title: Reactions to institutional violence: patient strategies for facing infringements of the right to health in Brazil.
abstract: In this article we identify evidences of inequalities, prejudices and discrimination in the access and utilization of public health services belonging to the Brazilian Unified Health Care System, considering them to be institutional violence and a negation of rights, in order to look at the reactions of the subjects victimized by this process. This research study utilized different methodologies, articulating participant observation, semi-structured interviews, focus groups and dramatization. The results highlight the trajectory in seeking health care as the main expression of inequalities, strengthened by structural factors such as the precarious condition of health care services, which potentiate power asymmetries, and the presence of discrimination derived from stigmas and prejudices. Most patients' reactions to the situation of institutional violence seek an individual solution to the problem, often reaffirming the conditions that generate rights violations. Few patients' reactions question the systemic conditions that determine the continued discrimination.
authors.affiliation: Psychologist. Doctor in Political Science. Titular teacher, Escola Brasileira de Administração Pública e de Empresas (EBAPE), Fundação Getulio Vargas (FGV). Brasil. sfleury@fgv.br
authors.forename: Sonia
authors.initials: S
authors.lastname: Fleury
authors.affiliation: Social assistant. Master in Public Administration. Assistant Professor, Universidade Federal Fluminense. Brasil.
authors.forename: Valéria
authors.initials: V
authors.lastname: Bicudo
authors.affiliation: Psychologist. Master in Public Policies. Secretaria General, Centro Brasileiro de Estudos de Saúde (CEBES). Brasil.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Rangel
mesh_terms: D001294:Attitude to Health; D001938:Brazil; D017144:Focus Groups; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006779:Hospitals, Public; D006786:Hospitals, Urban; D006801:Humans; D007407:Interviews as Topic; D009313:National Health Programs; D028701:Patient Rights; D011369:Professional-Patient Relations; D063508:Social Discrimination; D014754:Violence
keywords: Healthcare Disparities; Social Discrimination; Professional-Patient Relations; Patient Rights; Brazil