This article deals with the masculine absence and/or invisibility in primary healthcare services and the consequent exclusion of men of the preventive care. The analytical frame is based on the literature that discusses care related to health and masculinity. Methodologically the study uses qualitative analysis of the empirical data (reports) gathered by semi-structured individual interviews of 20 professionals and by two focus groups with 12 workers of the nursing assistants staff of two primary healthcare services of the city of Rio de Janeiro (RJ). Results point out two significant dimensions: the structural and the symbolic one. The structural dimension reveals low investment in the services' organization related to gender perspective approach, reinforcing the common sense that men are not primary healthcare users. The symbolic dimension shows the non consideration of the masculine universe themes as the difficulty men have in revealing themselves to the professional, demanding a special privacy for attendance. Dealing with these questions enhance the possibility of changing practices that are making men invisible to the primary healthcare programs and taking them apart of the self care condition as well as the condition of carriers of others.

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Os homens não vêm! Ausência e/ou invisibilidade masculina na atenção primária

In 2009, the Brazilian Comprehensive Healthcare Policy for Men (PNAISH) was launched in Brazil, seeking to reduce morbidity and mortality in this population group. This article strives to analyze the conceptions that health professionals have about the specific demands and behaviors of the male population served by the healthcare services. The data analyzed are part of a larger research project, the objective of which was to evaluate the initial actions of the implementation of PNAISH. Ethnographic observations in 11 health services and semi-structured interviews were conducted with 21 health professionals. From the perspective of health professionals, the presence of men in the healthcare services is still limited. According to them, it is comprised of two types of clients: workers and the elderly. The male behavior characteristics - haste, objectivity, fear and resistance - and the difficulty faced by health services in receiving this population are the main factors that drive men away from health services. Although the concept of gender is central to PNAISH, it is only triggered by healthcare professionals in order to justify the social standards expected in terms of men's behavior. The attribution of men's behavior to cultural factors ultimately obscures the relations of power that underlie gender relations.

https://www.scielosp.org/pdf/csc/2012.v17n10/2617-2626/pt

A visão dos profissionais sobre a presença e as demandas dos homens nos serviços de saúde: perspectivas para a análise da implantação da Política Nacional de Atenção Integral à Saúde do Homem

http://disciplinas.stoa.usp.br/pluginfile.php/179773/mod_resource/content/1/equity_and_women_s_health.pdf

Equity and women's health services for contraception, abortion and childbirth in Brazil.

First sexual intercourse is considered an important event in young people's lives and has occurred at an increasingly early age. The aim of this study was to identify factors associated with early age at first intercourse in individuals 18 to 24 years of age in Pelotas, Rio Grande do Sul State, Brazil. This was a population-based cross-sectional study in a representative sample of 1,621 young people from August 2007 to December 2008. Subjects answered a questionnaire on health behaviors, including items related to their sexual lives. Cox regression was used to assess the association between early age at sexual initiation. After multivariate analysis, variables that are directly related to early sexual initiation were: male gender, low socioeconomic status, low schooling, divorced parents, living with a partner, not practicing a religion, smoking, drug use in the previous three months, and non-use of condoms during last intercourse. Considering the current social context, the study highlights the need for adequate sexual orientation with a preventive approach.

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Fatores associados à idade da primeira relação sexual em jovens: estudo de base populacional

Este estudo objetivou conhecer e analisar a visao dos enfermeiros em relacao ao atendimento a saude do homem. Pesquisa qualitativa que teve como campo um Centro Municipal de Saude. Os sujeitos foram sete enfermeiros que atuavam em setores que atendiam homens, dos quais tres eram do sexo masculino e quatro, do sexo feminino. Utilizaram-se a entrevista com questoes semiestruturadas como instrumento de coleta e a analise de conteudo, para tratar os dados. Na fala dos sujeitos ficou evidenciado que os homens procuram menos os servicos devido a incompatibilidade de horario com a jornada laboral. E, ainda, segundo a percepcao dos sujeitos, sentem-se constrangidos em procurar atendimento, pois essa postura choca-se com a cultura andocrentrica. Verificou-se que a maioria dos sujeitos desconhecia a Politica Nacional de Atencao Integral a Saude do Homem. Sugere-se que haja capacitacao dos enfermeiros e que os servicos tenham infraestrutura fisica e de pessoal para garantir assistencia qualificada.

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A saúde do homem na visão dos enfermeiros de uma unidade básica de saúde

The present study aims at analyzing the meanings attributed to the digital rectal exam, seeking to problematize questions underlying the masculine discourse on the basis of aspects of the hegemonic masculinity model. Semi-structured interviews were held with 28 men in the city of Rio de Janeiro, in 2004. Among the main results is the idea that the digital rectal exam is something that violates an interdicted space, something that compromises the current understanding of masculinity, shall say, the digital rectal exam does not only affect the prostate, it also affects the masculinity, puts it to shame. We conclude that for understanding and problematizing the questions related to the prostate cancer prevention in special, and to the question of taking care of oneself from the masculine perspective in general, we need to consider the structural and symbolic aspects that underlie these questions.

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As arranhaduras da masculinidade: uma discussão sobre o toque retal como medida de prevenção do câncer prostático

This study analyzes recommendations for the prevention of prostate cancer reported in the specific literature on this topic. The method consisted of a review of this matter, adopting a qualitative approach, examined through the theme content analysis technique. Based on the following analysis categories: primary prevention, secondary prevention and masculinity and prevention, the discussion of the study findings concludes that: (a) the recommendations are either diverse or present some controversies among the various viewpoints; (b) the output of scientific papers in the collective health field is sparse on this matter; (c) the development of a more interdisciplinary approach is required for dealing with this matter and (d) few sources take the specific characteristic of maleness into account for recommendations on the prevention of prostate cancer.

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A prevenção do câncer de próstata: uma revisão da literatura

This paper seeks to analyze the male consumer viewpoint on primary healthcare services. The core objective is to find potential elements to underpin qualitative indicators of male user satisfaction. A qualitative approach involving semi-structured interviews with users was adopted, as well as studying medical records and ethnographic observation of three services in the municipality of Rio de Janeiro. The analysis was based on the method of interpretation of meanings, applying hermeneutic and dialectic principles. In general, users point to criteria to evaluate services positively, taking humanized care as a benchmark, based on communication and ability to offer swift care. The conclusion was that user recommendations involve demands primarily relating to failings in services to provide care specifically geared towards men.

http://www.scielo.br/pdf/csc/v16n11/a24v16n11.pdf

A atenção básica à saúde do homem sob a ótica do usuário: um estudo qualitativo em três serviços do Rio de Janeiro

O envolvimento de homens na prevencao da aids tem sido um dos grandes desafios mundiais. Na busca de subsidios para o enfrentamento desse desafio, este estudo analisa a producao do conhecimento da saude sobre prevencao da aids, voltada para homens. O metodo ancora-se numa revisao critica de artigos cientificos, publicados no periodo de 1997 a 2009, acessados na Biblioteca Virtual em Saude. O corpo analitico, constituido de 25 artigos, foi trabalhado numa perspectiva qualitativa, priorizando-se a interpretacao dos sentidos das ideias centrais presentes no conjunto da literatura analisado. Como resultados da analise destacam-se tres temas: representacoes da aids; potencialidades e limites da informacao na prevencao primaria, e o preservativo como personagem central da prevencao. Conclui-se que a producao cientifica acerca do assunto impoe um grande desafio da prevencao que e o de transformar aspectos culturais e sociais que potencializam a vulnerabilidade a transmissao do HIV.

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Lúcia Emilia Figueiredo de Sousa Rebello

Papers

Os homens não vêm! Ausência e/ou invisibilidade masculina na atenção primária

As arranhaduras da masculinidade: uma discussão sobre o toque retal como medida de prevenção do câncer prostático

A prevenção do câncer de próstata: uma revisão da literatura

A atenção básica à saúde do homem sob a ótica do usuário: um estudo qualitativo em três serviços do Rio de Janeiro

Homens e a prevenção da aids: análise da produção do conhecimento da área da saúde