Protocolo Brasileiro para Infecções Sexualmente Transmissíveis 2020: violência sexual

Abstract

Resumo Este artigo aborda a violência sexual, tema que compõe o Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil. São apresentadas orientações aos gestores para o manejo programático e operacional, com foco na rede de atendimento às pessoas em situações de violência sexual, recomendações aos profissionais de saúde acerca de medidas profiláticas de gravidez e de infecções sexualmente transmissíveis virais e não virais, além das estratégias para as ações de vigilância. A violência sexual constitui um problema amplo, extrapola o campo de saúde e envolve desafios conceituais e programáticos tanto para os profissionais de saúde, na linha de frente na atenção às pessoas afetadas, quanto para a sociedade, em termos de possíveis formas de prevenção.

Blood-borne infections and pregnancies among women attending a sexual violence assistance center in Brazil: A 10-year retrospective study

“…The objective of prophylaxis in sexual violence victims is to prevent and treat the most prevalent STI and pregnancy, and the Brazilian Ministry of Health recommends protocols and technical standards for this type of assistance which are followed by the PAVIVIS team [ 9 – 11 ]. Since 2001, the inclusion of violence–domestic, sexual, and other forms of violence–in the list of compulsorily notifiable diseases by the Brazilian Ministry of Health implemented the National Policy for the Reduction of Morbidity and Mortality from Accidents and Violence made data from health sector become visible, sometimes more than those from police sector [ 20 ].…”

“…An increasing number of women seek health services for protective measures promptly, but an important percentage is not given adequate medication for STI prophylaxis [ 12 , 24 ]. This inability to assist approximately half of the women in sexual violence conditions reveals a failure to ensure reproductive rights involving health policies, training of medical students and health professionals, and dissemination to the population of the importance and availability of early care provided by UNHS for people in sexual violence conditions [ 11 ].…”

“…The objective of prophylaxis in sexual violence victims is to prevent and treat the most prevalent STI and pregnancy, and the Brazilian Ministry of Health recommends protocols and Frequency of procedures performed in the period technical standards for this type of assistance which are followed by the PAVIVIS team [9][10][11].…”

“…The biopsychosocial consequences of sexual violence are difficult to measure as they affect most victims and their families and can produce intense and devastating, often irreparable, emotional effects [ 4 ]. Immediate medical assistance to people in sexual violence condition (ideally up to 72 hours after the assault) allows offering the prophylaxis of non-viral STI (gonorrhea, chancroid, chlamydia, syphilis, and trichomoniasis), viral STI (hepatitis B and HIV) and emergency contraception (which can be done up to 5 days after the assault), thereby avoiding future damage to women’s health [ 9 – 11 ]. However, health national database figures for 2011 from the Notifiable Diseases Information System (SINAN) show that 46.1% of adolescents and 63.8% of adults in sexual violence condition have prophylaxis for STI and 35% of adolescents and 44% of adults performed emergency contraception [ 12 ].…”

“…An American population-based study showed a higher risk of STI diagnosis and treatment in women who suffered sexual violence, regardless of the time after the event [ 13 ]. It is known that the risk of acquiring STI depends on several factors, such as the type of violence suffered (vaginal, anal, or oral penetration), the number of aggressors, the type of exposure (single, multiple, or chronic), the occurrence of genital trauma, the woman’s age and susceptibility, hymenal condition, the presence of STI, pregnancy length and the form of coercion used by the aggressor [ 11 ].…”