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.

The relationship between the Maria da Penha Law and intimate partner violence in two Brazilian states.

BACKGROUND: Globally, inequality between men and women manifests in a variety of ways. In particular, gender inequality increases the risk of perpetration of violence against women (VAW), especially intimate partner violence (IPV), by males. The World Health Organization (WHO) estimates that 35 % of women have experienced physical, psychological and/or sexual IPV at least once in their lives, making IPV unacceptably common. In 2006, the Maria da Penha Law on Domestic and Family Violence, became the first federal law to regulate VAW and punish perpetrators in Brazil. This study examines the relationship between Brazilian VAW legislation and male perpetration of VAW by comparing reported prevalence of IPV before and after the enactment of the Maria da Penha Law. METHODS: To assess changes in magnitude of IPV before and after the law, we used data from the 2013 Brazilian National Health Survey; we replicated the analyses conducted for the WHO Multi-Country Study on Women's Health and Domestic Violence Against Women-whose data were collected before the passage of the Maria da Penha Law. We compare findings from the two studies. RESULTS: Our analyses show an increase in the reported prevalence of physical violence, and a decrease in the reported prevalence of sexual and psychological violence. The increase may result from an actual increase in physical violence, increased awareness and reporting of physical violence, or a combination of both factors. Additionally, our analysis revealed that in the urban setting of São Paulo, physical violence was more likely to be severe and occur in the home; meanwhile, in the rural state of Pernambuco, physical violence was more likely to be moderate in nature and occur in public. CONCLUSION: The Maria da Penha Law increased attention and resources for VAW response and prevention; however, its true impact remains unmeasured. Our data suggest a need for regular, systematic collection of comparable population-based data to accurately estimate the true prevalence of IPV in Brazil. Furthermore, such data may inform policy and program planning to address specific needs across diverse settings including rural and urban communities. If routinely collected over time, such data can be used to develop policies and programs that address all forms of IPV, as well as evidence-based programs that address the social and cultural norms that support other forms of VAW and gender inequality.