Este trabalho apresenta estudo de caráter etnográfico acerca da relação entre homens e a assistência à saúde na Atenção Primária, realizado em oito serviços de quatro estados brasileiros. Seu objetivo é compreender a (in)visibilidade dos homens no cotidiano da assistência a partir da perspectiva de gênero, que discute os mecanismos promotores de desigualdades presentes no trabalho em saúde. Foram identificadas, nesse contexto, diferentes dimensões desta (in) visibilidade: os homens como alvo de intervenções no campo das políticas públicas de saúde; como usuários que enfrentam dificuldades na busca por atendimento e no estímulo à sua participação efetiva; como sujeitos do cuidado (de si e de terceiros). O trabalho reforça a importância dos estudos de gênero e sua relação com a saúde, na medida em que discute a produção das iniquidades sociais (re) produzidas pelas desigualdades de gênero presentes no imaginário social e nos serviços de saúde.

OBJECTIVE:To analyze the results from the "WHO Multi-country Study on Women's Health and Domestic Violence", on the prevalence of intimate partner violence against women found in Brazil. METHODS:This cross-sectional study was part of the "WHO Multi-country Study on Women's Health and Domestic Violence against women", which was carried out in ten countries between 2000 and 2003. All the countries used a standardized structured questionnaire, devised for this study. In order to obtain data from contrasting settings within each country, the biggest city and a rural region were investigated whenever feasible. A representative sample of women aged 15 to 49 years was selected from the city of São Paulo and 15 municipalities in a rural region of the northeast, the Zona da Mata de Pernambuco. The study included 940 women from São Paulo and 1,188 from Zona da Mata de Pernambuco who had had an intimate partner at some time in their lives. Violence was classifi ed as psychological, physical and sexual types, and was analyzed in relation to overlapping, recurrence of episodes, severity and when it occurred. RESULTS:The women in São Paulo and Pernambuco respectively reported the following at least once in their lifetimes: psychological (N=383; 41.8% and N=580; 48.9%); physical (N=266; 27.2% and N=401; 33.7%); sexual (N=95; 10.1% and N=170; 14.3%) violence. There was signifi cant overlapping among the types of violence, which seemed to be associated with the most severe types of violence. The greatest single type was psychological violence, in São Paulo and Pernambuco (N=164; 17.5% and N=206; 17.3%), and the smallest was sexual violence (N=2; 0.2% and N=12; 1.0%). CONCLUSIONS:The results show that violence is a very common phenomenon. The fi ndings reiterate previous international studies results with regard to high magnitude and overlapping of types of intimate partner violence.KEY WORDS: Battered women. Violence against women. Spouse abuse. Domestic violence. Cross-sectional studies.

It shows the thematic "men and health" as a contemporary matter of the Public

O trabalho analisa as concepções de gênero e masculinidades de profissionais de saúde da Atenção Primária à Saúde em quatro estados do país (PE, RJ, RN, SP) a partir de duas perspectivas: os significados associados a ser homem e a relação masculinidade e cuidados em saúde. O estudo de natureza qualitativa é parte de pesquisa multicêntrica tendo por referência a triangulação de métodos. Foram analisadas 69 entrevistas em profundidade de profissionais de saúde com formação de nível superior. Os relatos dos profissionais (re)produzem a noção de que os serviços são "espaços feminilizados", o que se traduz no seu cotidiano por um reforço à ideia do corpo masculino como lócus do não cuidado em oposição ao corpo feminino visto como lócus desse cuidado. Sobressai a representação dos profissionais sobre os homens centrados na forte presença de um padrão hegemônico de masculinidade, que influencia o pouco envolvimento destes com os cuidados em saúde. A existência de um modelo estereotipado de gênero acarreta a (re)produção de desigualdades entre homens e mulheres na assistência a saúde e compromete a visibilidade de outros significados e expressões de identidades de gênero.

Estudam-se relações entre masculinidades e cuidado em saúde, abordando o reconhecimento de necessidades por homens usuários de atenção primária e respostas dos serviços. É parte de pesquisa realizada em quatro estados brasileiros, com oito serviços amostrados por conveniência. Triangulou-se observação etnográfica com entrevistas semi-estruturadas com 182 usuários de 15 a 65 anos e com 72 profissionais. A análise temática dos registros etnográficos e das entrevistas foi baseada nos referenciais de gênero e em estudos do trabalho em saúde. Os resultados apontam como a medicalização das necessidades de saúde marca usuários, profissionais e serviços, ocultando questões vinculadas à masculinidade. Permitem caracterizar a atenção primária como voltada para as mulheres, reproduzindo no funcionamento dos serviços e nos desempenhos profissionais as desigualdades de gênero, em que para as mulheres há a disciplina do cuidado e para os homens, impropriedades para assistir e cuidar.

Os homens não vêm! Ausência e/ou invisibilidade masculina na atenção primáriaMen don't come! Absence and/or invisibility in primary healthcare services

OBJECTIVE:To estimate the prevalence of physical and/or sexual violence by intimate partners and factors associated with this, in different sociocultural contexts. METHODS:This cross-sectional study was part of the "WHO Multi-country Study on Women's Health and Domestic Violence against Women". It consisted of representative samples of women from the municipality of São Paulo (Southeastern Brazil) and from the Zona da Mata of Pernambuco (Northeastern Brazil), this latter is a region with more traditional gender norms. Interviews were conducted in the homes of 940 women in São Paulo and 1,188 in the Zona da Mata, in the years 2000-1. The women were aged 15 to 49 years and had all had at least one intimate partnership with a man during their lifetimes. Three sets of factors were constructed, corresponding to hierarchically organized categories: sociodemographic, family and female autonomy/submission characteristics. Hierarchical logistic regression was used to analyze factors associated with intimate partner violence at each location. RESULTS:A prevalence of 28.9% was found in Sao Paulo (95% CI 26.0;31.8) and 36.9% (95% CI 34.1;39.6) in Zona da Mata. Up to eight years of schooling, conjugal physical violence between the women's parents, sexual abuse during childhood, fi ve or more pregnancies and drinking problems were associated with intimate partner violence at both locations. Financial autonomy for the woman, informal partnership, age and consent to the fi rst sexual intercourse were associated with higher rates only in Zona da Mata. The socioeconomic characteristics that presented associations in the fi rst category were mediated by other factors in the fi nal model. CONCLUSIONS:The fi ndings show the relativization of socioeconomic factors in relation to other factors, particularly those representing gender attributes. Sociocultural differences were found between the two locations, and these were refl ected in the associated factors.

Violence against women attending public health services in the metropolitan area of São Paulo, Brazil ABSTRACT OBJECTIVE: To estimate the prevalence of (physical, psychological, and sexual) violence against women by an intimate partner and non-partner perpetrators among users of public health services and to compare these women's perception of having ever experienced violence with reports of violence in their medical records in the different services studied. METHODS:The study was conducted in 19 health services, selected as a convenience sample and grouped into nine research sites, in metropolitan area of São Paulo from 2001 to 2002. Questionnaires on having ever experienced violence in their lifetime and in the last 12 months and perpetrators were applied to a sample of 3,193 users aged 15 to 49. A total of 3,051 medical records were reviewed to verify the notifi cation of violence. Comparative analyses were performed by Anova with multiple comparisons and Chi-square test followed by its partition. RESULTS:The following prevalences were found: any type of violence 76% (95% CI: 74.2;77.8); psychological 68.9% (95% CI: 66.4;71.4); physical 49.6% (95% CI: 47.7;51.4); physical and/or sexual 54.8% (95% CI: 53.1;56.6), and sexual 26% (95% CI: 24.4;28.0). The prevalence of physical and/or sexual violence by an intimate partner in their lifetime was 45.3% (95% CI: 43.5;47.1), and by non-partners was 25.7% (95% CI: 25.0;26.5). Only 39.1% of women reporting any episode of violence perceived they had ever experienced violence in their lifetime and 3.8% of them had any reports of violence in their medical records. The prevalences were signifi cantly different between sites as well as the proportion of perception and reports of violence in medical records. CONCLUSIONS:The expected high magnitude of the event and its invisibility was confi rmed by low rate of reports in the medical records. Few perceived abuses as violence. Further studies are recommended taking into account the diversity of service users.