Reporting of violence against people experiencing homelessness: an analysis of SINANAbstract
This study aims to analyze notifications of violence against people experiencing homelessness (PEH) and the associations between the characteristics of victims, the nature of the abuse, and the perpetrators. We collected data from the Notifiable Diseases Information System (SINAN) from 2015 to 2022, totaling 42,621 records. An annual upward trend in notifications was observed, with a decrease during the pandemic year of 2020 and a resurgence in 2021. Physical violence was the most common type, and most victims were Black individuals. Correspondence analysis showed an association between violence resulting from legal interventions involving firearms, with police officers as the perpetrators. Among Black male victims, physical violence with blunt objects was associated with unknown perpetrators, and bars or similar venues were common locations of abuse. For white female victims, recurrent psychological/moral violence, involving threats and physical force, was more likely to involve known perpetrators such as intimate partners or family members and occurred within the home. These varied profiles highlight the need for public policies that address the distinct vulnerabilities within this population.
Key words:
Violence; Exposure to violence; Social vulnerability; Socioeconomic factors; Homeless people
Resumo
O objetivo do estudo é analisar as notificações das violências praticadas contra pessoas em situação de rua e a associação entre as características da vítima, da agressão e dos agressores da violência. Foram utilizados os dados do Sistema de Informação de Agravos de Notificação (SINAN) de 2015 a 2022, totalizando 42.621 registros. Houve tendência de aumento anual das notificações, com queda durante o ano pandêmico de 2020 e, em 2021, um retorno ao crescimento. A violência física foi o tipo mais comum e a maioria das vítimas eram pessoas negras. A análise de correspondência mostrou associação entre a violência por intervenção legal, meio de agressão por arma de fogo e agressores policiais. Entre vítimas do sexo masculino negras, violência física, meio de agressão por objeto contundente e agressores desconhecidos, e o local da agressão foi um bar ou similar. Entre vítimas do sexo feminino, autodeclaradas brancas, violência psicológica/moral, recorrentes, por meio de ameaça e força corporal, agressor conhecido/parceiros íntimos/familiares, em residência. A existência de diferentes perfis demonstra a necessidade de se construir políticas públicas que levem em conta as diferentes vulnerabilidades que coexistem nessa população.
Palavras-chave:
Violência; Exposição à violência; Vulnerabilidade social; Fatores socioeconômicos; Pessoas mal-alojadas
Resumen
El estudio analiza las notificaciones de violencia contra personas en situación de calle y su relación con características de víctimas, agresores y agresiones, usando datos del SINAN (2015-2022), con 42.621 registros. Se observó un aumento anual de notificaciones, con caída en 2020 y repunte en 2021. La violencia física fue la más común, principalmente contra personas negras. El análisis de correspondencia mostró asociación entre violencia por intervención legal, arma de fuego y policías como agresores. En hombres negros, predominó la violencia física con objetos contundentes, por desconocidos, en bares o similares. En mujeres blancas, destacó la violencia psicológica/moral, recurrente, mediante amenazas y fuerza corporal, en el hogar, por agresores conocidos, parejas íntimas o familiares. La diversidad de perfiles evidencia la necesidad de políticas públicas que consideren las múltiples vulnerabilidades de esta población.
Palabras clave:
Violencia; Exposición a la violencia; Vulnerabilidad social; Factores socioeconómicos; Personas sin hogar
Introduction
Social Protection is the institutionalization of measures aimed at reducing or preventing social vulnerabilities by meeting essential human needs1. Social Protection policies must be coordinated with other social policies, such as health and safety, to ensure decent living conditions2. People experiencing homelessness (PEH) are characterized as heterogeneous, with diverse trajectories marked by a lack of access to the minimum conditions necessary for survival, exclusion, and violence3. Therefore, the need for public policies and services aimed at expanding and facilitating these individuals’ access to their rights is recognized4.
The National Policy for People Experiencing Homelessness was established in 2009 and was a milestone in guaranteeing the rights of this population5. Provided for in Decree Nº 7.053 of December 23, 2009, is the implementation of Specialized Reference Centers for the PEH (Centro Pop), Special Social Protection units that work to develop the autonomy and social inclusion of these people4. However, the issue of violence and its confrontations is little portrayed.
The WHO affirms that there are three broad categories of violence, based on the characteristics of violent act perpetrators: self-inflicted or self-directed violence; interpersonal violence; and collective violence.6 Understanding violence as a multifaceted event with complex interactions between its individual, microsystemic, and macrosystemic dimensions also allows for another way of categorizing violence, defined as structural, which concerns socioeconomic, political, and cultural processes that reproduce inequalities7. Beyond these four broad categories are several forms of violence, which can be classified according to the nature of the violent acts as physical, sexual, psychological, and violence related to deprivation or abandonment6. These four types of violent acts occur in each of the broad categories.
Violence is considered a major Public Health problem, recognized by the WHO, with repercussions for the health of individuals and communities and an impact on health services due to high morbimortality. The effect of violence can be highlighted in economic terms, with removals, absenteeism, hospitalization costs, and potential years of life lost in the general population. There is a close relationship between inequality and violence, which exposes vulnerable groups, such as PEH, to these problems.
In recent years, the increase in the number of PEH has exposed the enormous social inequalities in the country, creating social and health problems that deserve greater attention. PEH are characterized by the lack of conventional housing, extreme poverty, and fragile family ties, making them especially susceptible to aggression and rights violations9. Living on the streets has been synonymous with living with daily violence that occurs in a variety of ways, such as physical and psychological violence imposed by stigmatization, violent approaches by public security professionals, neglect of services, and a lack of public policies10.
However, the public perception of this group is determined by a stigma of aggressiveness and criminality, not recognizing them as a group victimized by urban violence, but rather as one responsible for it11. PEH are therefore victims of violence that manifests itself both concretely and symbolically - that is, the type of violence that does not “appear” as violence, such as labeling and stigmatization, which allows for the naturalization of abysmal social inequality like that of Brazil12. These attitudes uphold prejudice and normalize violence against these people, increasing their invisibility and perpetuating their vulnerability. This situation reduces their chances of finding work and integrating into society, preserving a continuous cycle of violence.
The issue of violence in the Unified Health System (SUS) was institutionalized in 2001, with the publication of the National Policy for Reducing Morbimortality from Accidents and Violence13,14. On January 25, 2011, Ordinance GM/MS Nº 104 was published, later supplemented by Ordinance GM/MS Nº 1.271 of June 6, 2014, which includes the notification of violence as part of the compulsory notification list, universalizing it in all public or private health services15. In 2014, the “reason for violence” field was included in the notification form, which includes whether the violence was caused by the victim’s homelessness, sexism, homophobia/lesbophobia/biphobia/transphobia, racism, religious intolerance, xenophobia, generational conflict, or disability, including a field for other unspecified reasons16. Thus, the Notifiable Diseases Information System (SINAN) can be used as an important source of information on this issue, as it has national coverage and provides information on the victim, the violence, and the perpetrator.
Despite published evidence on violence against people experiencing homelessness, epidemiological studies detailing the violence types and the factors associated with its occurrence are poorly documented in Brazilian literature. Understanding that this knowledge is essential to support more effective actions to mitigate and address this severe Public Health problem, this study aims to analyze reports of violence against PEH and the association between the characteristics of the victim, the abuse, and the perpetrators of violence against this social group.
Methods
This exploratory analysis of reports of violence against PEH from 2015 to 2022 extracted data from the Notifiable Diseases Information System (VIVA/SINAN)17, which is reported by health professionals or those responsible for public and private healthcare facilities, through the completion of the Individual Notification Form (INF). Interpersonal and Self-Harm Violence Surveillance is exceptionally vital for providing visibility to violence against PEH. For this study, cases of violence involving PEH were selected from the database using the variable “reason for violence” (field 55) and the choice of category7, “homelessness”, from the SINAN individual violence notification form.
The following variables were selected in the INF: gender (male and female), age group (0-19 years, 20-59 years, and 60 years or older); ethnicity/skin color (white, Black, or other); place of occurrence (home, collective housing, school, sports venue, public street, bar or similar, commerce/service, industry/construction, other); violence type (physical, psychological/moral, torture, sexual (sexual harassment or rape), human trafficking, financial/economic, neglect/abandonment, child labor, legal intervention, other); means of abuse (bodily force/beating, sharp object, blunt object, threat, firearm, other); recurrent violence (yes or no); probable perpetrator (father, mother, stepfather, stepmother); boyfriend, spouse; police officer/law enforcement officer, known, and unknown); alcohol use by the probable perpetrator (yes or no).
Initially, an analysis of the historical series of notifications from 2015 to 2022 was performed by Brazilian Federation Unit. Subsequently, a bivariate table was created between demographic characteristics and those related to violence by gender. Simple correspondence analysis (SCA) was adopted to analyze the variables under study jointly. This statistical technique is suitable for analyzing multiple categorical variables. It is helpful in identifying associations, understanding the profiles of the object under study, and subsequently constructing hypotheses about that object. SCA is an exploratory phase of the data and utilizes contingency tables, also called cross-tabs, composed of multiple categorical variables in the row and column.
In this study, the column variable was composed of the victim’s demographic characteristics: gender (male and female); ethnicity/skin color (white and Black); while the row variable includes characteristics related to violence: violence type (physical, legal intervention, psychological/moral); means of abuse (threat, firearm, bodily force/beating, blunt object); perpetrator (acquaintance/intimate partner/family member, stranger, police officer/law enforcement officer); place of occurrence (bar or similar, home); and recurrence (yes or no).
CA synthesizes the data’s variability structure in terms of dimensions. This technique is equivalent to factor analysis, but the results are presented graphically, where the smallest distances between row and column categories represent the strongest associations. In contrast, the most considerable distances represent dissociations. To verify the dependence between rows and columns, the technique uses the chi-square test of independence as a measure of association, with H0 representing the independence between the two variables and H1 representing the dependence between them. If hypothesis H0 is rejected, it means the variable categories can be reduced into new dimensions. The choice of the number of dimensions depends on the percentage of variation explained by each dimension, with the maximum number of dimensions being represented by the smallest number of rows or columns minus 1.
In this study, the first two dimensions explain almost all of the data variability, with dimension 1 explaining 94.1% and dimension 2, 5.3% (Table 1). The analysis was performed using SPSS version 25.0. This study used data from secondary public domain databases and, therefore, did not require approval by the Research Ethics Committee.
Results
According to SINAN, 42,621 reports of violence against PEH were recorded from 2015 to 2022. The Federative Units (UFs) with the highest percentages of reports of violence motivated by the victim’s homelessness in the 2015-2022 period were São Paulo (23.6%) and Minas Gerais (22.9%) (Table 2). The Southeast was responsible for 52.2% of the reports of violence motivated by the victim’s homelessness from 2015 to 2022, followed by the Northeast, with 21.5% (Table 2).
There was a trend of annual increase in notifications, with a decrease in the pandemic year (2020) (4,493 notifications in 2016, 5,263 notifications in 2017, 6,178 notifications in 2018, 6,351 notifications in 2019, 4,654 notifications in 2020). In 2021, there was a return to growth, with 5,095 notifications, followed by 5,311 notifications in 2022.
Among these, 93.3% were cases of physical violence, 19.2% were psychological/moral violence, and 4.1% sexual violence, and 18.8% of cases were recurrent. The victims were mostly male (52.9%, 47.1% were female), most of whom were Black (58.8%), aged 20-59 years (65.2%), and without a partner (63.9%). Perpetrators were mainly male (67.8%), with suspected alcohol use in 42.5% of the cases. Approximately 38.7% of the occurrences were perpetrated by strangers, 30.5% by friends or acquaintances of the victim, 7.3% by intimate partners, and 4.1% by family members. Furthermore, 45.8% of the notifications reported only one perpetrator, while 42.7% reported two or more.
The simple correspondence analysis (SCA) consisted of 13 row categories and 4 column categories. The chi-square test was used as a measure of association between row and column categories and identified an association (p-value < 0.01). For the column variables, gender had the most significant contribution in dimension 1, and ethnicity/skin color in dimension 2. For the row variables, the categories with the most significant contributions in dimension 1 were firearm violence (24.8%), psychological violence (17.9%), and police officer perpetrator (12.0%). In dimension 2, unknown (23.0%) and known (19.5%) perpetrators were the categories with the most significant contribution, as well as recurrent violence (14.1%) (Table 3).
From the observation of the proximities of the variables in the CA graph (Figure 1), three sets of situations were verified with the following associated variables: A) violence resulting from legal intervention, whose means of abuse was a firearm, and the perpetrators were police officers/law enforcement officers; B) male victims, self-declared Black, who suffered physical violence, whose means of abuse was a blunt object, the perpetrators were unknown, and the location of the abuse was a bar or similar; C) female victims, self-declared white, who suffered recurrent psychological/moral violence, through threats and physical force/beating, perpetrator being acquaintance/intimate partner/family member, and the violence occurred at home.
Biplot with profiles of violence against people experiencing homelessness registered in SINAN from 2015 to 2022.
Discussion
This study used data from SINAN reports on violence against PEH from 2015 to 2022, analyzing 42,621 incidents of violence against a social group in a highly vulnerable situation. This study is a pioneer in describing and analyzing information on this issue among PEH over seven years. Noteworthy is the gap in the literature on this topic involving PEH and the importance of interpreting data carefully. This study’s results revealed that women prevail as violence victims, primarily suffering attacks perpetrated by partners and acquaintances. Black men, more so than women, are affected by physical violence and legal interventions, often being victims of strangers and police officers, often with a high lethal potential.
The scenarios faced by the PEH population involve several vulnerabilities, which pose a challenge for public policies, especially those focused on health3. Being homeless increases vulnerability to illness due to several factors, such as the risks associated with living on the streets, the difficulty in accessing and adhering to appropriate and timely treatment, among others3. PEH stigmatization is another factor that makes them vulnerable and more exposed to several forms of violence. However, the growing number of reports over time should be analyzed with caution, as it may be linked to the implementation of surveillance for this problem. When this violence surveillance is in place, services tend to record more cases, and increasing reports do not necessarily indicate a higher incidence of violence in the regions mentioned above.
In the Epidemiological Bulletin released by the Health Surveillance Secretariat of the Ministry of Health in 2019, with data on reports of violence against the PEH in Brazil from 2015 to 2017, more than 15,000 cases of violence were recorded whose motivation was the victim’s homelessness19. In the present study, we observed that this number practically doubled from 2018 to 2022, totaling 27,589 reports of violence against this group. However, the data do not necessarily reflect an increase in violence. They may be the result of increased reporting of violence, greater demand for services. However, they may also reflect a growing PEH population due to increasing social exclusion, austerity policies, and impoverishment of the population, also due to the pandemic19.
However, as observed in the literature, there is a high proportion of cases of violence among PEH that are not always reported20. The reasons for underreporting vary from the victim not seeking health services (or having difficulty accessing the service), to the failure to register these cases in the reporting system by health professionals, and the failure to fill in the “reason for violence” field21. Corroborating this reality, this study, through an analysis of notifications recorded by SINAN in the federal units, identified that the Southeast (52%) stands out as the region with the highest number of reports of violence against PEH, followed by the Northeast (22%), North (7%), and Midwest (6%). This significant difference between regions and the possible underreported cases may be related to the smaller population in some of these regions, in addition to problems in implementing surveillance and difficulties in accessing specialized services20. Notably, in 2022, based on data from CadÚnico, the Southeast was home to 151,030 PEH, representing 50% of this population throughout Brazil22.
The social context of the streets is complex, marked by stigmas and gender-related power imbalances23. In this setting, according to the results of the report “The Homeless Population in the Single Registry Numbers” published in 2024, female PEH are fewer in number, representing approximately 15% of the PEH population nationwide24. Rosa and Bretas (2015) believe that this power disparity occurs because most of the PEH population is male25. This imbalance accentuates power inequality, increasing the vulnerability of women in this condition to several types of violence26. This situation occurs due to the historical context, in which heteronormative patriarchy “sees” women as subordinate to men23,26.
In the life trajectories of female PEH, we highlight that studies identify that relatives, partners, and/or partners attempt to exercise disciplinary roles over their lives9,23,25. From a gender perspective, we can identify that men and women experience and assimilate the experience of being homeless in significantly different ways. Among these differences, we observe that, for men, people experiencing homelessness were the result of a process of social rupture and degradation. On the other hand, for some women, people experiencing homelessness initially represented a way to escape situations of violence suffered in the domestic context.23,25,27
Several studies have found that female PEH frequently report domestic violence perpetrated by their partners, most often describing episodes of physical and/or sexual abuse9,25-29. Some tolerance for non-physical forms of violence has also been observed.25 However, other qualitative studies report numerous psychological violence cases coupled with neglect. For PEH, these situations involve any act of deprivation or omission in meeting an individual’s essential needs, including emotional aspects, health, education, nutrition, safety, housing, and living conditions. Although often considered minor, they are responsible for significant distress, as identified in this study9,25,29.
According to the National Epidemiological Bulletin of the Health Surveillance Secretariat covering the 2015-2017 period, reports of violence motivated by homelessness were more frequent among women19. A study conducted in Los Angeles, California, as part of a longitudinal study of PEH, revealed that most intimate partner violence occurred among the women surveyed30. A study conducted in a municipality in Minas Gerais indicated that homeless women were 42 times more likely to experience some type of violence than men28.
Gender inequality has deteriorated during the COVID-19 pandemic, as noted in the Pan American Health Organization (PAHO) report, “Gender and Health Analysis: COVID-19 in the Americas”, published on March 8, 2022. During this same period, there was a considerable increase in the PEH population and, as a direct consequence, an increase in the number of women experiencing homelessness, the main reason being domestic violence32.
Studies show that seeking the street as a form of protection is evident in the accounts of female PEH, who have had their rights violated within their families or suffered domestic violence and neglect. More often than not, the street ends up becoming an extension of the environment of violations and violence9,25,28,29. In addition to domestic violence being a determining factor in these women’s homelessness, the violence they face in this environment is rooted in gender-based social relations, in which patriarchy, power dynamics, and hierarchies of masculinity and femininity play predominant and widespread roles. In this context, the street is configured as a predominantly male space, increasing these women’s vulnerability and the risk of further violence23. Furthermore, because they are predominantly Black women, they are also affected by the oppressions resulting from racism and the silencing of the violence they suffer32. Thus, these women, already vulnerable due to their condition, are even more exploited28.
The overall findings of this study indicate an association between PEH and violence resulting from legal intervention by police officers or law enforcement officials, with firearms being the primary means of abuse. Race, class, and gender are determining factors in the frequency and aggressiveness of police stops, making PEH frequent targets of repressive and potentially lethal actions by law enforcement officials33. The massacre that occurred in Praça da Sé, São Paulo, on August 19-22, 2004, was a landmark event that exposed violence against PEH. These events led to the emergence of a movement dedicated exclusively to defending the rights of this population, especially after suspicions of police involvement in the violence arose34. This finding is also identified in several other studies3,9,25,27,29,35.
A recent study that aimed to characterize the violence suffered by PEH in a medium-sized municipality in Minas Gerais, for example, found that police violence is a reality for this population, with less than half of those interviewed reporting feeling protected by the institution28. In another study conducted in Florianópolis, data on police violence against homeless people reinforce these findings. This type of violence was frequently reported by this group, with reports of physical and verbal violence being used to expel them from public spaces, confiscation of belongings, and “physical searches”, among other abuses9.
PEH are often perceived by society as a threat, rather than as a group in a condition of extreme social vulnerability.28 From this perspective, both social and political, people living on the streets are seen as something to be controlled by the police force, which helps to explain the recurring cases of police violence against this group, reported not only in this study, but also in several other studies9,25,27,29,35.
One of the objectives of the National Policy for People Experiencing Homelessness (PNPSR) is to establish human rights defense centers and channels for reporting violence5. However, the Government frequently violates the rights to life, liberty, equality, and security of this population, in addition to developing insufficient and ineffective public policies3. Government interventions are often hygienist, intended to conceal social inequality without addressing the fundamental issues.
The association between self-identified Black victims who suffered physical violence, using a blunt object as the means of abuse, with unknown assailants and incidents in bars or similar venues also deserves attention. To understand the complex social situation of homelessness in Brazil, it is fundamental and essential to revisit structural racism, which has left and continues to leave so many scars on the Black Brazilian population. According to Baez and Maisonnett (2016), after the supposed abolition of slavery in 1888, the Black population in the country was thrown onto the city streets, with no means of survival, housing, work, health care, or education27. With the lack of structuring public policies, the Black population continued to experience several forms of violence, such as stigmatization, silencing, systematic exclusion of their stories, criminalization, mass incarceration, and the elimination of their bodies36.
The predominance of the Black population on the streets, in favelas, favelas, urban outskirts, occupied areas, and in the Brazilian penitentiary system is not a simple coincidence or mere correlation of facts37. According to a survey by the Brazilian Observatory of Public Policies for the Homeless Population, linked to the human rights platform of the UFMG Citizenship Hubs Program, 58% of Brazilian PEH identify as Black38. This percentage is even higher in states such as Rio de Janeiro (78%), Minas Gerais (80%), Mato Grosso (82%), and Bahia (93%). Thus, the structural racism in Brazilian society continues to generate several violations against Black people, including homeless Black people37.
According to Oliveira et al. (2023), in a study conducted with PEH, the prevalence of violence against self-declared Black people was 66.7%28. Notably, according to the National Epidemiological Bulletin of the Health Surveillance Secretariat for the 2015-2017 period, reports of violence were more frequent among Black people, including both Black and brown people19.
The Atlas of Violence 2024 study shows that young Black males were the most common type of homicide victim in Brazil, and they were much more vulnerable to violence than non-Black youth39. The study also revealed that in 2022, Black men accounted for 76.5% of victims of violent deaths in Brazil39. The violence perpetrated against Black PEH reflects lives made vulnerable by the actions of governments, businesses, and Brazilian society in general, which perpetuate their privileges through the narcissistic pact of whiteness. As Bento (2022) highlights, this is a result of a colonial past marked by expropriations, violence, and brutality against the Black Brazilian population and the people of African countries40.
Furthermore, an association was identified between physical violence and homelessness among Black people. Another study corroborates these results by finding that physical violence was the most common type of violence among PEH who self-identified as non-white, who were nine times more likely to experience violence compared to white people.28 Another study conducted in 17 Brazilian cities with more than 1 million inhabitants found that, when living on the streets, people experience at least three types of violence, and physical and verbal abuse are the most prevalent, which reinforces the findings of this study41.
Among the limitations of this study, violence is reported in healthcare facilities, which may underestimate the magnitude of this problem among PEH, given that these individuals’ access to healthcare is limited. Furthermore, stigma may lead healthcare professionals to underreport violence because they normalize some violent acts in the lives of this population. Finally, the only way to identify PEH on the form is in the “reason for violence” field, which can also mask how many acts occur with PEH but are not initially motivated by this condition. Changes to the form to facilitate identification of this population could provide essential new information about the profile of this condition.
In conclusion, violence against people living with disabilities includes, among other cases, violence against women, often perpetrated by intimate partners, and violence against Black men, often committed by police officers and strangers, in legal interventions and physical abuse acts, with the use of firearms and blunt objects. The different profiles show the need to develop public policies that consider the diverse vulnerabilities within this population. More than that, the State needs to take a fresh look at this population, which lives in a context of extreme vulnerability and suffers from institutional and structural violence, as it denies them a fundamental human right: to live with dignity and adequate housing.
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The data sources adopted in the research are indicated in the article’s body.
Source: Authors.