Is violence a gender issue among community health agents in Northeast Brazil?

Abstract

Abstract A biopsychosocial phenomenon, violence may be defined as the hurtful outcome of conflicting social forces. Violence affects individual and collective health, creating a demand for targeted public policies and the implementation of services for the prevention and treatment of injury. Community Health Agents (CHAs) are the link between the Brazilian primary health care system and the community. As they live and work in the same neighborhoods, they are involved in what happens in the community, including observants and or potential targets of violence. We aimed to investigate the violence to which CHAs are exposed and if female CHAs experience and or perceive violence the same way as male CHAs. A structured questionnaire applied to CHAs was used to collect information. Two periods (2019 [n = 1402] and 2021 [n = 364]) were compared. The sampled CHAs were found to be highly exposed to violence (>80%), whether as victims in the workplace and at home or as witnesses within the community served. In general, while the occurrence of violence towards CHAs decreased, their perception of community violence increased. Moreover, between 2019 (before the Covid-19 pandemic) and 2021 (a year into the pandemic) the prevalence of perceived urban/community violence (physical aggression, assault, stabbing, lethal and non-lethal gunshots, and gang violence) increased among female CHAs, but remained practically unchanged (with the exception of ‘assault') among male CHAs, indicating a gender-related difference for this variable. In addition to impacting the health and work routines of CHAs, violence is also injurious to the health of the community (directly or indirectly - inability of CHA to deliver care). Given the complexity of violence and its repercussions on the daily routines of CHAs, intersectoral and interdisciplinary partnerships between health workers and other stakeholders are needed to create strategies capable of dealing with expressions of violence in the territories served. Key messages • CHA are highly exposed to violence (> 80%), whether as victims in the workplace and at home or as witnesses within the community served. • There is a gender-related difference for the perception of violence among CHA, which may be due to social inequalities or women's vulnerability to violence.