Health needs: the interface between the discourse of health professionals and victimized women1

Objective: to understand the limits and the evaluative possibilities of the Family Health Strategy regarding the recognition of the health needs of women who experience violence. Method: a study with a qualitative approach, grounded in the perspective of gender, and which adopted health needs as the analytical category. The data were collected through interviews with health professionals and women who made use of a health service, and were analyzed using the method of discourse analysis. Results: the meeting between the discourses of women who use the services and the professionals of the health service revealed, as the interface, human needs, as in the example of autonomy and of bonds. The understanding regarding the needs was limited to the recognition of health problems of physical and psychological natures, just as the predominance of the recognition of needs for maintaining life in the light of essentially human needs was revealed in the professionals' discourses as an important limitation of the practices. Conclusion: emphasis is placed on the perspective of gender as a tool which must be aggregated to the routine of the professional practices in health so as to confirm or deny the transformative character of the care in place regarding the recognition and confronting of the women's health needs.


Introduction
In Brazil, the Family Health Strategy (ESF) has constituted the cornerstone for the viabilization of the Unified Health System (SUS), facilitating approximation between health professionals and the clientele in their defined areas of coverage, in this way revealing problems which had previously remained unknown by the services, as is the example with gender violence (1) .
In the collective, the strategy represents the most fertile characteristic of the implementation of the practices in collective health in Brazil, being configured as the privileged locus for the recognition of health needs which, articulated with the other instances of the health network, seeks to meet these needs (2) .
In the ambit of women's healthcare, the ESF constitutes a space for implementing the National Policy for Integral Attention to Women's Health (PNAISM).
Healthcare, taking into account gender inequalities, as well as the recognition and confronting of needs which can go beyond those of a biological and reproductive character, considering the specific social characteristcs, are principles which guide the current policy. However, the work processes which concretize these policies have been contradictory, as the practices end up being translated, on most occasions, into attending biological aspects of the female body (3) .
In relation to women's health, female vulnerability when faced with certain health issues is more related to the situation of discrimination in society than to biological factors. The historical and social construction of gender relationships has imputed, to women, poor are closely related to their health needs (4) .
Gender violence, although characterized as a relational phenomenon between men and women, is principally imposed on women, constituting a health issue. It is estimated (5) that this problem is a greater cause of deaths among women aged between 15 and 44 years old than cancer, malaria, traffic accidents and war.
There is, furthermore, a Brazilian estimate that at least 35% of the complaints which women bring to the health services are related to some type of violence (5) .
Women who experience violence present specific health problems and health needs, such that health practices directed towards them must take as a work object the needs generated by life processes which are common to this social group. It is considered that the work for recognizing and meeting the health needs of women who experience violence must presuppose the denaturalization of inequalities between the sexes and promote women's empowerment.
One study undertaken in the Municipality of São Paulo, in 19 primary care services, in which 3,193 women were heard, showed that physical and/or sexual violence from an intimate partner in life was experienced by 45.3% of women, such that one in three women using the health services had already suffered violence in her life (6) . However, violence remains an invisibilized phenomenon as a demand in these services. One study which investigated the professional practices of the ESF directed towards women who experience violence (1) detected that the professionals recognize the importance of embracing the women who bring this demand, but feel themselves to be impotent and afraid of becoming involved with the situation. This importance is reiterated in various other studies focussing on a similar group when they refer to professional attitudes and practices related to gender violence (7)(8) .
In the light of the above, it is argued that in the perspective of a generified practice (9) of health, various possibilities for investigation are found which the universe of the changes in the area of health in the perspective of gender shape. In this study, we emphasize the changes which operate in the ambit of attention to the health needs of women who experience violence in São Paulo.
The present study aimed to understand the limits and evaluative possibilities of the Family Health Strategy in relation to the recognition of health needs of women who experience violence.

Method
This study had a qualitative approach, and was  professional teams, and with 13 women who use the service who had experienced situations of gender violence, selected according to different inclusion criteria: among the health professionals, the inclusion was sought of at least one professional from each category of the five teams which made up the UBS which constituted the study scenario, respecting their interest and availability for participating in the study. Among the women using the service, those were invited who, in the period determined for this specific stage of data collection, were waiting for some form of attendance in the waiting room of the health service. Those who showed interested in participating when they learnt about the study had an interview arranged for a later time. The interviews were held by the researcher individually in an attendance room of the health service, were recorded, and were later transcribed and subject to discourse analysis.
As its theoretical framework, the study adopted the conceptual field of Collective Health, based on the Marxist conception of needs (10)

Results
Based on the analysis of the women's and health professionals' accounts, the emerging themes were First, she needs to stop taking drugs that she uses, and also to improve how she eats (Professional-1).
She has addictions that she can't free herself from because she practically lives inside a crack house (Professional 1).

It is a region where there are lots of criminals and she is
terrified that he will kill her mother.

Discussion
The analysis of the accounts reveals that the Translator's note.
independence and/or work in the public world, and was revealed as a need for women for their transformation and liberation from oppression and violence. This was a convergent aspect with the professionals' discourses.
In revealing a discourse which points to autonomy, the interviewees overcome the understanding of needs for maintaining life, pointing towards essentially human needs, which means an object theme which can broaden, indicating a quality which is revealed in the discourses, although within the limits mentioned above.
Studies demonstrate that the women who experience violence have something more to say besides the complaints which they bring to the health services, that is to say, in the gender relationships, the way male domination tries to impose silence on the women involved in violent relationships, such that, when these seek the health services, they bring an indirect discourse and nearly always speak of other complaints (4,8) . This aspect revealing what the studies have also indicated: the mind-body dichotomy in the health work (3,8,11) . In this way, when a problem is not inscribed on the body or