Abstract

In patriarchal societies of peripheral countries, women suffer the effects of social and gender exclusion, which exposes them to the acquisition of HIV, and which remain after becoming ill. The aim of this paper is to explore the experiences of gender violence in the trajectory of women living with HIV. We conducted a qualitative study in which 61 women victims of gender violence registered in a Specialized Care Service for HIV/AIDS in a municipality in the interior of Rio Grande do Sul were interviewed, through a critical analysis of the discourse of the narratives produced by these women. All interviewees reported having suffered violations of rights throughout their lives, due to historical processes of exclusion, limitations in access to school, work, health services, and security. In health services, the care provided is based on a biopolitical medical model capable of postponing death, but not care for them fully. We denominate these women’s trajectories as “naked lives,” a concept of the philosopher Giorgio Agamben, considering that they are considered devalued and superfluous in society, marked by violence and HIV.

Keywords:
Women; HIV; Aids; Violence; Gender

Introduction

This study, based on narratives produced by women with HIV/AIDS, seeks to understand how social and gender inequalities and health practices can be central to the production of marginalized lives, devoid of rights and possibilities. Thus, we refer to women who are on the other side of the line, a situation of current capitalism that Boaventura de Souza Santos delimits as radical limits that divide the population into two groups: one on this side of the line and another on the other side, in which whoever belongs there disappears as a reality, becoming non-existent, irrelevant, and excluded (Santos, 2002SANTOS, B. S. Os processos da globalização. In: SANTOS, B. S. Globalização e ciências sociais. 3. ed. São Paulo : Cortez, 2002. p. 25-104., ²⁰⁰⁶SANTOS, B. S. A gramática do tempo: para uma nova cultura política. 3. ed. São Paulo : Cortez, 2006., ²⁰⁰⁷SANTOS, B. S. Para além do pensamento abissal: das linhas globais a uma ecologia de saberes. Novos Estudos Cebrap, São Paulo , n. 79, p. 71-94, 2007.).

For the female group, this exclusion was aggravated with the advent of contemporary neoliberal globalization, which seeks the “non-State” or the “State of non-law,” in which governors comply with international economic orders, to increase profit. In this model, the female domination and exploitation process is accentuated (Saffioti, 2001SAFFIOTI, H. I. B. Contribuições feministas para o estudo da violência de gênero. Cadernos Pagu, Campinas, n. 16, p. 115-136, 2001.). Women continue to be the object of economic and sexual exploitation in the domestic and public markets (Pateman, 1993PATEMAN, C. O contrato sexual. Rio de janeiro: Paz e Terra, 1993.). The State is an agent of exclusion, representing the interests of those who hold economic power, and the inclusion of all as having rights does not matter to capital, because it is not a source of profits (Rocha, 1999ROCHA, C. L. A. O princípio da dignidade da pessoa humana e a exclusão social. Revista Interesse Público, São Paulo , n. 4, p. 27-49, 1999.).

The lives of women are neglected in favor of their preservation, since abyssal lines delimit borders and spaces of death, resulting from care only for the rights of the “universals.” This occurs when the State withdraws from social regulation and public services are privatized or cease to exist, increasing inequalities and violence (Atkinson; Blandy, 2008ATKINSON, R.; BLANDY, S. International perspectives on the new enclavism and the rise of gated communities. Housing Studies, Abingdon, v. 20, n. 2, p. 177-186, 2008.; Glon, 2005GLON, J. C. Good fences make good neighbors: national security and terrorism: time to fence in our southern border. Indiana International and Comparative Law Review, Indianapolis, v. 15, n. 2, p. 349-388, 2005.; Santos, 2002SANTOS, B. S. Os processos da globalização. In: SANTOS, B. S. Globalização e ciências sociais. 3. ed. São Paulo : Cortez, 2002. p. 25-104., ²⁰⁰⁶SANTOS, B. S. A gramática do tempo: para uma nova cultura política. 3. ed. São Paulo : Cortez, 2006., ²⁰⁰⁷SANTOS, B. S. Para além do pensamento abissal: das linhas globais a uma ecologia de saberes. Novos Estudos Cebrap, São Paulo , n. 79, p. 71-94, 2007.).

Violence is one of the means of control and subjection used by patriarchy and is triggered when there are failures in the imposition of power hierarchies in the female domination and exploitation system (Okareh et al., 2015OKAREH, O. T. et al. Management of conflicts arising from disclosure of HIV status among married women in southwest Nigeria. Health Care Women International, Washington, DC, v. 36, n. 2, p. 149-160, 2015.; Schraiber; Barros; Castilho, 2010SCHRAIBER, L. B.; BARROS, C. R. S.; CASTILHO, E. A. Violência contra as mulheres por parceiros íntimos: usos de serviços de saúde. Revista Brasileira de Epidemiologia, São Paulo , v. 13, n. 2, p. 237-245, 2010.). The multiple forms of violence, including physical or sexual abuse, coercion, threats, and non-guarantee of rights, accentuate women’s vulnerability to HIV/AIDS, as many have been infected through sexual violence (Jewkes et al., 2010JEWKES, R. K. et al. Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study. Lancet, London, v. 376, n. 9734, p. 41-48, 2010.). On the other hand, the acquisition of HIV increases the possibility of violence, both in conjugal relationships, when they reveal the diagnosis to the partner and are blamed for the acquisition of the disease, and in societal relationships, when they suffer prejudices, discrimination, and social rejection (Carvalhaes; Teixeira Filho, 2012CARVALHAES, F. F.; TEIXEIRA FILHO, F. S. Histórias de vida de mulheres HIV+ ativistas: mudanças e permanências. Estudos Feministas, Florianópolis, v. 20, n. 2, p. 377-398, 2012.; Santos et al., 2009SANTOS, N. J. et al. Contextos de vulnerabilidade para o HIV entre mulheres brasileiras. Cadernos de Saúde Pública , Rio de Janeiro, v. 25, p. 321-333, 2009. Suplemento 2.; Villela; Barbosa, 2017VILLELA, W. V.; BARBOSA, R. M. Trajetórias de mulheres vivendo com HIV/aids no Brasil: avanços e permanências da resposta à epidemia. Ciência e Saúde Coletiva , Rio de Janeiro, v. 22, n. 1, p. 87-96, 2017.). Violence, therefore, coexists with the HIV/AIDS condition, although it is not possible to establish a cause and effect relationship, even though one in seven infections could be prevented if women were not subjected to violence or were not in power inequality in relationships (Jewkes et al., 2010). Besides, individual, programmatic, and social conditions contribute to increasing the vulnerability of women (Ayres, 2008AYRES, J. R. C. M. Sobre o risco: para compreender a epidemiologia. 3. ed. São Paulo: Hucitec, 2008.).

The use of the gender category, within a perspective of the theory of patriarchy (Pateman, 1993PATEMAN, C. O contrato sexual. Rio de janeiro: Paz e Terra, 1993.; Saffioti, 2001SAFFIOTI, H. I. B. Contribuições feministas para o estudo da violência de gênero. Cadernos Pagu, Campinas, n. 16, p. 115-136, 2001.) to investigate the lives of women with HIV/AIDS who suffer violence, implies recognizing them as subordinate, dominated, and exploited subjects since the social guarantee of its integrity is conditioned to male tutelage. The patriarchy playbook imposes on women passivity, formalism, and silence as a “screen in front of the public,” cemented by the myth of romantic love. Women are socialized to seek a partner, to yield to male sexual desire, regardless of what they want. However, those who acquire HIV/AIDS are seen as promiscuous and sexually reckless. Thus, in sexist and conservative contexts, there is an exacerbation of prejudice, stigma, and social rejection of women who do not behave according to the canons of patriarchy. Besides, health services, in most cases, focus their practices only on the biological aspects of AIDS and clinical care, with no concern with the integrality of care and with psychosocial problems that affect women (Gottert et al ., 2016GOTTERT, A. et al. Measuring men’s gender norms and gender role conflict/stress in a high HIV-prevalence South African setting. Aids and Behavior, New York, v. 20, n. 8, p. 1785-1795, 2016.; Marcondes Filho, 2001MARCONDES FILHO, C. Violência fundadora e violência reativa na cultura brasileira. São Paulo em Perspectiva, São Paulo, v. 15, n. 2, p. 20-27, 2001.).

The aim of this study was to explore the experiences of gender violence in the trajectory of women living with HIV.

Methodological strategies

This is a qualitative study in which narratives of women with HIV/AIDS who were victims of gender violence were heard. The narrative made it possible to broaden the understanding of the women’s life context and to highlight elements that are invisible in the daily life of services and health care directed at them. Furthermore, it recognizes the importance of listening and narratives as a rescue of the narrator’s memory and voice (Marre, 1991MARRE, J. História de vida e método biográfico. Cadernos de Sociologia, Porto Alegre, v. 3, p. 55-88, 1991.).

The research participants were heard in 2013 at the Specialized Care Service for STD/HIV/AIDS (SAE) in a medium-sized city in the interior of Rio Grande do Sul, which, at the time of the survey, ranked 5th in Brazil in cases of HIV/AIDS. The choice for the location considered the high incidence of the disease (Brasil, 2014BRASIL. Ministério da Saúde. Boletim Epidemiológico HIV-AIDS. Brasília, DF, ano 3, n. 1, 2014.).

The study is part of a larger study in which, in the quantitative stage, 160 women who lived with HIV/AIDS participated (Ceccon; Meneghel; Hirakata, 2014CECCON, R. F.; MENEGHEL, S. N.; HIRAKATA, V. N. Mulheres que vivem com HIV: violência de gênero e ideação suicida. Revista de Saúde Pública, São Paulo, v. 48, n. 5, p. 758-765, 2014.). When evidencing the high prevalence of violence (75%), women who reported having suffered gender violence were asked to freely narrate their life stories. Thus, 61 women over the age of 18, who lived with HIV/AIDS and were registered with the SAE, were heard. They spoke spontaneously about their life trajectories, reporting feelings related to living with HIV/AIDS and violence, based on the triggering question: “Tell me your life and talk about HIV and the violence you have suffered.”

The narratives allow us to understand how people construct explanations for their own experiences and the contexts in which they are inserted (Mishler, 1986MISHLER, E. Research interviewing: context and narrative. Cambridge: Harvard University Press, 1986., ¹⁹⁹⁹MISHLER, E. Storylines: craftartists’ narratives of identity. Cambridge: Harvard University Press , 1999., ²⁰⁰²MISHLER, E. Narrativa e identidade: a mão dupla do tempo. In: LOPES, L. P. M.; BASTOS, L. C. Identidades: recortes multi e interdisciplinares. Campinas: Mercado de Letras, 2002. p. 97-119.; Ochs; Lisa, 2001OCHS, E.; LISA, C. Living narrative: creating lives in everyday storytelling. Cambridge: Harvard University Press , 2001.; Riessman, 2008RIESSMAN, C. K. Narrative methods for the human sciences. 2. ed. Thousand Oaks: Sage, 2008.). The material obtained in the interviews was transcribed and organized according to two thematic categories: gender, defined a priori, and naked life, which emerged from the analysis of the material, being a concept developed by Giorgio Agamben (2004AGAMBEN, G. Homo sacer: o poder soberano e a vida nua. 2. ed. Belo Horizonte: Editora UFMG, 2004.) to describe the process of necropolitics undertaken by governments in the current stage of capitalism, by leaving certain population groups absolutely excluded and unprotected.

The understanding of the narratives was based on the critical discourse analysis, aiming to show how the discursive practices are related to the socio-political structures of power and domination in society. The narrative discourse was understood as a social practice that constitutes reality and how social actors are built for performance and resistance (Mishler, 1986MISHLER, E. Research interviewing: context and narrative. Cambridge: Harvard University Press, 1986., ¹⁹⁹⁹MISHLER, E. Storylines: craftartists’ narratives of identity. Cambridge: Harvard University Press , 1999., ²⁰⁰²MISHLER, E. Narrativa e identidade: a mão dupla do tempo. In: LOPES, L. P. M.; BASTOS, L. C. Identidades: recortes multi e interdisciplinares. Campinas: Mercado de Letras, 2002. p. 97-119.; Ochs; Lisa, 2001OCHS, E.; LISA, C. Living narrative: creating lives in everyday storytelling. Cambridge: Harvard University Press , 2001.; Riessman, 2008RIESSMAN, C. K. Narrative methods for the human sciences. 2. ed. Thousand Oaks: Sage, 2008.).

The research respected the recommendations of the Declaration of Helsinki (AMM, 1964AMM - ASSOCIAÇÃO MÉDICA MUNDIAL. Declaração de Helsinque: princípios éticos para a pesquisa envolvendo seres humanos. Helsinque: AMM, 1964.) and was conducted according to Resolution No. 196/1996 of the National Health Council (Brasil, 1996BRASIL. Ministério da Saúde. Conselho Nacional de Saúde. Resolução CNS nº 196, de 10 de outubro de 1996. Aprova diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos. Diário Oficial da União, Brasília, DF, 16 out. 1996.). The study is part of a doctoral thesis presented to the Postgraduate Program in Nursing at the Federal University of Rio Grande do Sul, and the project was approved by the Research Committee and by the Research Ethics Committee under number 22209.

Results and discussion

Gender and violence: the lives of women with HIV/AIDS

The narratives produced by women showed female itineraries marked by unequal power relations that occur in a class-based society, which is racist and patriarchal. Violence was understood as any act that results or is likely to lead to physical, sexual, psychological, or suffering for women, including the threat of such acts, coercion, or arbitrary deprivation of liberty in a public or private environment (WHO; UNODC; Unaids, 2012WHO - WORLD HEALTH ORGANIZATION; UNODC - UNITED NATIONS OFFICE ON DRUGS AND CRIME; UNAIDS - JOINT UNITED NATIONS PROGRAMME ON HIV/AIDS. WHO, UNODC, UNAIDS technical guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users: 2012 revision. Geneva: WHO, 2012.).

It became evident that the women interviewed are on the other side of the line (Santos, 2006SANTOS, B. S. A gramática do tempo: para uma nova cultura política. 3. ed. São Paulo : Cortez, 2006.), included in the modern sub-humanity in which the excluded live, those who are not even considered candidates for social inclusion since the current stage of capitalism separates groups by apartheid. Thus, these poor, black, uneducated, prostitutes and women with HIV/AIDS are inserted in the sub-humanity destined to sacrifice (Santos, 2006SANTOS, B. S. A gramática do tempo: para uma nova cultura política. 3. ed. São Paulo : Cortez, 2006.), with another humanity composed of included individuals considered universal, represented by white and rich heterosexual men. It is not a matter of deviations from alleged normality, but of being placed in a marginalized place, due to poverty, skin color, low education, less valued jobs, and the disease that causes abjection (Veiga-Neto, 2011VEIGA-NETO, A. Incluir para excluir. In: LARROSA, J.; SKLIAR, C. (Org.). Habitantes de babel: políticas e poéticas da diferença. 2. ed. Porto Alegre: Autêntica, 2011. p. 105-118.), as shown below:

The women interviewed reported having suffered rights violations throughout their lives, mainly limitations on access to school, work, health services, and security. They live in a city where poverty and social exclusion have intensified in recent years, in a context of growth and wealth of agribusiness, undertaken by regional elites. Financial and social power is perpetuated for generations among a few families, aggravating social inequalities (Campos, 2011CAMPOS, C. S. S. A face feminina da pobreza em meio à riqueza do agronegócio. Buenos Aires: Clacso, 2011.).

The fact that the women interviewed reported restricted or non-existent access to housing, education, food, income, and protection throughout their lives shows the situation of political, legal, and social unprotection determined by the absenteeism of the State and the predatory performance of non-state agents (Santos, 2006SANTOS, B. S. A gramática do tempo: para uma nova cultura política. 3. ed. São Paulo : Cortez, 2006.). State absenteeism can be considered in situations where the services are only symbolic, not guaranteeing the implementation of protective measures, or exist with such scarcity that they fail to achieve minimum coverage, such as temporary shelters for women in situations of violence or the insufficient number of professionals in the SAEs.

The AIDS epidemic in Brazil affects a large number of women and poor, dispossessed, voiceless, and powerless people who are on the other end of the line. In addition, institutions broadcast increasingly authoritarian and conservative speeches, which include mandatory heterosexuality and threats to women’s sexual and reproductive rights, such as non-access to HIV prophylaxis after sexual violence, increasing female vulnerability (Carvalho; Piccinini, 2008CARVALHO, F. T.; PICCININI, C. A. Aspectos históricos do feminino e do maternal e a infecção pelo HIV em mulheres. Ciência e Saúde Coletiva, Rio de Janeiro, v. 13, n. 6, p. 1889-1898, 2008.). The social determination of health/disease is replaced by the attribution of individual responsibility, and sexually transmitted diseases are seen as the result of morally objectionable behaviors. Thus, women with HIV/AIDS are considered transgressive and promiscuous, with no empathy for them and no social commotion with their deaths (Sontag, 1989SONTAG, S. Aids e suas metáforas. São Paulo : Companhia das Letras, 1989.).

The patriarchal, capitalist and racist ideology in force in society divides and separates, excludes, and limits access to rights, focusing mainly on the most vulnerable in terms of economic condition, gender, and race. It is empowered in politically democratic societies in its formal, yet authoritarian, conservative, violent, and exclusionary mechanisms in practice (Ceccon, 2016CECCON, R. F. Vidas nuas: mulheres com HIV/aids em situação de violências de gênero. 2016. Tese (Doutorado em Enfermagem) - Universidade Federal do Rio Grande do Sul, Porto Alegre, 2016.). This ideology is also configured as a state of exception that operates using violence as a mechanism of control, discipline, and submission, and the naturalization and trivialization of violence, in addition to blaming the victims themselves, a fact that hinders their confrontation (Santos, 2002SANTOS, B. S. Os processos da globalização. In: SANTOS, B. S. Globalização e ciências sociais. 3. ed. São Paulo : Cortez, 2002. p. 25-104.; Segato, 2007SEGATO, R. L. Qué es un feminicidio: notas para un debate emergente. In: BELAUSTEGUIGOITIA, M.; MELGAR, L. (Coord.). Fronteras, violencia, justicia: nuevos discursos. Ciudad de México: Unifem, 2007. p. 35-48.). This mechanism maintains the abyssal line between women who will be protected and cared for and those whose lives are eliminable, invisible, and disposable. They constitute precarious lives, such as the interviewed black and poor women who acquired HIV/AIDS and whose only certainty, after diagnosis, is that “life is over.”

The subordination/exploitation of women through violence is part of the current phase of capitalism, denominated as “apocalyptic,” whose lives are tie to a “politics of violence” (Segato, 2003SEGATO, R. L. Las estructuras elementales de la violencia: ensayos sobre género entre la antropología, el psicoanálisis y los derechos humanos. 2. ed. Buenos Aires: Universidad Nacional de Quilmes/Prometeo, 2003. p. 131-148.). This situation, observed in the study, was considered a marker of gender inequality, in which women with HIV/AIDS reported having suffered, throughout their lives, assaults of various types, perpetrated by people who fulfilled the function of care, such as family members, parents, brothers, husbands, companions, boyfriends, and even bosses and strangers. The trajectories are constituted by violations of rights that resulted in violence and acquisition of HIV:

Women reported that physical and sexual aggressions were frequent in childhood, a situation that forced them to secrecy, constituting family practices, a place where violence is used to correct, discipline, and submit (Garbin; Queiroz; Rovida, 2012GARBIN, A. S.; QUEIROZ, C. D. G.; ROVIDA, A. S. R. A violência familiar sofrida na infância: uma investigação com adolescentes. Psicologia em Revista, Belo Horizonte, v. 18, n. 1, p. 107-118, 2012.; Santos, 2002SANTOS, B. S. Os processos da globalização. In: SANTOS, B. S. Globalização e ciências sociais. 3. ed. São Paulo : Cortez, 2002. p. 25-104.). Furthermore, in the family, the hierarchy and obedience of the family group are directed to the male figure, characteristics naturalized and legitimized by the patriarchal system (Narvaz; Koller, 2004NARVAZ, M. G.; KOLLER, S. H. Famílias, gênero e violências: desvelando as tramas da transmissão transgeracional da violência de gênero. In: STREY, A. J. Violência, gênero e políticas públicas. Porto Alegre: Editora da PUCRS, 2004. p. 149-176.).

In adulthood, they continued to suffer psychological, physical, sexual, and patrimonial abuse by men who were parents, brothers, boyfriends, husbands, partners, bosses, or pimps. Violence, as a fundamental part of the patriarchal social mandate, is a condition for the reproduction of unequal relations, with positions marked by hierarchical distancing. This means that violence plays a necessary role in the reproduction of the symbolic economy of power and gender inequality (Segato, 2003SEGATO, R. L. Las estructuras elementales de la violencia: ensayos sobre género entre la antropología, el psicoanálisis y los derechos humanos. 2. ed. Buenos Aires: Universidad Nacional de Quilmes/Prometeo, 2003. p. 131-148.). The reports of violence, present in all life stories, indicate how much this fact is part of the process of subordination of women with HIV/AIDS:

Violence works as a punishment against women who have left their place, from subordinate and tutored positions in a status system. This place shows the signs of female sociability and sexuality, governed by the needs and interests of men, and the simple movement of women in a position that is not intended for them in the hierarchy puts into question the male position in this structure, based on status as a value in the system of relationships. Violence is used to discipline and control, and the act of punishing and depriving women of vitality is also a moralizing gesture. This social mandate is not aimed at a specific woman, but at a generic woman, since her subjection is necessary for the rapist’s symbolic economy and for the balance of the gender order to remain intact. Generic women are those who are subject to the feminine role, whose fixed itinerary in the structure reinforces the need for violence marked by gender inequality (Segato, 2003SEGATO, R. L. Las estructuras elementales de la violencia: ensayos sobre género entre la antropología, el psicoanálisis y los derechos humanos. 2. ed. Buenos Aires: Universidad Nacional de Quilmes/Prometeo, 2003. p. 131-148.).

A group of women interviewed only found the possibility of survival in prostitution. This activity, which, in past times, was managed by women themselves, has now been appropriated by the Mafia patriarchy, making them need to pay for the “protection” of pimps and hustlers, which means an increase in exploitation. Currently, the sex market and the sexual exploitation of women is one of the most profitable sectors worldwide. In this market, prostitutes are given the status of sexual objects, which can be easily discarded when they become ill, rebel, or grow old, and it is maintained continuously by the entry of poor young people, minority ethnicities, migrants, and those from countries at war or war conflicts, where they are the target of human trafficking, drugs and commercial sexual exploitation (Carcedo, 2010CARCEDO, A. No olvidamos ni aceptamos: feminicidio en Centroamérica 2000-2006. San José: Asociación Centro Feminista de Información y Acción, 2010.). Among the factors that lead young women to prostitution are poverty, family abuse, pregnancies without resources in traditional societies, and the lack of social and financial support networks (Ribeiro; Oliveira, 2011RIBEIRO, M. A.; OLIVEIRA, R. S. Território, sexo e prazer: olhares sobre o fenômeno da prostituição da geografia brasileira. 2. ed. Rio de Janeiro: Gramma, 2011.).

The practice of prostitution is, most of the time, carried out in territories where the law of the strongest and violence prevails, where gangs, dealers, pimps, male escorts, and hustlers prevail, which subject women to violence, abuse, and exploitation. As users pay for sex, they feel entitled to use the paid body according to their wishes, making them objects of violence and even death, in addition to causing a high risk of contracting HIV/AIDS, since many men reject condom use or withdraw it during sexual practice (Lipszyc, 2003LIPSZYC, C. Prostitución o esclavitud sexual? 2. ed. Lima: Cladem, 2003.). At the same time, prostitution operates in places of production of affections and cultural, academic, and political products. It is carried over and built by people with subjectivities that do not fit into cohesive constructions of “groups,” let alone “risk groups” (Guimarães; Merchán-Hamann, 2005GUIMARÃES, K.; MERCHÁN-HAMANN, E. Comercializando fantasias: a representação social da prostituição, dilemas da profissão e a construção da cidadania. Estudos Feministas , Florianópolis, v. 13, n. 3, p. 525-544, 2005.).

The rights of women, often nonexistent or confiscated as a result of patriarchy, make them, instead of being citizens, subservient to men in all areas of life, in the form of submission or because they have a body capable of being sanctioned with violence whenever it breaks the rules. They are subjected to the patriarchal and capitalist system, excluded, victims of violence as a corrective practice, deprived of rights, citizenship, and reduced to precarious and unprotected lives. Furthermore, compared to other job options, prostitution can be understood as an effective way to guarantee these women a sufficient amount of money not only to survive but to rehearse a socioeconomic rise (Blanchette; Silva, 2009BLANCHETTE, T. G.; SILVA, A. P. Amor um real por minuto: a prostituição como atividade econômica no Brasil urbano. In: PARKER, R.; CORREA, S. (Org.). Sexualidade e política na América Latina: histórias, intersecções e paradoxos. Rio de Janeiro: SPW, 2009. p. 192-233.).

The production of naked lives

Social inequalities and gender-based violence can be considered one of the modus operandi to maintain patriarchal capitalism, exclude and reduce women to “naked life,” a concept proposed by Agamben (2004AGAMBEN, G. Homo sacer: o poder soberano e a vida nua. 2. ed. Belo Horizonte: Editora UFMG, 2004.) to refer to unprotected subjects, whose lives are expendable. Poor, black, and HIV-infected women become deprived of possibilities since the protection mechanisms used by the dominant groups in society are not available to them. However, these lives are not eliminated in clearly observable acts, but their survival is rendered unsustainable, and the State, in its governance mechanisms, is the entity that lets them die (Agamben, 2004; Reihling, 2010REIHLING, H. Rejeitar ou priorizar a vida? Ambiguidades da biopolítica da aids no Uruguai. Ciência e Saúde Coletiva , Rio de Janeiro, v. 15, p. 1159-1168, 2010. Suplemento 1.).

Although letting women with HIV/AIDS die is not a deliberate act of power, biopolitical actions operate through mechanisms of coercion and control related to subtle practices that require the participation of women themselves (Reihling, 2010REIHLING, H. Rejeitar ou priorizar a vida? Ambiguidades da biopolítica da aids no Uruguai. Ciência e Saúde Coletiva , Rio de Janeiro, v. 15, p. 1159-1168, 2010. Suplemento 1.). Even if their lives are reduced to “naked lives,” forms of intervention need not necessarily occur through direct interventions. They can take place through the lack of efficient forms of protection, and, in the case of the disease, the non-availability of prevention, care, and health care mechanisms that consider women in full and have a significant expression in the population, through public policies, not being reduced to specific actions (Douglas, 1976DOUGLAS, M. Pureza e perigo. São Paulo: Perspectiva, 1976.).

The instances capable of determining the limit between protected life and “naked life,” politicizing the phenomenon of life by including it or excluding it from the legal sphere, are part of the biopolitical regime, which has the power to protect or discard the lives of these women. In this way, the state of exception, in which “naked life” is simultaneously excluded from the legal order and imprisoned in it, constitutes the contemporary rule and the hidden foundation of the sovereign organization of political bodies in the West (Foucault, 1976FOUCAULT, M. História da sexualidade I: a vontade de saber. Rio de Janeiro: Graal, 1976.).

The narratives produced by women show that the State also does not guarantee sexual and reproductive rights, including access to contraceptive practices and HIV prevention drugs in the face of rape or guaranteed abortion provided for by law, according to the excerpt:

Most of the time, women are infected for not having adequate protection, for male refusal to use condoms, for suffering sexual abuse, rape, commercial sexual exploitation, or even in the course of dating and conjugal relations (Ceccon; Meneghel; Hirakata, 2014CECCON, R. F.; MENEGHEL, S. N.; HIRAKATA, V. N. Mulheres que vivem com HIV: violência de gênero e ideação suicida. Revista de Saúde Pública, São Paulo, v. 48, n. 5, p. 758-765, 2014.). The sexual morality of society reinforces “the myth of romantic love,” in which women must satisfy men at the expense of their sexual and reproductive autonomy (Santos et al., 2014SANTOS, A. C. et al. A violência contra a mulher e o mito do amor romântico. Cadernos de Graduação: Ciências Humanas e Sociais, Maceió, v. 2, n. 2, p. 105-120, 2014.).

The large number of women still infected by HIV in Brazil is an indication that there is a female contingent without autonomy to protect themselves, to use condoms and to refuse unwanted sex, acquiring HIV/AIDS early, although currently, the epidemic has increased again among men, especially homosexuals and in urban centers. However, in relation to women, it is still men who decide when, and how sex will be done. Therefore, gender inequalities maintained by patriarchy are conditions that, by subjecting and making women vulnerable, contribute to the production of leftover, superfluous, and expendable lives (Saffioti, 2001SAFFIOTI, H. I. B. Contribuições feministas para o estudo da violência de gênero. Cadernos Pagu, Campinas, n. 16, p. 115-136, 2001.).

The trivialization of life also occurs when health services focus only on the clinical care of AIDS, ignoring the inequalities, violence, and suffering that affect them, thus breaking with the principle of integral care. Thus, the health sector provides, as a State, fragmented and partial care, which fails to meet the needs of users in its entirety:

The care practices offered to women who have the virus are centered on biomedical interventions through early diagnosis, clinical consultations, periodic exams to monitor CD4 and viral load levels, and supply of medication. There is not always non-judgmental and qualified listening, with the necessary time and the proper ambiance. These actions, by not including biopsychosocial aspects, constitute a fragmented biomedical practice restricted to the medicalization of life. Even so, these actions, which do not respect the principle of integrality, are not carried out in the same way for all women, with others that, due to difficulties in access or adherence, or even due to obstacles encountered due to race, ethnicity, class, sexual orientation or job insertion will receive unfair treatment, with discrimination and impairment in treatment adherence, many of them needing to live with disabling opportunistic diseases, and others dying precociously (Ceccon; Meneghel; Hirakata, 2014CECCON, R. F.; MENEGHEL, S. N.; HIRAKATA, V. N. Mulheres que vivem com HIV: violência de gênero e ideação suicida. Revista de Saúde Pública, São Paulo, v. 48, n. 5, p. 758-765, 2014.).

Getting someone to live just with the supply of medication, treatment, and tests are not enough considering the precariousness of women’s lives. The care of life goes beyond what is prescribed in the offerings of the health sector and definitely enters the field of politics. And AIDS remains one of the diseases that most have a political interface. Medicalization is unable to solve a series of questions derived from it, having to exercise other ways of responding to the disease, understood in its necessarily social face, although without giving up pharmaceutical advances (Paiva et al., 2015PAIVA, V. et al. The current state of play of research on the social, political and legal dimensions of HIV. Cadernos de Saúde Pública , Rio de Janeiro, v. 31, n. 3, p. 477-486, 2015.), although, at the present historical moment, even that is at risk.

Following the strategy of offering treatment and not facing the political side of AIDS establishes two action fronts that do not lead to the same objective. They represent counterpoints: one makes you live, another lets you die. One speech advocates for testing and treating, another denies equal rights. It is necessary to ensure the autonomy of subjects, regardless of race, gender, and social class to face the disease, and this implies designing possible futures for these lives because life’s viability is also a project of happiness. It is necessary to talk about sex, rescue the erotic, promote access to human rights, and build a world of equal opportunities between people. AIDS indicates, above all, the precariousness of life - naked life - and is, therefore, a political problem that can be solved with equitable and universal policies (Seffner; Parker, 2016SEFFNER, F.; PARKER, R. Desperdício da experiência e precarização da vida: momento político contemporâneo da resposta brasileira à aids. Interface: Comunicação, Saúde, Educação, Botucatu, v. 20, n. 57, p. 293-304, 2016.).

This situation can be made invisible by the neutrality discourse of the clinical and biomedical model, which is not concerned with the desires and social, psychological, and affective needs of women (Reihling, 2010REIHLING, H. Rejeitar ou priorizar a vida? Ambiguidades da biopolítica da aids no Uruguai. Ciência e Saúde Coletiva , Rio de Janeiro, v. 15, p. 1159-1168, 2010. Suplemento 1.). On many occasions, due to the precariousness of their lives, they do not consider AIDS as a problem and do not realize the limitations of the care practices offered by the service.

The abandonment of care offered by the service was reported by several women and many others who were on the service register and have already abandoned it. In Brazil, there is a lot of evasion of users in SAEs, and the services do not carry out an active search, considering them as “archive,” whose death is already contained in the metaphor. In turn, the services face difficulties, with incomplete teams of professionals, creating work overload and making it difficult to offer collective activities (Schraiber; D’Oliveira; Couto, 2009SCHRAIBER, L. B.; D’OLIVEIRA, A. F. P. L.; COUTO, M. T. Violência e saúde: contribuições teóricas, metodológicas e éticas de estudos da violência contra a mulher. Cadernos de Saúde Pública , Rio de Janeiro, v. 25, p. S205-S216, 2009. Suplemento 2.).

In relation to gender-based violence that affects women, the health sector is part of the coping network, but services are not yet concerned with identifying these situations, limiting themselves to treating injuries. Professionals, in most services, including SAEs, are limited to inquiring about the materiality of violence, doing little to change it, and women with HIV/AIDS are faced with the low resolution of the institutions that are part of the network to confront and prevent violence. The mechanisms used to curb aggression are also inefficient, as noted in this study, in which many of the interviewees had sought out the police to report the same aggressors who continued to victimize them (Meneghel; Hirakata 2011MENEGHEL, S. N.; HIRAKATA, V. N. Femicídios: homicídios femininos no Brasil. Revista de Saúde Pública , São Paulo, v. 45, n. 3, p. 564-574, 2011.; Meneghel; Iñiguez, 2007MENEGHEL, S. N.; IÑIGUEZ, L. R. Contadores de histórias: práticas discursivas e violência de gênero. Cadernos de Saúde Pública, Rio de Janeiro, v. 23, n. 8, p. 1815-1824, 2007.).

To overcome situations of violence, society must deconstruct the ideological mechanisms that maintain hierarchies of power between the sexes (Meneghel et al., 2013MENEGHEL, S. N. et al. Repercussões da Lei Maria da Penha no enfrentamento da violência de gênero. Ciência e Saúde Coletiva , Rio de Janeiro, v. 18, n. 3, p. 691-700, 2013.), but the patriarchy continues to use these mechanisms to maintain the situation of submission/exploitation of these women, whose trajectories have been marked by so many inequities that they can only be considered as naked lives.

It is not possible to think of the State without relating it to the figure of the homo sacer, the one whose life is sacrificable - such as that of women with HIV/AIDS in this study - so that as long as there is a sovereign power, there will be naked life exposed to abandonment and death. The one who has power and who can sacrifice anyone without restrictions is sovereign is, while the homo sacer is the one who can have his life without possibilities and be eliminated without constituting a homicide. This is the treatment of the State for the poor and excluded classes, for those who live in the slums and apartheid regions of large cities. This is the treatment offered to those on the other end of the line. One of the ways to operationalize this regime is to limit the distribution of resources and social equipment, making universal access to rights guaranteed by the Constitution not for everyone, in such a way that a portion of the population is left to die (Agamben, 2004AGAMBEN, G. Homo sacer: o poder soberano e a vida nua. 2. ed. Belo Horizonte: Editora UFMG, 2004.; Santos, 2002SANTOS, B. S. Os processos da globalização. In: SANTOS, B. S. Globalização e ciências sociais. 3. ed. São Paulo : Cortez, 2002. p. 25-104., ²⁰⁰⁷SANTOS, B. S. Para além do pensamento abissal: das linhas globais a uma ecologia de saberes. Novos Estudos Cebrap, São Paulo , n. 79, p. 71-94, 2007.).

If the state of exception has become the norm in the contemporary world, there should be no surprise with the rise of totalitarianism, with the existence of extermination camps and refugees, with the increasing number of slums, with the ostensible presence in the territories of paramilitary groups, militias, and mafias, responsible for the summary elimination of the undesirable people. In today’s society, the biopolitical regime becomes increasingly rigid, continually redefining and reducing the threshold between what is within the political order or the lives that will be protected and the lives that are on the other side, considered superfluous lives (Agamben, 2004AGAMBEN, G. Homo sacer: o poder soberano e a vida nua. 2. ed. Belo Horizonte: Editora UFMG, 2004.).

Agamben’s reflection helps to identify contemporary types of homo sacer as the legal status of modern biopolitics. Among these types, there are the human guinea pig for medical experiments; the patient in a deep coma kept alive by technological means; survivors in refugee camps; suspects linked to terrorism or illegal immigration, detained and held incommunicado; the inhabitants of ghettos and slums on the outskirts of large cities, especially in cases where the confrontation between two sovereign forces, the police, and organized crime, generates a space of indistinction in which naked lives are discarded. This process occurs when a woman, a citizen and a holder of rights, starts to be considered a life that does not deserve to be lived, whose elimination through negligence or even murder is simply filed or forgotten without punishment (Agamben, 2004).

Final remarks

In this study, we extended the condition of naked life, formulated by Agamben, to women with HIV/AIDS, poor and black women, who reported paths crossed by violence, exclusion, exploitation, and gender inequalities. Not all women with HIV/AIDS can be included in this condition, and Brazil remained, until 2016, a reference for HIV/AIDS, investing billions of reais in medicines and in a network of services to carry out diagnosis, treatment, and monitoring of patients. However, when the focus of HIV/AIDS care focuses only on clinical aspects when the principles of integrality and equity are broken when the life situation is so precarious that AIDS becomes a secondary problem, and when the patients leave the service, these women may be in the condition of mere “naked life.” Killable, superfluous, and disposable life.

References

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