Abstract

BackgroundGender-based violence is a globally recognized social problem impacting women and girls worldwide. Intimate partner violence (IPV) represents the most common form of gender-based violence. Among the countries grappling with gender-based violence is Brazil, which has identified high rates of IPV along with co-occurring social conditions such as adverse childhood experiences, community violence, and substance use. While the syndemic framework has incorporated IPV into understandings of HIV and other diseases, none have explicitly applied syndemic framework to understand IPV and co-occurring social conditions -- referred to here as “social comorbidities” -- in the absence of a biological outcome. This study aims to: (1) Examine perspectives on violence and relevant social comorbidities (substance use, community violence, and childhood abuse) among women living in Santo André, São Paulo State, Brazil; and (2) Apply the syndemic framework to a set of social comorbidities among women living in Santo André, São Paulo State, Brazil.MethodsThis thematic analysis applies a syndemic framework to 28 in-depth interviews with women in Santo André, Brazil. Interviews were recorded and transcribed verbatim in Portuguese. Our analysis examined themes relating to IPV, community violence, substance use, and other individual experiences and community issues using syndemics as an organizing framework (e.g. diseases, adverse interactions, disparity conditions, and enhanced disease transmission).ResultsMost participants described experiencing multiple social comorbidities including IPV, adverse childhood experiences, community violence, family violence, and substance use. Adverse interactions included increased financial conflicts, a sense of isolation, and increased severity of violence due to substance use. Long term enhanced “disease” progression included injury, increased mental health symptoms, femicide, and death.ConclusionsOur results suggest that using a syndemic framework to understand IPV in the context of social comorbidities could be useful for understanding how these social phenomena may mutually reinforce each other and cause adverse interactions. Similar applications across other social phenomena may also be possible.

Highlights

  • Gender-based violence is a globally recognized social problem impacting women and girls worldwide

  • Brazil — in addition to having high rates of Intimate partner violence (IPV) — faces elevated rates of non-lethal community violence, drug possession crimes, and homicide [2,3,4,5]. We examine this range of comorbid social conditions through a thematic analysis of qualitative interviews from Brazil conceptually framed with syndemics

  • Violence has long been considered a component of syndemics, it was part of the first conceptualized syndemic in combination with HIV and substance use in what was known as SAVA [7]

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Summary

Introduction

Gender-based violence is a globally recognized social problem impacting women and girls worldwide. Among the countries grappling with gender-based violence is Brazil, which has identified high rates of IPV along with co-occurring social conditions such as adverse childhood experiences, community violence, and substance use. Brazil — in addition to having high rates of IPV — faces elevated rates of non-lethal community violence, drug possession crimes, and homicide [2,3,4,5] In this analysis, we examine this range of comorbid social conditions through a thematic analysis of qualitative interviews from Brazil conceptually framed with syndemics. In the violence literature IPV has long been examined in relationship to other social or behavioural health concerns Drawing upon both fields we introduce a new terminology for referring to co-occurring social phenomena when applying the syndemics framework which we refer to as social comorbidities. To our knowledge our paper is the first to explicitly apply the syndemic framework to understand IPV and co-occurring social conditions in the absence of a biological outcome

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