Background
Syndemic framework and IPV
IPV and social comorbidities
The context of Santo Andre, Brazil
Current study
Methods
Data collection
Data management and analysis
Study ethics
Results
Variables | N | % | Mean | SD |
---|---|---|---|---|
Neighborhood | ||||
Centreville | 1 | 3.6 | ||
Cidade São Jorge | 9 | 32.1 | ||
Jardim Santa Christina | 3 | 10.7 | ||
Jardim Santo Antonio de Padua | 1 | 3.6 | ||
Jardim Teles de Menezes | 1 | 3.6 | ||
Jardim, Santo André | 2 | 7.1 | ||
Parque Marajoara | 2 | 7.1 | ||
Parque Novo Oratório | 1 | 3.6 | ||
Principe de Gales | 1 | 3.6 | ||
Vila Sacadura Cabral | 2 | 7.1 | ||
Sítio das Vianas | 1 | 3.6 | ||
Vila Guiomar | 2 | 7.1 | ||
Vila Lucinda | 1 | 3.6 | ||
Vila Suiça | 1 | 3.6 | ||
Age | 41.3 | 14.2 | ||
Race | ||||
Black | 6 | 21.4 | ||
Multi-racial | 7 | 25.0 | ||
White | 13 | 46.4 | ||
Other | 2 | 7.1 | ||
Education | ||||
None | 1 | 3.6 | ||
Primary School | 6 | 21.4 | ||
Some Secondary | 9 | 32.1 | ||
High School Diploma | 10 | 35.7 | ||
Some College | 1 | 3.6 | ||
College Degree | 1 | 3.6 | ||
Religion | ||||
Catholic | 10 | 35.7 | ||
Evangelical | 17 | 60.7 | ||
None | 1 | 3.6 | ||
Relationship Status | ||||
Single | 7 | 25.0 | ||
Separated | 2 | 7.1 | ||
Divorced | 1 | 3.6 | ||
Widowed | 3 | 10.7 | ||
Cohabitating | 6 | 21.4 | ||
Married | 9 | 32.1 | ||
Family Monthly Income | 1297.7 Reais | 1130.6 Reais | ||
Employment Status | ||||
Unemployed | 16 | 57.1 | ||
Unable to work/on leave | 2 | 7.1 | ||
Employed | 8 | 28.6 | ||
Retired | 2 | 7.1 |
Syndemic ‘diseases’ or social comorbidities
Intimate partner violence
‘My eight year relationship was jealousy and betrayal, a lot of betrayal I didn't accept… he said ‘You want to separate from me for something that didn't happen,’ I said to him: ‘It didn't happen but I got it, I saw it.’ Then it started to drive him crazy there, he wanted to hit me ... he threw me on the floor and took a stick to hit me.’
‘When it happened, I thought, I thought, ‘now nobody will marry me anymore, because I'm not a virgin,’ and I'm sure even if my mother knew what happened, she was going to make me marry, because I got married, my whole life, almost 17 years of marriage, I kept getting beaten, kicked, drug out of the house by the hair, starving with my children, three sons…he worked, from 13 years old until 1996, he always worked, he just didn't like hard work, but the money that he took he spent everything with [another] woman. I starved, I went cold, still with three children.’
Family/childhood violence
Another example is witnessing the abuse of a mother at the hands of a father. For example, one participant described how her mother stayed in an abusive relationship for years, because she felt obligated to stay in the relationship.‘He always was [aggressive], he always was… he lived at home, because he didn’t have a house to live in. My mother kicked him out of the house, because he can’t live near us. Everywhere he lives he gets into a fight and nobody can stay. If you rent him a place to stay, he breaks everything. He explodes wherever he goes… He broke [my mother’s] glasses and she was without glasses for the longest time.’
Participants also recounted violent partners’ stories of witnessing violence. One participant described the experience of her ex-husband witnessing his father beat his mother and attempting to protect his mother.‘My father had another woman and he was a womanizer. He beat my mother a lot, but my mother thought she had to take this thing to the end.’
‘She was attacked… physically. My ex-husband… often witnessed [it]. He would fight his father to protect his mother… He would not accept his father beating his mother. That’s why I am telling you, he never assaulted me…’
In keeping with much of the IPV literature, the connection between witnessing abusive experiences during childhood and later perpetration of violence by males was substantiated. It also highlights how verbal abuse is not always characterized by participants in the same light as physical violence – or in the same categories as researchers.‘You know the person when they drink, their word is shameless, ‘slut’ ... They use it a lot.’
In keeping with the correlation between early exposure to family violence and the likelihood of female victimization, this same participant later described her prolonged experiences of intimate partner violence.‘My mother gave my brother, one of the oldest, the responsibility of ... of this way, of educating the younger ones, and this brother of mine, he would come to my house to beat us, but the younger ones would ask my mother if I was doing the right job, if I was obeying her, then he would go there hit us…it was like this ... a very difficult adolescence you know, very hard, childhood too, already working at home, doing everything, taking food in the fields, I have no good memory of my, me as a child, nor of my teenage years.’
Similar experiences were frequently discussed as connected to drugs, alcohol, and money. They were almost exclusively about male family members and included a range of familial ties such as brothers, sons, sons-in-law, or cousins.‘He drank and [my daughter] left. He was there in the house making a mess and breaking everything. Then he tried to punch me. My son came and told him that he couldn’t hit me. My son-in-law said ‘I can hit anyone.’ Then my son said ‘You can’t beat my mother’… and [my son] told him [my son-in-law] to never enter my house again. Now my son and I don’t talk to him.’
Community violence
Community violence was frequently connected to substance use such as drinking at a bar. For example, one participant described a nearby bar that was known for fights within her neighbourhood. Including fights between those drinking and couples.‘Oh, every now and then, right there I hear fights, husband shouting at wife. Who is right I don't know. I don't know the person, I just hear screaming.’
Community violence also included descriptions of violence between police and people in the neighbourhood who committed crimes. One such example was one participant who described their ex-boyfriend being shot by police. This occurred when the police followed-up on a robbery the ex-boyfriend committed. This example is discussed further as a part of enhanced disease transmission.‘In the street down the road, there is a bar where people fight, sometimes because they are drunk. Sometimes it’s a couple, too.’
Substances
A connection was also drawn between substances and other forms of violence such as familial violence and community violence. For example, one participant described how her father-in-law would drink heavily and verbally abuse her mother-in-law and get into fights with other people including the participant herself.‘Then when he drinks he starts to treat me differently. My daughter says she doesn’t like it, a guy like him. ‘What does he do that’s useful? What does he offer?…Have you ever imagined the future? You’re going to live with this man in suspense. You don’t know if he is coming drunk.’
Ultimately, in many cases participants linked drugs conceptually to violence and aggression of all kinds. In some cases, nearly all of the aggressors that participants described across their lives were men under the influence of a substance and/or alcohol.‘When he left work at noon he would go straight to the bar. He would drink and when it was about 5 p.m. he would come down and when he got to the gate he would shout at my mother-in-law ‘you slut!’ My mother-in-law—the poor thing—was a saint… Because of his drinking he got into a lot of fights in all the places that he went.’
Disparity conditions
Financial dependence was also a factor that was described as being connected to relationship entanglement such as the presence of children. ‘Because of the child, they have to be together.’ However, financial concerns were not frequently discussed in the context of structural poverty or other macro conceptualizations; gender oppression, on the other hand was discussed on a macro-level.‘My sons-in-law were drug users, now by the grace of god they are free of this problem. My husband drank, he had several addictions. They are gone now… Yes, [there are reasons such as] money, unemployment, everyone wants to raise their kids their own way. … unemployment is very difficult right.’
While this critique was not explicitly stated by other participants, some other participants did allude to gendered dynamics of violence.‘Ah, I think the meaning of violence against women, regardless of whether it is physical or moral, right, I believe it is a form of pressure [for] women right, to slow her down to prevent her from imposing herself on society. Often within your own home, within your own family. I think it's a form of oppression… I think nothing justifies [violence against women]. Although I understand that in these new relationships, which are very unprepared, very young, I think that violence often happens because of [the couples’] family history and unpreparedness. Because, usually, offenders, they have this family background; It's very hard for us to see an attacker who doesn't have a troubled track record.’
Adverse interactions
Financial tensions, conflict and drugs could be mutually exacerbating. Some participants described how multiple comorbidities contributed to a sense of isolation. One participant’s story illustrated how multiple comorbidities worked in concert in her life to contribute to this sense of isolation,‘It's because of money right; so drinks cost money right and then fighting starts, and arguing with each other, the husband is there wanting to hit his wife right now, I was not born for that. Then the money is missing to pay rent, to pay things right, then they are preoccupied, and he wants to fight with her.’
‘My life is difficult, to this day I am alone, I have three children, but one there in Rio de Janeiro and two here, but each one lives their life, I am sick I have already starved inside my house. I found a month-old bread that was there right and ate it. I have to buy my food. I have to take myself to the doctor… I'm a very lonely person, very lonely… My family is big, my mother had 17 children…my father had with another woman, my father was very womanizing too, beat my mother a lot, but my mother thought she had to take this thing to the end… I have a scar here, see… My son broke a broom in my head… because I went to ask him for money for the utility bill.’
Enhanced disease transmission
Several participants also spoke the effects of violence on mental health. One specifically stated that the emotional scars were worse than the physical ones. ‘I am not talking about physical health. I am talking about emotional health. The marks on your body fade, but the [emotional] stay.’‘Sometimes we would fight, but once he assaulted me. I even took a stab here [gestures to body]. I almost died. But then again, I fought back. So, I stayed. It was about jealousy. ‘
Another described how her ex-husband’s propensity for fighting led to his death in a public brawl.‘He was jealous of her… She suffered, but I think she loved him, and they had children, everything. Today, her daughter got married. Her son was killed by the police. Her husband also died ran over by a car, but I think they really wanted to kill him.’
Participants also mentioned stories of people who killed by police, for one participant this included her boyfriend who had been a drug dealer and was ultimately shot when fleeing the police.‘He started drinking and staying that way. Only then we separated. I got a good break, but he died later, because he fought with his cousin. They argued… when it was over, his cousin hit his head and broke his neck.’
While these examples were focused on the death of violent perpetrators, participants also discussed the salient concern of femicide. This came up in cases where women report violent partners, but feared retaliation.‘This guy I dated for 3 years. When I was 16 I found out he had two jobs. By day he was a mechanic and at night he was a drug dealer. It was that side job that I didn’t know… One day when I came home from school, I passed by his house to get to mine, and he came and took my arm: ‘let me talk to you,’ he said. I said: ‘I don’t want to talk to you leave me alone it’s over, we’re not getting back together’…That same day at dawn he committed a robbery—Look at what I was getting myself into—the police were notified and they told him to reveal who had told him to commit the robbery and he didn’t want to talk. He said, ‘I’ll die, but I don’t care.’ He ran from the police and they shot 23 times… That’s when my depression began. I discovered that I had bipolar disorder a little while later, but my depression began at 13. My experience with [sexual] violence was at 18.’
These fears are reinforced by stories about women who were killed by their partners or whose partner attempted to kill them after reporting violence to officials.‘I saw on the television a commercial that spoke about the Maria da Penha law, but I don’t have faith in it, because they get out. Women remain afraid and trapped. Yesterday there was a case where a woman lost her job because she feared leaving her house to be killed.’
‘I know of a case of a woman who now lives today in São Paulo (city), her husband stayed here because he threatened to kill her. He went to the door of the school where she works to kill her, and she had to run away with her two year old daughter.’