Violencia comunitaria en el entorno de riesgo de VIH: un estudio cualitativo entre jóvenes en Brasil

Katague, Marina; Knauth, Daniela; Barbosa, Regina; Teixeira, Luciana; Fachel, Andrea; Hentges, Bruna; Stockman, Jamila; Tsuyuki, Kiyomi

doi:10.1590/0102-311XEN041825

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ARTICLE • Cad. Saúde Pública 42 • 2026 • https://doi.org/10.1590/0102-311XEN041825 linkcopiar

Violencia comunitaria en el entorno de riesgo de VIH: un estudio cualitativo entre jóvenes en Brasil

Autoría SCIMAGO INSTITUTIONS RANKINGS

Resumen

En Brasil, las tasas de infección por VIH están aumentando entre los jóvenes de 15-24 años. Las iniciativas de prevención del VIH suelen pasarporalto los determinantes social es de la salud como obstáculos para adoptar comportamientos saludables. Este estudio investiga cómo la violencia comunitaria influye en el riesgo de VIH entre los jóvenes. Realizamos un análisis cualitativo secundario de entrevistas semiestructuradas con jóvenes (N = 53) de dos periferias urbanas de São Paulo y Porto Alegre, utilizando el marco del entorno de riesgo de VIH. Los hallazgos indican que la violencia policial y la actividad de las pandillas son omnipresentes en los espacios frecuentados por los jóvenes, lo que perturba la vida cotidiana y crea un ambiente de miedo e intimidación, limitando la libertad de movimiento. La violencia acelera la inseguridad social, especialmente entre los jóvenes varones y los jóvenes negros, que son objeto de ataques de manera desproporcionada. El consumo de sustancias vincula la violencia comunitaria con el riesgo de contraer el VIH. La violencia comunitaria obstaculiza el rendimiento educativo y las oportunidades deempleo, perpetuando los ciclos de pobreza e inestabilidad. Los robos con agravantes y las dificultades económicas obligan a las personas a realizar actividades de alto riesgo, lo que las sumerge aún más en la violencia y aumenta su vulnerabilidad al VIH. Las prácticas policiales, caracterizadas por intervenciones agresivas, agravan el entorno de riesgo de VIH al fomentar la desconfianza y llevar a los miembros de la comunidad a buscar protección en las pandillas. Si bien se ofrecen pruebas y tratamientos gratuitos para el VIH, barreras como la violencia comunitaria impiden el acceso a la atención médica. Este estudio afirma la necesidad de intervenciones que aborden las causas fundamentales de la violencia para mejorar el entorno de riesgo de VIH y las disparidades en materia de salud entre los jóvenes brasileños en situación de riesgo.

Palabras-clave:
Exposición a la Violencia; VIH; Prevención de Enfermedades; Investigación Cualitativa

Characteristics	São Paulo (n = 36)	Porto Alegre (n = 17)	Total (N = 53)
n (%)	n (%)	n (%)
Mean age (years) [SD]	19.64 ± 2.51	21.59 ± 2.48	20.37 ± 2.71
Sex
Female	30 (83)	8 (47)	38 (72)
Male	6 (17)	9 (53)	15 (28)
Self-identified race/skin color
Black	14 (39)	8 (47)	22 (42)
Mixed-race	15 (42)	0 (0)	15 (28)
White	7 (19)	9 (53)	16 (30)
Education level
Lower than high school	21 (58)	5 (29)	26 (49)
High school	10 (28)	2 (12)	12 (23)
Incomplete higher education	5 (14)	10 (59)	15 (28)

	MICRO-ENVIRONMENT	MACRO-ENVIRONMENT
Physical	Direct violence in youth-frequented spaces (bars/clubs, community centers, neighborhoods)	Drug trafficking and distribution routes in São Paulo and Porto Alegre
Physical	Limited freedom of movement	Pervasive police surveillance
Social	Fear and intimidation inspiring avoidance behaviors	Systemic racism and marginalization of Black youth
Social	Stress, anxiety, and trauma	Gendered risk
Economic	Salience of robberies/aggravated burglaries	Scarcity of income generation/employment opportunities
Economic	Interrupted school attendance	Growth of informal economies (drug trafficking, weapons trafficking)
Policy	Local access to HIV testing and care facilities	Ineffective laws governing protection of health and human rights fail to address the root causes of violence Inconsistent enforcement of laws governing drug possession and paraphernalia

	REFERENCE	ILLUSTRATIVE QUOTE
Physical	Q1	“[The police] arrive, they’re shooting, throwing gas bombs. Then people start running, then there is more confusion. I’ve run from them a lot, but it’s easier for us here in Community 1 to run, because here we already know everything. There are people that don’t know police catch and then beat them” (São Paulo)
	Q2	“You have to run. Some older boys, they had already drawn their guns to shoot the police. And we were all there in the middle of the dance party… running. They threw a bottle [back] at the police…The police came hitting, so they threw a bottle, they shot...” (São Paulo)
	Q3	“He had the rifle pointed at me, ‘hands on the wall, man!’, then I went to the wall, they kicked me, my brother, and little [friend’s name] in his legs. The kid was what, I think about 11, 10 years old? They were kicking the kid’s leg. I got pissed off attacking them, they put the rifle to my head like that, they kept pointing like ‘Where’s the drugs?’ And it’s just because I was drinking, you know? The woman police officer came just like that… she searched me, almost crushed our cell phones on the floor” (Porto Alegre)
	Q4	“[A neighbor] was telling me that her son was sitting on the sofa, and she was sweeping the house and they came in armed and killed him on the sofa. He was into drugs” (São Paulo)
	Q5	“We don’t go out on the street,” one participant shared, “because the trafficker gangs are currently at war, so my children haven’t been to class since the shootings started” (Porto Alegre)
	Q6	“They entered my courtyard and stole a lot of things, they stole my clothes from the clothesline, they stole my son's bicycle, they stole my father’s stuff. And my father went from drug dealer to drug dealer to find out if they had gone there to trade for drugs and he found out who did it. My father went out at dawn to look for the person and gave him a beating. He went and said to the robber’s mom, “I want everything back, otherwise I’m going to the police and I’m going to hand you over and your son. Then they had to give it back, and the robber didn’t even live for a long time. He stole from everyone, and then there came a time when someone put an end to him” (Porto Alegre)
Social	Q7	“I’m a little scared. Whenever I’m at a soccer game at the stadium, I feel that, as a Black person, I’m more vulnerable to violence” (Porto Alegre)
	Q8	“They [(the police)] go more because of drugs, there’s a lot of it... it also depends on the street” (São Paulo)
	Q9	“Nowadays I prefer to stay at home more than go out because the violence is too much, it’s very dangerous, we take it, we go out into the street and we don’t know, it’s not like... Before, it was always dangerous, but today it’s getting worse. I do stay at home” (Porto Alegre)
Economic	Q10	“He comes back [from work] with Uber because he was robbed in front of the bus stop near his workplace, because he leaves around midnight. He was robbed and they took everything from him; he had rent money, cell phone, he had clothes, everything in his backpack. They took it all” (Porto Alegre)
Economic	Q11	“Poor people have fewer resources to recover from violence… if my cell phone gets stolen, replacing it would be more difficult compared to someone with more financial stability. So, I’m afraid for my safety” (Porto Alegre)
Policy	Q12	“When the police arrive like this, if you don’t run, you die, because they (the police) go out killing” (São Paulo)
Policy	Q13	“I trust [a drug trafficking group] more than the police themselves, because if something goes down here, [the drug trafficking group], they'1l help me. If I wait for the police, I die and they don’t come” (São Paulo)

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[TFN1] SD: standard deviation.