Abstract

Introduction

Covid-19 is a respiratory infection caused by the SARS-CoV-2 coronavirus that may either produce asymptomatic forms or severe respiratory conditions. The disease has spread worldwide, becoming a Public Health Emergency of International Importance,¹1 World Health Organization. Coronavirus disease (Covid-19). Coronavirus disease (Covid-19) pandemic [Internet]. Geneva: WHO; 2021 [citado 19 Mar 2021]. Disponível em: https://www.who.int/emergencies/diseases/novel-coronavirus-2019.
https://www.who.int/emergencies/diseases... of which, to date, more than 109 million cases and two million four hundred thousand deaths have been reported¹1 World Health Organization. Coronavirus disease (Covid-19). Coronavirus disease (Covid-19) pandemic [Internet]. Geneva: WHO; 2021 [citado 19 Mar 2021]. Disponível em: https://www.who.int/emergencies/diseases/novel-coronavirus-2019.
https://www.who.int/emergencies/diseases... . The disastrous outcomes that have occurred in different countries contributed to the adoption of serious countermeasures around the world²2 Freitas ARR, Napimoga M, Donalisio MR. Análise da gravidade da pandemia de Covid-19. Epidemiol Serv Saúde. 2020; 29(2):e2020119.. Among these, the most important are rigorous hand hygiene, the use of alcohol-gel, the use of masks, avoiding crowds, keeping a distance of one meter between people, and, above all, social distancing³3 Organização Panamericana de Saúde. Folha informativa Covid-19. Escritório da OPAS e da OMS no Brasil [Internet]. Brasil: OPAS; 2020 [citado 19 Mar 2021]. Disponível em: https://www.paho.org/pt/covid19.
https://www.paho.org/pt/covid19... .

That said, it should be recognized that distribution of infection, disease, and mortality caused by the virus do not spread equally, in a democratic fashion⁴4 Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet [Internet]. 2020 [citado 19 Mar 2021]; 395(10223):470-473. Doi: https://doi.org/10.1016/S0140-6736. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30185-9/fulltext.
https://www.thelancet.com/journals/lance... . This argument is justified, because access to water, housing, health services, healthy food, and body and home hygiene products are factors that mark differences in population groups that are exposed to greater or lesser risks. The existence of weakened relational bonds of protection is also an element that influences this disadvantageous picture⁵5 Schuch P, Furtado CDC, Sarmento CS. Covid-19 e a população em situação de rua: da saúde à segurança pública? [Internet]. Rio Grande do Sul: Instituto de Filosofia e Ciências Humanas; 2020 [citado 19 Mar 2021]. Disponível em: https://www.ufrgs.br/ifch/index.php/br/covid-19-e-a-populacao-em-situacao-de-rua-da-saude-a-seguranca-publica.
https://www.ufrgs.br/ifch/index.php/br/c... ,⁶6 Lancet Migration. Leaving no one behind in the Covid-19 pandemic: a call for urgent global action to include migrants & refugees in the Covid-19 response [Internet]. Lancet; 2020 [citado 19 Mar 2021]. Disponível em: https://www.migrationandhealth.org/statements.
https://www.migrationandhealth.org/state... .

It must be considered that in the Brazilian reality there is a peculiar impact of the pandemic of Covid-19; it is a consequence of the strong presence of social inequalities⁷7 Santos JAF. Covid-19, causas fundamentais, classe social e território. Trab Educ Saúde. 2020; 18(3):e00280112.. Lower-income people, who survive in precarious housing or who use the streets as their home, are uniquely exposed to the virus⁵5 Schuch P, Furtado CDC, Sarmento CS. Covid-19 e a população em situação de rua: da saúde à segurança pública? [Internet]. Rio Grande do Sul: Instituto de Filosofia e Ciências Humanas; 2020 [citado 19 Mar 2021]. Disponível em: https://www.ufrgs.br/ifch/index.php/br/covid-19-e-a-populacao-em-situacao-de-rua-da-saude-a-seguranca-publica.
https://www.ufrgs.br/ifch/index.php/br/c... . The field of Collective Health contributes to the understanding of the social determination of the health and disease process in these segments. In the context of the pandemic, such elements support the reasoning that death by coronavirus represents, actually, death by various precariousness and invisibilization²2 Freitas ARR, Napimoga M, Donalisio MR. Análise da gravidade da pandemia de Covid-19. Epidemiol Serv Saúde. 2020; 29(2):e2020119.,⁴4 Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet [Internet]. 2020 [citado 19 Mar 2021]; 395(10223):470-473. Doi: https://doi.org/10.1016/S0140-6736. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30185-9/fulltext.
https://www.thelancet.com/journals/lance... ,⁵5 Schuch P, Furtado CDC, Sarmento CS. Covid-19 e a população em situação de rua: da saúde à segurança pública? [Internet]. Rio Grande do Sul: Instituto de Filosofia e Ciências Humanas; 2020 [citado 19 Mar 2021]. Disponível em: https://www.ufrgs.br/ifch/index.php/br/covid-19-e-a-populacao-em-situacao-de-rua-da-saude-a-seguranca-publica.
https://www.ufrgs.br/ifch/index.php/br/c... . In this way the pandemic renders explicit, for example, the relevance of the public health status with the guarantee of access to rights.

The homeless population faces significant clashes with the capitalist mode of production, with the developments of globalization, as well as the changes in production processes⁸8 Pinho RJ, Pereira APFB, Lussi IAO. Homeless, the world of work and the specialized reference centers for population in street situation (centro pop): perspectives on actions for productive inclusion. Braz J Occup Ther. 2019; 27(3):480-495. Doi: https://doi.org/10.4322/2526-8910.ctoAO1842.
https://doi.org/10.4322/2526-8910.ctoAO1... . Such contexts and their singularities have a high capacity to stigmatize them and push them into a cycle of frailties that contributes to the stability of this setting. In relation to the Brazilian reality, this is proven, among other factors, by the lack of consistent data on the homeless population, hindering not only the implementation of public policies aimed at this group, but also reproducing the social invisibility in the context of social policies⁹9 Natalino MAC. Estimativa da população em situação de rua no Brasil (setembro de 2012 a março de 2020). Rio de Janeiro: IPEA; 2016.. Moreover, the common sense that conceives them as abandoned, passive and powerless can strengthen their victimization, sustaining the logic of charity as a strategy for settling social imbalances. In this same sense, it also derives into the simplification of these subjects by associating them with transgressors who end in the streets as a result of their choices. All this reflects without doubt, in the disputes between the different existing social groups¹⁰10 Pimenta MDM. The homeless population in Porto Alegre: social invisibility and stigmatization processes. Civitas. 2019; 19(1):82-104. Doi: http://dx.doi.org/10.15448/1984-7289.2019.1.30905.
https://doi.org/10.15448/1984-7289.2019.... and even reinforces a set of practices such as structural and institutional racism that flows into the operationalization of necropolitics¹¹11 Calmon TVL. As condições objetivas para o enfrentamento ao Covid-19: abismo social brasileiro, o racismo, e as perspectivas de desenvolvimento social como determinantes. NAU Soc. 2020; 11(20):131-136.,¹²12 Mbembe A. Necropolítica. Arte Ensaios. 2016; 2(32):123-151..

Against this backdrop and the worrisome context of the pandemic of the Covid-19, the collective Nós Nas Ruas allied itself to the actions of the Corra Pro Abraço Program with the aims of reflecting and collaborating in the conduction of its strategies to confront the pandemic in Salvador-Bahia.

Facing the challenges presented to the whole society during the pandemic of Covid-19, the central questions that emerged from the two groups were: how will this virus manifest itself in socially vulnerable populations? How to indicate measures of social distancing and home care to those who have no home? How to recommend hygiene measures to those who barely have access to water? How to sensitize society to understand that the homeless population is not a risk, but a population at risk?

Based on reflections about the speed of coronavirus transmission in crowded environments and exposure situations imposed by social inequities and inequities of access to social and health services, the present production aims to describe and discuss the joint actions directed to homeless people developed by the collective Nós Nas Ruas and by the Corra Pro Abraço Program in Salvador, Bahia, in the context of the Covid-19 pandemic.

Methodology

This article brings a compilation of experiences, in the format of an experience report, jointly built between the members of the Nós Nas Ruas collective (composed of professors, graduate and undergraduate students of the health field) and professionals of the Corra Pro Abraço Program, in the context of the pandemic of Covid-19, in Salvador, capital of the state of Bahia.

Salvador had an estimated population of 2.872.347 inhabitants in 2019, with a demographic density of 4,145.9 hab/km²2 Freitas ARR, Napimoga M, Donalisio MR. Análise da gravidade da pandemia de Covid-19. Epidemiol Serv Saúde. 2020; 29(2):e2020119. ¹³13 Instituto Brasileiro de Geografia e Estatística. IBGE cidades panorama [Internet]. Salvador: IBGE; 2020 [citado 19 Mar 2021]. Disponível em: https://cidades.ibge.gov.br/brasil/ba/salvador/panorama.
https://cidades.ibge.gov.br/brasil/ba/sa... . In Salvador, the Human Development Index (HDI) is 0.759, a value considered high¹⁴14 Klugman J. A verdadeira riqueza das nações: vias para o desenvolvimento humano. Nova Iorque: PNUD; 2010., even though is evident that this index hides the social inequalities, that are strikingly demonstrated in the municipality through the variation of HDI values between neighborhoods in the periphery and those of the middle and upper classes. In 2010, the city neighborhoods with the lowest HDI were Ilha de Maré (0.578), Nova Brasília (0.579) and Cassange (0.607), while those with the best indicators were Chapada do Rio Vermelho (0.959), Itacaranha (0.952) and Caminho das Árvores (0.953). This reveals, in reality, the social abyss existing between people with a very high standard of living, contrasted by the social portion with extremely low standard of living in the same city¹⁵15 Barreto RCS, Santos EI, Carvalho ÍCS. A pobreza multidimensional em salvador diminuiu? Evidências a partir da abordagem espacial. Rev Estud Soc. 2018; 20(40):192-225.. As a short and noteworthy reflection on the fragility of the index, although the HDI is widely used as a basis for classifying countries around the world, it is unable to translate into numbers such complex and distinct social realities in the same urban center¹⁶16 Dalberto CR, Ervilha GT, Bohn L, Gomes AP. Índice de desenvolvimento humano eficiente: uma mensuração alternativa do bem-estar das nações. Pesqui Planej Econ. 2015; 45(2):337-363..

In 2016, it was estimated that the homeless population of Salvador was calculated between 14.000 and 17.000 people¹⁷17 Carvalho MAC, Santana JP, Vezedek L. Cartografias dos desejos e dos direitos: mapeamento e contagem da população em situação de rua na cidade do Salvador, Bahia, Brasil. Salvador: Centro Projeto Axé de Defesa e Proteção à Criança e ao Adolescente; 2017.. It is believed that the quantitative population experiencing this reality is even higher, especially after the dire social consequences of the Covid-19 pandemic in the country. The lack of a specific census for the homeless population in Brazil reflects, among other things, the difficulty of including this population group in actions of public attention and reinforces the persistence of their invisibility in the policies⁹9 Natalino MAC. Estimativa da população em situação de rua no Brasil (setembro de 2012 a março de 2020). Rio de Janeiro: IPEA; 2016.. Moreover, Salvador still has 882.204 people living in informal settlements, classified by IBGE as “subnormal agglomerations”¹⁸18 Instituto Brasileiro de Geografia e Estatística. Censo: aglomerados subnormais [Internet]. Salvador: IBGE; 2020 [citado 19 Mar 2021]. Disponível em: https://cidades.ibge.gov.br/brasil/ba/salvador/pesquisa/23/25359.
https://cidades.ibge.gov.br/brasil/ba/sa... . This means that this number of people have precarious housing conditions, marked by the lack or absence of infrastructure and urban public services. The city also recorded an unemployment rate of 24.9% in May 2019¹⁹19 Superintendência de Estudos Econômicos e Sociais da Bahia. Pesquisa de emprego e desemprego [Internet]. Bahia: SEI; 2020 [citado 19 Mar 2021]. Disponível em:https://www.sei.ba.gov.br/index.php?option=com_content&view=article&id=23&Itemid=417#2.
https://www.sei.ba.gov.br/index.php?opti... .

The Corra Pro Abraço Program is part of the Secretariat of Justice, Human Rights, and Social Development of the Bahia State Government, linked to the Superintendence of Policies on Drugs and Shelter for Vulnerable Groups, and is run by two civil society organizations: Comvida - Comunidade Cidadania e Vida and Cipó Comunicação Interativa. Operating since July 2013, this program aims to contribute to the promotion of citizenship and rights of people who abuse drugs in contexts of vulnerability, or affected by problems related to the criminalization of drugs, based on strategies of risk reduction, physical and social harm²⁰20 Programa Corra Pro Abraço. O corra pro abraço [Internet]. Salvador: Comvida; 2020 [citado 19 Mar 2021]. Disponível em: https://corraproabraco.wordpress.com/sobre/.
https://corraproabraco.wordpress.com/sob... . Currently, the Program’s team that works with homeless people has social workers, psychologists, legal educators, social scientists, educators, and art educators, who approach the population on the streets and at the Program headquarters with a focus on harm reduction, as well as referrals to the networks of psychosocial care, education, health, and justice. In addition, they develop art-education workshops, using body expression and music techniques, reading and writing workshops, among others²⁰20 Programa Corra Pro Abraço. O corra pro abraço [Internet]. Salvador: Comvida; 2020 [citado 19 Mar 2021]. Disponível em: https://corraproabraco.wordpress.com/sobre/.
https://corraproabraco.wordpress.com/sob... . Faced with the pandemic of Covid-19, this care device was faced with the challenge of planning/improving the actions to face the disease, without losing the central focus of its work strategies²¹21 Secretaria de Justiça, Direitos Humanos e Desenvolvimento Social do Estado da Bahia. Corra pro abraço [Internet]. Bahia: SJDHDS; 2020 [citado 19 Mar 2021]. Disponível em: http://www.justicasocial.ba.gov.br/modules/conteudo/conteudo.php?conteudo=60.
http://www.justicasocial.ba.gov.br/modul... .

The Nós Nas Ruas Collective began on March 17, 2020, when professors and students of collective health and nursing from the Institute of Collective Health / Federal University of Bahia (ISC/UFBA) and the State University of Bahia (UNEB) shared concerns about the difficult or impossible implementation of “stay at home” orders for people from Salvador living on the streets, without the minimum socioeconomic and housing conditions to adopt the social distancing and hand washing recommended by health authorities²²22 Siqueira E. ISC promove ação social de combate à Covid-19 [Internet]. Salvador: Instituto de Saúde Coletiva da UFBA; 2020 [citado 19 Mar 2021]. Disponível em: http://www.isc.ufba.br/professores-e-estudantes-do-isc-ufba-promovem-acao-social-de-combate-a-covid-19/.
http://www.isc.ufba.br/professores-e-est... . At that moment, they mobilized themselves to articulate emergency strategies to confront Covid-19 aimed at the vulnerable portion of the population of Salvador. Thus, the group started a campaign for the acquisition of goods and financial resources for donations, which allowed the purchase and distribution of personal hygiene kits, mineral water, snacks for homeless people, and food baskets for socially vulnerable families. However, the Nós Nas Ruas team had no previous experience in approaching and working with homeless people, and because of this, the articulation with the Corra Pro Abraço Program was crucial.

The members of Nós Nas Ruas organized dialogue roundtables and sensitization about Covid-19 and training on the proper use of personal protective equipment and hygiene protocols, as well as of the utensils and transportation used in the field actions. In addition, qualified and reliable information was shared in virtual communication groups, from books, manuals and technical publications of the official health organizations, about the health recommendations to face the pandemic of Covid-19 and the support in the preparation of informative materials with the appropriate language for homeless people or people who use psychoactive substances.

This report documents the experiences of the two groups in facing the pandemic of Covid-19 and a joint reflection, the result of the articulation of public equipment of the State and academic, social and solidarity experiences, which allowed an interpretation of the pandemic in a reflective way and articulated with the specialized literature.

Results and discussion

The actions included: interventions in the streets of Salvador, participation in planning and evaluation meetings of the Corra Pro Abraço Program team, dialogues about the adaptations needed to ensure the protection of workers and assisted street population against coronavirus infection, reflections on the impact of the pandemic on the homeless population and coping strategies.

The first activities resulting from this articulation started sharing of experiences that allowed drawing up a situational diagnosis and estimation of the street population that was already assisted by the Corra Pro Abraço Program. This allowed the understanding of the work process and the support to the planning of actions by the Program’s teams. The first challenge was to support and cooperate with these teams in the process of reinventing their practices in an adverse moment, as a result of the shake-up provoked by the pandemic and gives even greater visibility to inequalities, precariousness, social invisibilization and frailty of rights⁸8 Pinho RJ, Pereira APFB, Lussi IAO. Homeless, the world of work and the specialized reference centers for population in street situation (centro pop): perspectives on actions for productive inclusion. Braz J Occup Ther. 2019; 27(3):480-495. Doi: https://doi.org/10.4322/2526-8910.ctoAO1842.
https://doi.org/10.4322/2526-8910.ctoAO1... ,¹¹11 Calmon TVL. As condições objetivas para o enfrentamento ao Covid-19: abismo social brasileiro, o racismo, e as perspectivas de desenvolvimento social como determinantes. NAU Soc. 2020; 11(20):131-136.. Such teams already dealt daily with the repertoire of vulnerability that homeless people face. The pandemic, with its recommendations for social isolation, remote work, and reinforcement of personal hygiene practices, immediately created a stress, as the workers need to ensure their own physical and emotional health conditions to continue the actions already developed. At the same time, they are called upon to offer support to those who do not have conventional housing, are hungry, thirsty, and lack adequate access to water and personal hygiene items⁵5 Schuch P, Furtado CDC, Sarmento CS. Covid-19 e a população em situação de rua: da saúde à segurança pública? [Internet]. Rio Grande do Sul: Instituto de Filosofia e Ciências Humanas; 2020 [citado 19 Mar 2021]. Disponível em: https://www.ufrgs.br/ifch/index.php/br/covid-19-e-a-populacao-em-situacao-de-rua-da-saude-a-seguranca-publica.
https://www.ufrgs.br/ifch/index.php/br/c... ,¹¹11 Calmon TVL. As condições objetivas para o enfrentamento ao Covid-19: abismo social brasileiro, o racismo, e as perspectivas de desenvolvimento social como determinantes. NAU Soc. 2020; 11(20):131-136..

Working groups were then organized for actions in different points of the streets of Salvador and with different offers from the Program. These groups were composed mostly of health facility workers and some members of the collective Nós Nas Ruas. The actions were based on the educational component from the perspective of health education based on critical thinking about reality, and constituted a moment to reinforce the need to adopt, as much as possible, respiratory etiquette and hygiene measures.

A part of the group worked in the morning at the Street Support Unit (Unidade de Apoio à Rua - UAR), located in Largo dos Mares, where there is a space for bathing and using the toilet, performing qualified technical listening to the assisted population, offering snack kits and hygiene kits containing soap, toothpaste, toothbrushes, toilet paper, shampoo, condoms, and pads, in addition to leaflets containing general information about Covid-19 as well as guidance on self-care.

The other part, in turn, developed actions in the afternoon shift in points of the streets of Salvador where, routinely, there is presence of homeless people, such as Aquidabã, Piedade, Gamboa, Pela Porco, Largo dos Mares, Gravatá, Comércio, Chácara do Santo Antonio, and Água de Meninos. In order to confront the problem of Covid-19, in all the locations there was the distribution of hygiene kits, snacks, water, and an intense orientation work about the disease in order to protect and promote health. There was an effort by the team to offer sensitive listening, in short periods of time, to what was said by all of the participants, and to make referrals to emerging demands. However, it was evident the team’s concern with the de-characterization of the essence of the work proposed by the Corra Pro Abraço Program²⁰20 Programa Corra Pro Abraço. O corra pro abraço [Internet]. Salvador: Comvida; 2020 [citado 19 Mar 2021]. Disponível em: https://corraproabraco.wordpress.com/sobre/.
https://corraproabraco.wordpress.com/sob... ,²¹21 Secretaria de Justiça, Direitos Humanos e Desenvolvimento Social do Estado da Bahia. Corra pro abraço [Internet]. Bahia: SJDHDS; 2020 [citado 19 Mar 2021]. Disponível em: http://www.justicasocial.ba.gov.br/modules/conteudo/conteudo.php?conteudo=60.
http://www.justicasocial.ba.gov.br/modul... before the pandemic occurred, or even that they were developing purely assistentialist actions of distributing hygiene items and snacks. Such discomfort was also due to the approaches of some actors who showed that their main interest either in words and/or proposals out of context was to find personal motivation and/or occupy their idle time during the first months of isolation.

In the analytical process of the questions raised by the subjects involved in the actions, the importance of seeking the recognition of the limit between the ethics based on charity and the assistance directed to vulnerable subjects was outlined. In a pandemic context, this self-analytical process of the collective is at the limit of the approach of the notion of “emergence of the bond”. This emergency, mistakenly, can reduce the homeless population to those “in need”, which, given this condition, is subjected to the imperative of the charities²³23 Caponi S. Da compaixão à solidariedade: uma genealogia da assistência médica [Internet]. Rio de Janeiro: Fiocruz; 2000 [citado 19 Mar 2021]. Disponível em: https://static.scielo.org/scielobooks/dg2mj/pdf/caponi-9788575415153.pdf.
https://static.scielo.org/scielobooks/dg... . This distorted understanding reinforces the importance of criticism raised in self-analytical moments, which question the limits and risks of the propositional interventions and, at the same time, have clarity on the danger of assistentialist interventions based on charity. Actions of this nature reinforce the condition of vulnerability and invisibility of the social group involved, demarcated in the wishes and “engagement” of the “benefactors”. In this process, there is a great risk of establishing a division between those who magnifies themselves by performing the action and those who are diminished by receiving it²³23 Caponi S. Da compaixão à solidariedade: uma genealogia da assistência médica [Internet]. Rio de Janeiro: Fiocruz; 2000 [citado 19 Mar 2021]. Disponível em: https://static.scielo.org/scielobooks/dg2mj/pdf/caponi-9788575415153.pdf.
https://static.scielo.org/scielobooks/dg... .

It is key to remark that the concern of the teams is deeply relevant and reinforces the need to make visible the heterogeneity in the ways of surviving the pandemic. This reality strongly shakes-up society to reflect that it is not only about facing the emergency, but also the structural violence that persists and affects different segments²2 Freitas ARR, Napimoga M, Donalisio MR. Análise da gravidade da pandemia de Covid-19. Epidemiol Serv Saúde. 2020; 29(2):e2020119.,⁵5 Schuch P, Furtado CDC, Sarmento CS. Covid-19 e a população em situação de rua: da saúde à segurança pública? [Internet]. Rio Grande do Sul: Instituto de Filosofia e Ciências Humanas; 2020 [citado 19 Mar 2021]. Disponível em: https://www.ufrgs.br/ifch/index.php/br/covid-19-e-a-populacao-em-situacao-de-rua-da-saude-a-seguranca-publica.
https://www.ufrgs.br/ifch/index.php/br/c... ,⁷7 Santos JAF. Covid-19, causas fundamentais, classe social e território. Trab Educ Saúde. 2020; 18(3):e00280112.,¹¹11 Calmon TVL. As condições objetivas para o enfrentamento ao Covid-19: abismo social brasileiro, o racismo, e as perspectivas de desenvolvimento social como determinantes. NAU Soc. 2020; 11(20):131-136.. The understanding that the homeless population is a social group sustained on the idea of “lacking” and that the simply removing them from the streets would end the debate, constitutes a persistent problem also in the confrontation of Sars-CoV-2.5 Even with the important contribution of health policies and social assistance in Brazil, it is necessary to highlight the persistence of palliative and verticalized actions with a strictly solidary character. The experience of facing the pandemic showed aspects that make this clear: the State operates a policy that prioritizes lives and the homeless population integrates the neglected group¹²12 Mbembe A. Necropolítica. Arte Ensaios. 2016; 2(32):123-151..

In the process of recognizing the reality of people on the streets, in line with the specificities presented by the pandemic, the two teams mentioned a common fact that caught their attention: there was a considerable number of elderly people surviving on the streets. Faced with this scenario, the Corra Pro Abraço Program’s team sought to survey the profile of the group of people assisted by the actions. The process of carrying out this survey was done using the instruments for recording the assistance that allowed us to monitor the profile of these new people. First of all, it was observed that there has been a significant increase in the number of homeless people in the territories where the actions take place. It was found that between March and October 2020, 3.876 people were assisted who had never been in the program before. Among these, 300 were elderly people.

It is well known that there is an increased risk for illness, complications, and worse prognosis of Covid-19 in the homeless population, confirmed by the high prevalence of recurrent comorbidities such as chronic diseases, tuberculosis, HIV/Aids, and alcohol and drug abuse²⁴24 Brasil. Ministério da Saúde. Manual sobre o cuidado à saúde junto a população em situação de rua [Internet]. Brasília: Ministério da Saúde; 2012 [citado 19 Mar 2021]. Disponível em: https://cetadobserva.ufba.br/sites/cetadobserva.ufba.br/files/539.pdf.
https://cetadobserva.ufba.br/sites/cetad... . Staying on the streets, as already pointed out, can also be the result of different causes, including the exercise of autonomy that allows, in some way, deviating from the norms of social insertion instituted, as well as experiences lived in society⁸8 Pinho RJ, Pereira APFB, Lussi IAO. Homeless, the world of work and the specialized reference centers for population in street situation (centro pop): perspectives on actions for productive inclusion. Braz J Occup Ther. 2019; 27(3):480-495. Doi: https://doi.org/10.4322/2526-8910.ctoAO1842.
https://doi.org/10.4322/2526-8910.ctoAO1... .

During the actions, it was identified that the information disseminated to society in general about the pandemic did not include the context of this social group. Because of this, the group held conversations with homeless people elucidating the reasons why the streets were empty, what the modes of transmission were, and the signs and symptoms of Covid-19. We suggested that they avoid sharing pipes and other objects to reduce the chances of contamination, encouraging hand washing when possible, and asking them to share the information with other people living on the streets.

In the weekly evaluation and planning meetings, the challenges, advances, perceptions and strategies for the continuity of the work were discussed, so that the largest number of points of agglomeration of the city with homeless people could be contemplated. At the same time, there was a concern of the workers in relation to their own physical and emotional health, and in relation to the guarantee of individual protection equipment by the State, especially appropriate masks, and regarding the self-care strategies to be adopted by themselves before, during and after working hours.

Additionally regarding the issues discussed in these meetings with the teams, it is important to consider the difficulties in the working conditions of professionals who work on the frontline with homeless people such as the lack of appreciation of professional performance in some institutional and extramural environments²⁵25 Alecrim TFA, Mitano F, Reis AA, Roos CM, Palha PF, Protti-Zanatta ST. Experience of health professionals in care of the homeless population with tuberculosis. Rev Esc Enferm USP. 2016; 50(5):808-815. Doi: http://dx.doi.org/10.1590/S0080-623420160000600014.
https://doi.org/10.1590/S0080-6234201600... . In addition to the chronic issues associated with the work of social assistance and health professionals in Brazil, these teams had the understanding that the stigmatization associated with the homeless population extends to the entire group that works with them. Despite this reality, there was a concern to build the daily work routine with the team, as well as adopting all biosafety and assistance measures in the process.

In the present climate of insecurity and uncertainty, the Nós Nas Ruas Collective proposed instances of dialogue about the recommendations of health organizations, not only in relation to the use of masks and other PPE, but also in the care required during the use, removal, and storage of this equipment. In addition, the need for hand hygiene measures was reinforced, as well as the need to reduce the use of personal belongings and accessories in field activities, strategies for displacement considering different means of transport, either individual or collective, care when returning home, and ways to deal with the emotional stress generated by the situation.

Gradually, it became evident the need to go beyond the general recommendations moving forward towards coping strategies in tune with the culture and the precarious living conditions of the homeless population. After all, inequality, historically, is the basis that sustains the reality of this social group. Basically, there was nothing new for the homeless people or professionals of the Corra Pro Abraço Program regarding the way the pandemic was structured in society and, at the same time, reaffirmed the inequalities⁵5 Schuch P, Furtado CDC, Sarmento CS. Covid-19 e a população em situação de rua: da saúde à segurança pública? [Internet]. Rio Grande do Sul: Instituto de Filosofia e Ciências Humanas; 2020 [citado 19 Mar 2021]. Disponível em: https://www.ufrgs.br/ifch/index.php/br/covid-19-e-a-populacao-em-situacao-de-rua-da-saude-a-seguranca-publica.
https://www.ufrgs.br/ifch/index.php/br/c... ,¹¹11 Calmon TVL. As condições objetivas para o enfrentamento ao Covid-19: abismo social brasileiro, o racismo, e as perspectivas de desenvolvimento social como determinantes. NAU Soc. 2020; 11(20):131-136..

Over the nine-month period, there were five cases of Covid-19 in the team of 40 professionals in the Corra Pro Abraço Program, and three of these were professionals who worked only at the headquarters, i.e., not on the streets. Such a reality indicates a good preventive performance for acting in a pandemic. Furthermore, extra transportation was provided to the teams that had more difficulty getting to and from the workplace in order to reduce exposure in public transportation. The use of instruments and the time spent in the field was reduced, and the team workload was only reintegrated as they learned to deal with prevention strategies. The orientation provided to the Corra Pro Abraço Program team by the Nós Nas Ruas Collective was fundamental for the adoption of these and other measures.

The beginning of phase 2 was marked by the resumption of economic activities in the municipality with the reopening of establishments by adopting the recommended protocols. This pre-electoral moment reflected in the great mass a false process of overcoming the pandemic and reestablishing social and economic standards. Due to the fact that history confirms a trajectory of sacrifices present in the daily lives of marginalized groups, it was suspected that the resumption of activities would reveal the persistence of inequalities. As a result, they felt the negative consequences of this process as, for example, with the closing of part of the food distribution stations, possible reduction in the offer of emergency vacancies in institutional Shelter Units, and others. All this reinforces the relevance, not only of the partnership between the Corra Pro Abraço Program and the Nós Nas Ruas Collective in their quest for mobilization, but also of various sectors, social movements and entities, which even with the few tools available, were able to question the dominant persistence of socioeconomic inequality and access.

The next steps involve confronting the logic of a “new normal”, since we start from the understanding that this logic reflects veiling social injustices. The Corra Pro Abraço Program intends to work in the survey of information related to the access to aid that guaranteed income and food during the pandemic period. The intention is also to clarify the difficulties of access to basic services, such as the Specialized Reference Center for the Homeless Population (Centro POP), Specialized Reference Centers for Social Assistance (CREAS), and the Social Assistance Reference Centers (CRAS). Another intention is to understand the impact of the pandemic on drug use in these months, observing the frequency and quality of use. Such information will be useful to continue the work of sensitizing society, the quest for the guarantee of rights, keeping the managerial instances on their toes, to guarantee responses to the needs.

Final considerations

The operation of the Nós Nas Ruas collective in partnership with the Corra Pro Abraço Program sought to join efforts to face the impact of Covid-19 on the homeless population of Salvador, Bahia. All actions carried out were based on the premise that the determinants of the street situation involve a complex reality, plural and are plagued by social injustices. Those involved were provoked to be aware that the fight of the moment goes beyond the production of specialized spaces for the segregation of these people.

Given the challenge of developing this work, remains evident the importance of the creation and implementation of the Contingency Plan for the Coronavirus Pandemic (Covid-19) for the Homeless Population. This plan also reflects the provocations from the state coordination of the National Movement for the Homeless Population - Bahia.

In this background, the Nós nas Ruas Collective has been striving for months to exercise the duty of citizenship and awareness of different social groups (civil society, academic community and management) regarding the gaps in the debate of the visibility of homeless people. Such gaps are permeated by pulsating realities such as poverty, helplessness, violence, social inequalities and racism, which permanently intersect and clearly demarcate the confrontation of Covid-19 in the territory of Salvador.

The interpretation of the pandemic is done through a broader glance than the one that may be obtained only with numerical data. Although they have their importance, the understanding, communication, and misuse of epidemiological knowledge tends to make the subjects responsible for self-care, camouflaging the collective perspective of getting sick, being additionally unaccountable to public management. The improper stratification of social categories into classes based on socioeconomic conditions limits the segments removed from production and from the model of capitalist social organization framing them as a vulnerable and extremely poor category, without considering the particularities of their formation as a social group. The narratives and decisions proposed to face the pandemic in Brazil have confirmed this. Thus, the actions of the collective are also sustained by the recognition of the heterogeneity of survival paths before, during, and after the pandemic, as well as by avoiding the denial of the existence of bodies historically and daily threatened to death.

We don’t disregard that the mobilization of the collective Nós Nas Ruas occurs in a historical moment, characterized, above all, by a public health emergency. The humanitarian crisis is deepening in the Brazilian context, at every moment, besides the health crisis. Facing this scenario, the collective acknowledges that its engagement occurs with the adoption of actions that are also palliative in nature. We do not believe that they, by themselves, can unfold into robust changes in realities in the medium and long term.

While conducing an auto analytical exercise, it is salutary to recognize that in the structure of the collective itself, contradictions have been outlined and questioned, for example, the process of association to the collective or the different motivations to act in the actions. We reflect that they might occur for different reasons, among which a strategy to contribute to social reparation, subjective intentions to do something in the context of the pandemic, to justify the non-compliance with the health recommendations of social isolation, and to offer contributions with the intentionality of achieving a certain feeling of peace, benevolence, and duty accomplished. Nine months after the beginning of the actions, the actors were able to analyze their practices during the course of the work and realized that, although the Nós Nas Ruas collective was supported by institutionality, it was evident the engagement of “university students” and not of “universities”.

In the long run, it reinforces the importance of intersectoral articulation among social actors and workers from different areas, working with homeless people, and especially the health and social assistance teams. In cases where the work fronts of these different teams act disarticulated, it reflects in the understanding of the problem by the actors involved and in the efforts directed to the vulnerable social group. For all these reasons, the socio-political intentionality is key for the transformations (even those present before the pandemic) to exist and remain.

Acknowledgments

We thank all the members of the collective Nós Nas Ruas, the whole team of the Corra Pro Abraço Program, and especially the homeless population of Salvador, Bahia.

References

Publication Dates

History