O enfrentamento ao fenômeno discriminatório em uma população de adultos / Facing the discriminatory phenomenon in adult population

Resumo A discriminação é um fenômeno social causador de prejuízos e iniquidades em saúde. O objetivo desta pesquisa foi explorar a discriminação e suas formas de enfrentamento por servidores universitários. Trata-se de estudo qualitativo analítico, usando entrevistas individuais semiestruturadas, interpretadas pela fenomenologia. A amostra foi intencional, definida pela técnica da bola de neve. Utilizou-se a análise de conteúdo temática proposta por Bardin, com o auxílio do software NVivo para definir categorias analíticas. Os principais resultados revelam um modelo de enfrentamento/combate à discriminação, no qual as categorias se inter-relacionam. A categoria cultura ocupa papel central, interligando as estratégias de cotas, educação formal, legislação e políticas públicas, mídias e educação informal. As cotas viabilizam acesso à educação formal, que reduz discriminação e aumenta oportunidades entre os indivíduos. As leis e políticas alteram o comportamento, tanto pelo seu papel educativo, quanto coercitivo. A mídia permite a interação e discussão sobre nós críticos da discriminação na sociedade. A educação informal cria ambientes viáveis de discussão e estimula o convívio menos discriminatório desde a infância. Este estudo traz novas perspectivas e abordagens alternativas para compreender formas de enfrentamento à discriminação, que é um fenômeno injusto, que cruza múltiplos espaços e contextos sociais.

Abstract Discrimination is a social phenomenon that causes damage and inequities in health. This paper aimed to explore the discrimination and its ways of confrontation by university servants. This is a qualitative analytical study, using semi-structured individual interviews, interpreted by phenomenology. The sample was intentional, defined by the snowball technique. Thematic content analysis proposed by Bardin was used, with the help of NVivo software to define analytical categories. The main results reveal a model of confronting / combating discrimination, in which the categories are interrelated. The culture category occupies a central role, linking the strategies of quotas, formal education, legislation and public policies, media and informal education. Quotas allow access to formal education, which reduces discrimination and increases opportunities among individuals. Laws and policies change behavior by both its educational and coercive roles. The media allows interaction and discussion about us who are critical of discrimination in society. Informal education creates viable environments for discussion and encourages less discriminatory living since childhood. This study brings new perspectives and alternative approaches to understand ways to confront discrimination, which is an unfair phenomenon that crosses multiple spaces and social contexts.

Pacientes ilegítimos: Acceso a la salud de los inmigrantes indocumentados en Chile / Illegitimate patients: Undocumented immigrants' access to health care in Chile

RESUMEN Chile se ha ido convirtiendo en un país de destino para las migraciones sudamericanas, las cuales generan un impacto en los servicios públicos, en particular en salud, a nivel económico, social y cultural. El objetivo de este artículo es aportar información documentada sobre los problemas de acceso a la salud de los inmigrantes indocumentados. Trabajamos desde una metodología cualitativa, basada principalmente en una etnografía del espacio clínico. Para el análisis de los resultados nos hemos basado en las teorías de las relaciones asimétricas de poder, así como en las de las relaciones interétnicas. En los resultados de la investigación, se destaca el incumplimiento de la normativa y el ejercicio del criterio personal discrecional como barreras en el acceso. Concluimos que, en Chile, los inmigrantes en general e indocumentados, en particular, son considerados pacientes ilegítimos.

ABSTRACT In recent decades, Chile has become a destination for immigrants from other South American countries, which has significantly impacted public services - particularly the public health system - at the economic, social, and cultural levels. The aim of this paper is to provide substantiated information on issues concerning undocumented immigrants' access to health care in Chile. A qualitative methodology, fundamentally an ethnography of the clinical setting, was used. Results were then analyzed in relation to theories of power asymmetries and interethnic relations. The research results highlight the lack of compliance with existing regulations and the exercise of discretionary personal judgment as barriers to access. It is concluded that in Chile immigrants in general, and undocumented immigrants in particular, are considered to be illegitimate patients.

Pueblos indígenas, VIH y políticas públicas en Latinoamérica: una exploración en el panorama actual de la prevalencia epidemiológica, la prevención, la atención y el seguimiento oportuno / Indigenous peoples, HIV and public policy in Latin America: an exploration of the current situations of epidemiological prevalence, prevention, care and timely treatment

RESUMEN Este artículo describe y analiza la situación epidemiológica, de prevención, atención y tratamiento del VIH para pueblos indígenas en Latinoamérica. Se identificaron, clasificaron y analizaron 304 materiales publicados, entre ellos, declaraciones, protocolos de políticas públicas y programas en salud, estudios de caso y revisiones del estado del arte locales, nacionales y regionales. La vulnerabilidad social diferencial en la adquisición del VIH y la inequidad en el acceso a la atención de la población indígena en Latinoamérica, con respecto a otras, se debe a la yuxtaposición de factores como la violencia estructural, el género, el racismo, la discriminación por la condición de salud en el caso de las personas que viven con VIH y la posición subordinada que, en general, ocupan en sociedades estratificadas en función de esquemas sociales y económicos pero también étnicos y culturales. Los escasos estudios desagregados por etnicidad sobre prevalencia epidemiológica y morbimortalidad existentes revelan datos desalentadores y alertan sobre la necesidad de conocer el comportamiento de la epidemia en esta población y abordar sus repercusiones en términos preventivos, de atención y seguimiento oportuno.

ABSTRACT This article aims to describe and analyze the situations of epidemiological prevalence, prevention, care and treatment of HIV in indigenous populations of Latin America. In order to do so, 304 published materials - including declarations, public policy and health program protocols, case studies and literature reviews with local, national and regional scopes - were identified, classified and analyzed. The differential social vulnerability to HIV infection and the inequity in health care access among indigenous populations can be attributed to the juxtaposition of factors such as structural violence, gender, racism, and discrimination due health condition (living with HIV) as well as the subordinated position of indigenous peoples in societies stratified not only socially and economically but also ethnically and culturally. The few studies done in the region on epidemiological prevalence, morbidity and mortality that are disaggregated by ethnicity reveal alarming data highlighting the need for further information on the epidemic in this population so as to address its repercussions in terms of prevention, care and timely follow-up.

Atribución de malos tratos en servicios de salud a discriminación y sus consecuencias en pacientes diabéticos mapuche / Healthcare mistreatment attributed to discrimination among mapuche patients and discontinuation of diabetes care

Background: The negative impact of perceived discrimination on health outcomes is well established. However, less attention has been directed towards understanding the effect of perceived discrimination on health behaviors relevant for the treatment of diabetes in ethnic minorities. Aim: To examine the effects of healthcare mistreatment attributed to discrimination on the continuity of Type 2 Diabetes (DM2) care among mapuche patients in a southern region of Chile. Material and Methods: A non-probabilistic sample of 85 mapuche DM2 patients were recruited from public and private health systems. Eligibility criteria included having experienced at least one incident of interpersonal healthcare mistreatment. All participants answered an instrument designed to measure healthcare mistreatment and continuity of diabetes care. Results: Healthcare mistreatment attributed to ethnic discrimination was associated with the discontinuation of diabetes care. Conclusions: Healthcare mistreatment attributed to discrimination negatively impacted the continuity of diabetes care, a fact which may provide a better understanding of health disparities in ethnic minorities.

"Se podrían evitar muchas muertas": discriminación, estigma y violencia contra minorias sexuales en México / "Many deaths could be avoided": discrimination, stigma and gender violence against non-heterosexual men: the Mexican situation / "Poderiam ser evitadas muitas 'mortas'": discriminação, estigma e violência contra as minorias sexuais no México

A partir del análisis de la información recabada en diagnósticos participativos comunitarios realizados en 2011, este artículo describe formas, actores, lugares de discriminación y estigma padecidos en varias regiones metropolitanas de México por personas transexuales, travestis, gays y bisexuales, así como personas infectadas por el VIH. Se muestra cómo la violencia hacia dichas poblaciones es ejercida, reproducida y legitimada desde instituciones públicas, e interiorizadas por las propias minorías sexuales. Según se argumenta, la discriminación institucionalizada, la interiorización del estigma y la desinformación en relación a la salud sexual y prevención de VIH, conllevan una vulneración en términos de salud, acceso a servicios de justicia y defensa de derechos humanos. También favorecen una mayor segregación urbana y legitiman indirectamente el statu-quo social en el espacio urbano.

By presenting the results of participative community group evaluations held recently, this paper describes the forms, actors, and sites of discrimination and stigma affecting transsexuals, travesties, gays, bisexuals, and HIV-positives persons in various metropolitan regions of Mexico. It shows how the violence against those populations is reproduced and legitimated by public institutions. It argues that this institutionalized discrimination, together with the individual reproduction of stigma, and misinformation regarding sexual health and prevention; result in a dramatic degree of vulnerability for this populations, in terms of health and access to Human Rights defense, security, and legal services. Furthermore, those conditions also favor urban segregation and, indirectly, legitimize the social status quo in urban space.

A partir da análise da informação obtida em diagnósticos participativos comunitários realizados recentemente, este artigo descreve as formas, os atores, os lugares de discriminação e estigma sofridos em várias regiões metropolitanas do México por pessoas transexuais, travestis, gays e bissexuais, assim como por pessoas infectadas pelo HIV. Mostra-se como a violência contra tais populações é exercida, reproduzida e legitimada pelas instituições públicas, e interiorizadas pelas próprias minorias sexuais. Conforme se argumenta, a discriminação institucionalizada, a interiorização do estigma e a desinformação em relação à saúde sexual e à prevenção do HIV implicam a vulnerabilidade de tais populações em termos de saúde e acesso a serviços de justiça e defesa de direitos humanos. Também favorecem uma maior segregação urbana e legitimam indiretamente o status-quo social no espaço urbano.