u00e3o do hor\u00e1rio da medica\u00e7\u00e3o ou das consultas m\u00e9dicas, devido \u00e0 dist\u00e2ncia ou ao receio de revela\u00e7\u00e3o. O nosso racioc\u00ednio, que foi tamb\u00e9m a base da nossa hip\u00f3tese de investiga\u00e7\u00e3o, \u00e9 que viver num ambiente em que ocorre VPI (seja no passado ou atualmente) afecta a capacidade de uma mulher aderir ao tratamento. A investiga\u00e7\u00e3o tem um<\/p>\n\n\n\n

J\u00e1 foi demonstrado que viver num ambiente deste tipo pode levar a sofrimento psicol\u00f3gico, depress\u00e3o e m\u00e1 sa\u00fade mental, que s\u00e3o tamb\u00e9m factores de previs\u00e3o de uma menor ades\u00e3o \u00e0 TAR. Al\u00e9m disso, o nosso estudo revelou que o comportamento de controlo, que muitas vezes \u00e9 simplesmente descartado como um comportamento de superprote\u00e7\u00e3o ou ci\u00fame, pode ser psicologicamente mais prejudicial do que se estimava anteriormente.<\/p>\n\n\n\n

Uma das raz\u00f5es subjacentes \u00e0 realiza\u00e7\u00e3o deste estudo foi a de contribuir para a crescente evid\u00eancia cient\u00edfica dos efeitos adversos da<\/p>\n\n\n\n

efeitos que a VPI tem na sa\u00fade das mulheres. Especificamente, a VPI n\u00e3o deve ser vista apenas como uma quest\u00e3o social ou legal, mas sim como um problema de sa\u00fade p\u00fablica, mesmo quando n\u00e3o termina em feminic\u00eddio. Estudos efectuados pelo Organiza\u00e7\u00e3o Mundial de Sa\u00fade (OMS)<\/a> estabeleceram que as formas de VPI s\u00e3o causas subjacentes de les\u00f5es f\u00edsicas (morbilidade), problemas de sa\u00fade mental que conduzem a perturba\u00e7\u00f5es emocionais e ao suic\u00eddio, problemas de sa\u00fade cr\u00f3nicos (s\u00edndrome da dor, dores de cabe\u00e7a graves, doen\u00e7as coron\u00e1rias, \u00falceras estomacais) e mortalidade entre as mulheres a n\u00edvel mundial. Uma an\u00e1lise que efectuei para o FNUAP Suazil\u00e2ndia h\u00e1 alguns anos revelou uma taxa significativamente mais elevada de VPI entre as mulheres com gravidezes indesejadas, as mulheres que j\u00e1 tinham sofrido um aborto ou um aborto espont\u00e2neo e as mulheres gr\u00e1vidas que frequentavam menos frequentemente as cl\u00ednicas de cuidados pr\u00e9-natais.<\/p>\n\n\n\n

No que respeita \u00e0 migra\u00e7\u00e3o, a VPI n\u00e3o \u00e9 necessariamente significativamente mais elevada entre os grupos de migrantes do que na popula\u00e7\u00e3o nativa em geral. A VPI ocorre em todos os dom\u00ednios sociais, econ\u00f3micos, raciais, culturais e religiosos. No entanto, o processo de migra\u00e7\u00e3o ou a situa\u00e7\u00e3o migrat\u00f3ria podem agravar a vulnerabilidade e as experi\u00eancias de VPI entre as mulheres. H\u00e1 diferentes n\u00edveis em que isto acontece. Em primeiro lugar, a n\u00edvel pr\u00e1tico, as mulheres migrantes que s\u00e3o v\u00edtimas de VPI podem n\u00e3o ter acesso a recursos \u00fateis, porque podem n\u00e3o saber da sua exist\u00eancia ou como chegar at\u00e9 eles. Mesmo quando sabem, podem n\u00e3o ter recursos financeiros ou compet\u00eancias lingu\u00edsticas para contactar os prestadores de servi\u00e7os ou podem ser discriminadas.<\/p>\n\n\n\n

Do ponto de vista social, as mulheres migrantes podem n\u00e3o ter o apoio social que ajuda a ultrapassar uma rela\u00e7\u00e3o abusiva porque deixaram os seus amigos e fam\u00edlias nos seus pa\u00edses de origem. Este isolamento social d\u00e1 ao parceiro abusivo ainda mais poder para as controlar, especialmente se a mulher n\u00e3o tiver contacto com a popula\u00e7\u00e3o de acolhimento atrav\u00e9s do trabalho, da educa\u00e7\u00e3o, etc. Neste caso, as comunidades informais<\/p>\n\n\n\n

que os migrantes normalmente formam em terras estrangeiras podem ajudar a mitigar este isolamento e podem tamb\u00e9m atuar como uma fonte de apoio e informa\u00e7\u00e3o sobre direitos e recursos. No entanto, dependendo das normas sociais e culturais da comunidade, algumas mulheres podem recear deixar a sua rela\u00e7\u00e3o abusiva porque n\u00e3o querem ser ostracizadas e perder a \u00fanica liga\u00e7\u00e3o social que t\u00eam no pa\u00eds de acolhimento.<\/p>\n\n\n\n

Do ponto de vista jur\u00eddico, para muitas mulheres migrantes, o seu estatuto jur\u00eddico est\u00e1 ligado ao dos seus parceiros, por exemplo, \u00e0s leis de reagrupamento familiar. A maioria<\/p>\n\n\n\n

As leis de imigra\u00e7\u00e3o exigem que os c\u00f4njuges permane\u00e7am juntos durante um determinado per\u00edodo de tempo para que a uni\u00e3o seja legalmente reconhecida e para que a separa\u00e7\u00e3o ou o div\u00f3rcio possam ser apresentados. Por conseguinte, as mulheres suportam os abusos em sil\u00eancio porque t\u00eam medo de p\u00f4r em risco o processo. Para<\/p>\n\n\n\n

para os que t\u00eam parceiros cidad\u00e3os ou com resid\u00eancia legal, esta depend\u00eancia pode ser utilizada para os chantagear, levando-os a manter a rela\u00e7\u00e3o abusiva.<\/p>\n\n\n\n

No entanto, h\u00e1 bons exemplos que mostram que, com as interven\u00e7\u00f5es e o apoio adequados, tanto a n\u00edvel governamental como de programas locais nos pa\u00edses de acolhimento, as mulheres migrantes v\u00edtimas de VPI podem retirar-se a si pr\u00f3prias e aos seus filhos de situa\u00e7\u00f5es abusivas e perigosas. Um exemplo s\u00e3o os refugiados s\u00edrios na Alemanha e na Su\u00e9cia que utilizaram as leis dos pa\u00edses de acolhimento para se separarem dos seus parceiros abusivos e constru\u00edrem vidas independentes para si e para os seus filhos.<\/p>\n\n\n\n

<\/p>\n\n\n\n

Saiba mais<\/summary>\n

Para obter orienta\u00e7\u00f5es relacionadas com a sa\u00fade e medidas preventivas em situa\u00e7\u00f5es de crise, consulte o nosso artigo sobre\u00a0Dia Mundial da Sida: Eis como reduzir o risco de contrair o VIH (um guia da OMS)<\/a>.<\/p>\n<\/details>","protected":false},"excerpt":{"rendered":"

Earlier this year, my colleagues and I published a paper on how experiencing intimate partner violence (IPV) negatively affects the ability to maintain high rates of antiretroviral therapy (ART) adherence. For this study, 410 HIV positive women who had been on ART for at least six months were sampled from 12 public hospitals in Kenya. […]<\/p>\n","protected":false},"author":1,"featured_media":948,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_uag_custom_page_level_css":"","footnotes":""},"categories":[1],"tags":[],"class_list":["post-947","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-community-blog"],"acf":[],"yoast_head":"\nImpact of IPV on ART Adherence: Insights & Challenges - Mi-Health Europe<\/title>\n<meta name=\"description\" content=\"Discover the Impact of IPV on ART Adherence & Women\u2019s Health. 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