RISE Study ("Resist, Intervene, Support, Empower"): Addressing the impact of violence among queer women from Brazil
Creators: name: Malta, Monica
Publisher: name: Nature Awards for Inclusive Health Research
Year: 2024
Subjects: classificationCode: 420602
subject: Health equity

description: <b>Abstract</b>Femicide, the intentional killing of women because of their gender, is a pervasive global issue. In Latin America, rates have surged in recent times. Brazil is at the forefront of this troubling trend, with racialized and queer women bearing a disproportionate brunt, highlighting the intersecting layers of discrimination.Despite legislative advancements, elevated rates persist, largely due to survivors’ fear to report—fuelled by fear, dependency on perpetrators, and inadequate prosecution and conviction rates.The criminal justice system grapples with legislative gaps, lax enforcement, and discriminatory practices, eroding trust and perpetuating cycles of under-reporting and impunity. To address these challenges, the Resist, Intervene, Support, Empower (RISE) mobile app was collaboratively developed with members of affected communities, providing survivors with a remote-reporting platform and access to a comprehensive array of support services, including pro-bono legal aid, shelters, childcare, and mental health assistance, available round-the-clock.<b>Introduction</b>Annually, over 50,000 female-identifying persons are killed worldwide due to domestic violence. In 1996, Monica Malta made the courageous decision to leave an abusive husband after a decade of violence. Her journey took another challenging turn when she received a positive HIV/AIDS diagnosis while pregnant that same year. Despite being told she wouldn’t’t survive to raise her child, Malta defied the odds. Since then, her mission has been to stand in solidarity with women facing similar struggles. Malta has worked in many low- and middle-income countries, including her home country of Brazil. Today, as a professor and researcher, her commitment remains unchanged: to amplify survivors’ voices, empower them, and collaboratively develop culturally sensitive interventions tailored to their unique needs. Malta led the development of the patented, freely accessible RISE app with support from the National Institutes of Health (NIH) and several Canadian and Brazilian agencies, including the Brazilian Ministry of Health. Its development involved several grassroots organizations including Brazilian lesbian and transgender associations, with guidance from Duke University experts. Every step, from development to testing and refinement, was undertaken hand-in-hand with individuals with lived and living experiences, ensuring relevance and effectiveness.<b>Who should benefit?</b>Latin America and the Caribbean are regions of stark contradiction when it comes to the safety and rights of marginalized communities, particularly women and sexual and gender minorities (SGMs). Despite being a cradle of vibrant cultures and landscapes, these regions have become synonymous with some of the most alarming statistics on femicide and violence against the SGM community: rates of femicide are ten times higher than the global average, and more than 12 women and girls are killed every day, yet a staggering 98% of cases remain unprosecuted. Brazil is a leading figure in this grim narrative and shoulders over 40% of reported femicides in these regions.Latin America and the Caribbean are also the most treacherous territories for SGM individuals: nearly 75% of all registered murders of transgender and gender-diverse individuals occur here. Since 2009, Brazil has witnessed a third of these tragedies. Lesbian and bisexual women face endemic physical and sexual violence, and the burden is disproportionately borne by racialized persons and those grappling with socioeconomic disparities.Despite strides in recognizing SGMs rights over the past decade, Latin America faces formidable barriers to further progress. Hundreds of hate crimes go unprosecuted amidst pervasive violence and discrimination.The average life expectancy of trans women in the region is a mere 35 years, a damning contrast to the general population’s 80 years. Discrimination and violence plague SGM individuals across settings including schools, workplaces, healthcare facilities, and public spaces. Legal protections can be lacking; familial and communal rejection can compound these struggles; and violent crimes and hate incidents frequently go unreported and unpunished due to distrust between the community and law enforcement, exacerbated by persistent discrimination and harassment perpetrated even by the police.In light of these harrowing realities, we developed a mobile health intervention to combat rampant violence against SGM individuals in Brazil, addressing structural issues that perpetuate underreporting and crime.<b>Engagement</b>To develop the RISE app and address the unique challenges faced by SGM individuals in Brazil, a comprehensive community-based participatory research (CBPR) initiative unfolded between 2019 and 2020. We revised the study in collaboration with key SGM organizations, including the Brazilian Lesbian Articulation (ABL), the Brazilian National LGBTQ+ Association (ABGLT), and the Brazilian National Transgender Association (ANTRA). These collaborations formed the bedrock for the study’s Community Advisory Board (CAB), comprising representatives from our partners alongside other community leaders. Eleven participants from the Brazilian SGM community were included in the CAB, ensuring a wide spectrum of perspectives.Meeting monthly, CAB members engaged in an iterative process with the research team, delving into culturally nuanced recruitment strategies, protocol adaptations, and the interpretation and dissemination of research findings. Grounded in collective reflection and systematic inquiry, our CBPR methodology fostered collaborative efforts between researchers and SGM stakeholders.The CBPR involved collective, reflective, and systematic enquiry in which researchers and SGM community members worked together at all steps. CBPR is a key methodology for bringing about social change and is particularly useful when working with highly marginalized populations.Twenty-two focus-group discussions were conducted with 300 SGM persons from eight Brazilian cities—Belém, Aracaju, Rio de Janeiro, Niterói, Uberlândia, Brasília, Salvador, and São Paulo—which ranged from urban metropolises to harder-to-reach areas. In-depth interviews were also conducted with key informants, including community leaders and professionals providing services for SGM persons experiencing discrimination or violence. The primary objective was to unearth actionable strategies to amplify the reporting of incidents against SGM persons while facilitating access to comprehensive support services.Before the intensive data-gathering phase, the app was meticulously developed and subjected to pilot testing by SGM community members. This cohort provided invaluable feedback, assessing aspects ranging from the clarity of educational content to functionality and user-friendliness. Their insights informed a rigorous review process and led to changes to the user interface, increasing acceptability and efficacy.After the thorough pilot test, further rounds of review and tailoring ensued, culminating in the app’s official launch in December 2019. Community partners, who are recognized as authors or co-authors on all publications, have presented study results locally and internationally, and continue working with our team to develop knowledge dissemination and exchange strategies. For instance, to break the cycle of discrimination, violence, and social exclusion, MicroRainbow International annually organizes entrepreneurship courses for SGMs living in poverty, promoting their socioeconomic inclusion and empowerment in the fight against homo- and transphobia in Brazil.<br><b>Research</b>Our vision was to develop an app empowering SGM individuals to report episodes of discrimination or violence directly, bypassing conventional avenues like police stations which are often viewed as unsafe and bridging the gap between under-reporting and prosecution by facilitating online crime reporting.RISE features a panic button enabling users to swiftly share their location and details with five pre-registered emergency contacts. This has been identified by users as ‘literally life-saving’, and sets our app apart from generic personal safety and violence-prevention apps, as it caters specifically to the needs of SGM individuals.Our initial research phase, bolstered by collaborative engagement with community stakeholders via the CAB, unearthed additional concerns. Local SGM associations highlighted alarmingly high rates of suicide, suicide attempts, depression, anxiety, and post-traumatic stress disorder (PTSD) among SGM persons grappling with the daily onslaught of discrimination and violence. Pervasive experiences of violence and discrimination were reported to contribute to the elevated levels of mental health disorders, often underrecognized and undertreated, among SGM individuals. Responding to this feedback, app users can now access a personalized mental-health screening plan, report instances of violence and discrimination, and receive online support and treatment referrals to services identified as safe places. Those experiencing suicidal ideation or attempts are promptly connected to a 24/7 crisis line for immediate support.RISE is a testament to the power of collaboration between SGM individuals, researchers, and professionals serving this community in Brazil. Its prototype underwent rigorous testing and refinement based on community feedback led by Malta, who is herself a queer woman. Local NGOs and healthcare professionals played indispensable roles in its development and enhancement, contributing crucial expertise and perspectives. With the backing of the Brazilian Ministry of Health, RISE has been scaled up and is making a difference in the lives of SGM individuals across Brazil