Significados e percepções de risco associados ao vírus zika pela população e por profissionais de saúde da cidade de Salvador.

Abstract

Brazil experienced a severe epidemic caused by the zika virus between 2015 and 2016. Microcephaly in newborns was the first change associated with intrauterine infection by the zika virus, later other congenital malformations were also identified, a condition currently known as the congenital zika syndrome. The repercussions of this epidemic on the life of the Brazilian population generated a series of recommendations by health authorities, based mainly on advances in clinical and biomedical knowledge acquired about the disease. However, these guidelines took little into account the social and cultural context of individuals and their influence on the ways of understanding and reacting to this health problem. Understanding the sociocultural processes that permeate this new reality constituted after the epidemic is fundamental, since they are closely related to the meanings and perceptions of risk attributed by the population to issues associated with health and disease. These elements need to be better understood, as they will provide subsidies for the understanding of the meanings attributed to the zika virus by the population, in addition to qualifying health professionals so that they can act in an adequate manner in the face of the social and cultural reality of the population on which they want to intervene. Based on these premises, this thesis aimed to understand the meanings, risk perceptions and preventive practices associated with the zika virus by the population and health professionals in the city of Salvador-Bahia. This objective was answered through three articles. Article 1 – Narrative review of the literature in order to analyze and describe the existing literature on the perceptions, knowledge, attitudes and preventive practices of the population and health professionals about the zika vírus. The main findings of this investigation show that after approximately seven years of the beginning zika virus epidemic, there was a vast scientific production on this topic. However, some gaps remain, such as the absence of studies in Brazil and limited works in the international literature that investigate the perceptions, knowledge and guidelines on the zika virus developed by health professionals. In addition, there is little scientific production that analyzes male participation in preventive practices in the context of the zika virus epidemic. Therefore, it is necessary to overcome these gaps that still persist in the scientific literature due to the relevance of these groups in the dissemination of knowledge and health guidelines, as well as in the development of effective preventive practices in the context of the zika virus; Article 2 – Analysis of the knowledge, meanings, risk perceptions and preventive practices associated with the zika virus by men and women from different social strata of the city of Salvador-Bahia in a post-epidemic contexto. This article has a qualitative approach and was developed from focus groups and semi-structured interviews, from a socio-anthropological perspective. For this, eight focus groups were carried out with women aged between 18 and 45 years from different socioeconomic backgrounds and eight semi-structured interviews with male partners of women of reproductive age, also aged between 18 and 45 years and from different socioeconomic contexts. The main findings of this work show that there are still insufficiencies in knowledge, doubts and uncertainties about relevant aspects of the disease caused by the zika virus among all the groups interviewed. In addition, it was possible to identify the existence of variations in meanings, risk perceptions and preventive strategies related to zika virus infection between genders, social strata and age groups of the research participants. Despite men recognizing the zika virus as a “dangerous” disease that produces “critical consequences”, there was a perception that women were more vulnerable to this pathology, as its consequences were mainly concentrated in early childhood, which touches mainly the universe feminine in terms of responsibility and concern, reflecting the male lack of responsibility in this aspect. In addition, men's lack of knowledge about sexual transmission of the virus meant that they did not properly engage in prevention practices, which increases the risk of partner infection and its possible fetal outcomes. Women, on the other hand, reported a great “dread” and “desperation” for experiencing this new scenario in an endemic place for Aedes aegypti, where the presence of the mosquito constantly presupposed the occurrence of microcephaly. This perception of risk was more exacerbated among women aged 31-45 years due to the desire to become pregnant in a close setting or to live with pregnant women, and among those from lower socioeconomic strata, due to the socio-environmental vulnerabilities faced in popular neighborhoods. This apprehension motivated them to get involved in preventive measures, although women from lower socioeconomic strata have reported greater difficulty in accessing protective devices such as repellent for its high cost, which makes this public more vulnerable to infection; Article 3 – Understanding the perceptions, knowledge and guidelines developed by health professionals in the city of Salvador-Bahia on the zika virus in a post-epidemic context. This article also has a qualitative approach, carried out from a socio-anthropological perspective and developed from thirteen semi-structured interviews with various categories of health professionals in primary health care, as they are classified as references in the community to transmit information about the zika virus, influencing the way the population perceives and responds to this new disease. The data produced showed insufficiencies in the knowledge of health professionals about important aspects of the Zika virus infection, despite the data collection having taken place approximately one year after the end of the epidemic in Brazil. Regarding health guidelines, risk communication adopted in health education campaigns and prevention policies undertaken by health professionals showed its limited reach, especially among population groups that were more likely to develop the disease. Guidelines aimed primarily at controlling individual risk are not very sensitive to the specificities existing between different social contexts. Thus, health professionals recognized the need to consider social determinants such as the socioeconomic, political and environmental context in which individuals are inserted, as they provide different levels of susceptibility to illness and, based on that, invest in effective practices to ensure the health of the community. Therefore, based on the results of this research, it is expected to contribute to the improvement of future health actions, so that they are properly understood, address people's concerns about the disease and can safely support decision-making by the population. Keywords: Zika Vírus; knowledge, attitudes and practices in health; risk perception and management