Adolescentes em situação de rua: compreendendo o contexto e os determinantes sociais da saúde

Abstract

Adolescents living on the streets consider the street to be their family environment and a life context full of situations that favor social and economic exclusion. Thus, living on the street compromises their lives and their futures, being a difficult reality, but one that has been present for at least a century in Latin America. The objective is to understand the context of adolescents living on the streets in the light of the Conceptual Framework of the Social Determinants of Health. This is a mixed-methods research with a concurrent convergent approach, carried out from June 2020 to June 2021, in various locations on the street, being mainly in bus terminals, supermarkets, shopping malls, streets, squares, beaches and avenues of great flow, commercial and tourist areas. The population was composed of a heterogeneous group of adolescents living on the streets, and the sample was intentionally selected with data saturation. We highlight that the stages of the study were: submission to the ethics committee, visits to the adolescents, insertion in the field, interaction and bonding with the population, beginning of data collection, and interviews. The survey of quantitative data was conducted through the Sociodemographic Form and then, at the same time, the collection of qualitative data was started with a script of questions in the Semi-structured Interview. The analysis of quantitative data was performed using the Statistical Package for the Social Sciences (SPSS) software, version 25.0 for Windows. The qualitative data analysis was performed by reflecting the findings through the foundations of the Social Determinants of Health Frameworks and the aid software ATLAS.ti 9. In the results, 19 adolescents living on the streets were identified, 13 (68.4%) are between 16 and 19 years old, 11 (57.9%) are male, three (15.8%) female and 5 (26.3%) trans. As for skin color, 15 (78.9%) called themselves non-white (brown and black). Regarding origin, 14 (73.7%) were from the city of Fortaleza-CE. In relation to time on the streets, 9 (47.4%) have been on the streets for 2 to 12 years and 10 (52.6%) for 6 months. And finally, the weekly income of 10 (52.6%) adolescents is between 100 and 180 Reais, and for 9 (47.4%) it is between 200 and 300 Reais. The analysis of quantitative and qualitative data gave rise to five central categories: Structural and Social Determinants in Homeless Adolescents; Experiences of Homeless Adolescents and the influence of SDH; Feelings and aspirations of Homeless Adolescents and the relationship with the SDH; Inequalities of Health of Homeless Adolescents and Pandemic Covid-19: Experiences of Adolescents on the Street. The research allowed to recognize the adolescents as social actors and subjects and to improve the ability to reflect on the context of vulnerability and risk that they live. In general, vulnerability is related to the exposure of adolescents to risk, being the result of a set of aspects not only individual, but collective, contextual, which give rise to greater susceptibility in adolescents in situations of vulnerability. For the same reason, this research is essential to highlight the real experiences of the context of adolescents in street situation in the light of the Conceptual Framework of the DSS. In conclusion, we can say that, namely, this research is related to the social and political advances associated with the importance of working with vulnerable populations, reflecting in the development of certain public policies built for adolescents living on the streets, which ensure, in the legal domain, a set of social rights, among them the right to education, health, food, work, housing, leisure, security, social security, protection to motherhood and childhood. Thus, we see the enlargement of social rights and conditions of access to health services, hence the need to create these new policies for adolescents which are focused on their social rights and strategies for the street context in order to recognize them as subjects of rights and allow their voices to be heard and one way to achieve this challenge is by conducting more research with this focus. Therefore, this research considers that actions in the field of prevention and health promotion in nursing, based on the realities of their Social Determinants of Health, are of great importance to conduct a re-signification of health care for adolescents who live in this situation. This research, above all, is established as a social action based on equity, comprehensiveness, and as a political and viable act of transformation and social justice. For this reason, this research aims to provide some nursing actions, based on the street context and the conceptual framework of the DSS for the care of adolescents living on the streets, which will form the basis for developing future policies aimed at adolescents living on the streets.