(In)visible victims: stealthing and health consequences for Brazilian women

(In)visible victims: stealthing and health consequences for Brazilian women | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article (In)visible victims: stealthing and health consequences for Brazilian women Wendell Ferrari, Marcos Antonio Ferreira do Nascimento, Liliana Rodrigues, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4308238/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Stealthing refers to the practice in which a man removes a condom without the woman’s consent during sexual intercourse. This article is an investigation that portrays stealthing as an event within the broader framework of the exercise of heterosexual sexuality, intergender power relationships, and contraceptive negotiation between peers. This research aimed to highlight the web of social relationships that engender processes around unprotected sexual intercourse without mutual agreement. In-depth interviews were conducted with ten women who had been victims of stealthing. This article focuses on the sexual, reproductive, and mental health consequences of the act in their lives. The empirical material comprises ten in-depth interviews with women aged 19–58 living in Brazilian urban areas. Data were analyzed using thematic analysis. The complex power relationships established in the couple engender different outcomes: respondents reported a search for post-intercourse emergency contraception, stories of pregnancy, abortion, STIs, the lack of support from professionals and institutions sought, different consequences for their mental health and the challenges of debating stealthing more clearly due to its invisibility in the Brazilian context. Stealthing is a gap in the scientific, legal, and popular literature that needs to be addressed. Taking on the intergender tension on the issue of stealthing, between female autonomy and male responsibility, is a central theme for those researching gender inequality in the field of sexuality in the social sciences and health. Stealthing Sexual violence Consent Sexual and Reproductive Health INTRODUCTION Stealthing refers to condom removal without consent during sexual intercourse in the context of heterosexuality, thus breaking the pre-established agreement (Brodsky, 2017 ). The term is not translated to Portuguese, preventing understanding of this phenomenom in the Brazilian context and non-English-speaking countries (Cabette & Cunha, 2017 ; Muniz, 2020 ). Condom use is a well-known preventive method against Sexually Transmitted Infections (STIs), Human Immunodeficiency Virus (HIV), and pregnancy (WHO, 2018; WHO, 2022). In this context, stealthing can result in STI/HIV transmission or unplanned pregnancy, with significant personal sexual and reproductive health implications (Davus, 2019; Bonar at al, 2021). The term is recent and controversial, and its discussion has been scant in academic literature. American lawyer Alexandra Brodsky is considered the pioneer of these studies when she published the work Rape-Adjacent: Imagining Legal Responses to Nonconsensual Condom Removal in the Columbia Journal of Gender and Law (Brodsky, 2017 ). In her article, Brodsky warned of the existence of several groups and communities on online platforms where men share information on how to remove the condom during sexual intercourse without the woman’s consent. Despite attracting considerable attention from the popular media (Daroya, 2022 ) and a growing increase in scientific works on the event in recent years (Bonar et al, 2021 ; Lévesque & Rousseau, 2021 ; Alam & Alldred, 2021 ; Boadle et al, 2021 ; Bochenski & Zebracki, 2021 ; Grace et al, 2022 ), the scarcity of empirical work on stealthing is a reality at a global level, especially in non-English-speaking countries (Davis, 2019 ). In Brazil, authors (Cebette & Cunha, 2017; Soares, 2017 ; Lima, 2017 ; Nunes & Lehfeld, 2018 ) recognize stealthing as an affront to fundamental rights. They mention that the unconsented removal of condoms bears a strong relationship with gender violence since men are the perpetrators and women are the victims. Thus, men dismiss women’s consent to sexual intercourse, showing disregard and negligence, constituting a form of sexual violence motivated by gender rules (Soares, 2017 ; Nunes & Lehfeld, 2018 ). Only one empirical study on the subject was identified in Brazil (Costa et al, 2022 ). The authors of this work aimed to understand the prevalence of unconsented condom removal and its impact among students – of both sexes – at a public university in the state of São Paulo. Forty-three of the 380 participants in the survey reported that they had been victims of unconsented condom removal, totaling 40 women and three men. In legal terms, no State or federal law addresses this practice in Brazil. However, Bill N° 965/2022 was approved in September 2023 by the Constitution and Justice and Citizenship Committee (CCJC), which provides for the inclusion of the crime of stealthing in the Penal Code, with a penalty of up to four years in prison for those who practice it (Brasil, 2022 ). Therefore, the discussion on condom removal without consent is a gap in the academic and legal literature in the Brazilian context. It is an emerging and necessary debate involving different fields of knowledge, such as the social and human sciences, law, and health field. To help make this issue more visible in Brazil, this study aimed to understand how women who experienced stealthing understand the impacts of this act in their lives. METHODS The research was divided into two parts to delimit stealthing in Brazil and its consequences for the victims’ health. The first is the quantitative stage. From August 2022 to February 2023, an online questionnaire was applied to women from all regions of the country, regardless of their territoriality, class, age, sexual orientation, and schooling, among other social markers of difference, to understand the sociodemographic characterization and the aspects of the stealthing experience. The questionnaire also emphasized the answers’ confidentiality to improve the reliability of the responses to such a delicate and little-studied topic. All the participants agreed to the Informed Consent Form. The Ethics Committee of the University of Porto approved the quantitative research. The universe consisted of 2,275 literate women aged 18–58 living in urban Brazil, all of whom had been victims of stealthing. The second part was in-depth qualitative research. The latter refers to the aim of this article. Ten women who had experienced stealthing and had completed the online questionnaire mentioned above were interviewed. They left their contact details (e-mail and personal telephone number) and were contacted about the possibility of participating in the qualitative interview. The participants live in different regions of the country, and the interviews were held from September 2023 to February 2024. The Research Ethics Committee of the Fernandes Figueira Institute (IFF-Fiocruz) approved the qualitative research. Finally, the narratives were categorized using thematic analysis (Clarke & Braun, 2017 ). According to Table 1 , the interviewed women’s age ranged from 19 to 58. Four women were aged 19–27, four 32–35, and two 41–58. Four respondents self-declared white, four brown, and two Black. Almost all (nine) self-declared heterosexual, and all self-declared cisgender. Half of the respondents professed to be Catholic. Three respondents were from the Southeast, three from the North, two from the Northeast, one from the Midwest, and one from the South of Brazil. Two had no income, four had 1–3 minimum wages, and four had 4–6 minimum wages. All names used in this article are fictitious. Table 1 Sociodemographic characterization Name and age Ethnicity Religion Sexual orientation Gender identity Resided in Income in minimum wages (1) Tainá, 35 years Brown No religion Heterosexual Cisgender Southeast Five (2) Ana, 33 years White Evangelical Bisexual Cisgender Midwest Three (3) Mara, 27 years White No religion Heterosexual Cisgender Southeast Four (4) Isabela, 41 years White Catholic Heterosexual Cisgender Northeast Unemployed (5) Natália, 32 years Black Spiritualist Heterosexual Cisgender Southeast Three (6) Daniela, 33 years Brown Catholic Heterosexual Cisgender North Four (7) Carla, 25 years Brown Catholic Heterosexual Cisgender Northeast Unemployed (8) Sílvia, 23 years Brown Catholic Heterosexual Cisgender North One and a half (9) Teresa, 58 years White Spiritist Heterosexual Cisgender South Six (10) Tamires, 19 years Black Catholic Heterosexual Cisgender North Two Analyzing and discussing the results We listed the following categories to discuss how stealthing occurred in the lives of the respondents and the act’s consequences on their sexual, reproductive, and mental health: 1) The perception of unprotected sex and contract breaching; 2) Stealthing at different times in life and different relationship statuses with the partner; 3) Post-stealthing: the search for prevention prophylaxis and the morning-after pill; 4) Consequences for sexual and reproductive health: pregnancy, abortion, and STIs; 5) Consequences for mental health; 6) The lack of support in institutions and finally; 7) The (in)visibility of the term and the challenge of making violence visible. The perception of unprotected sex and contract breaching We should mention that all the women said that they had agreed to use condoms with their partners. None of them mentioned a supposed use of condoms that did not materialize afterward. Almost all of them demanded that the condom must be used before sexual intercourse began, while others said that their partner had the condom with him and put it on without any resistance. Therefore, there is a lack of respect for the initial agreement between the couple, in which sexual intercourse begins protected and becomes unprotected at some point through the partner’s choice: “When we were kissing, I asked him to put a condom on; he did just fine, and at no point did he complain. I can’t remember exactly how long it was before I noticed, but there was a moment when I realized he hadn’t put it on. I didn’t see it as violence at the time. I came to understand it years later.” (Tainá, 35) “He picked the condom from his drawer. I didn’t even have to ask. It was really quiet. I'm sure he took the condom and put it on him, and in the middle of the intercourse, I realized that he had taken it off without telling me! I didn’t say anything then. I only understood later that he had disrespected me and done something without my consent.” (Ana, 33) “I saw that he put it on, and we agreed he should wear it. It was all agreed! However, in the middle, I saw that he had taken it off, and I noticed. I was shocked! I consented to having sex with him, but I didn’t consent to having sex without a condom!” (Carla, 25). On this topic, some respondents perceived themselves as victims of violence during sexual intercourse, especially when they noticed that it was unprotected. Others, despite realizing that the condom had been removed without consent, did not see themselves as victims at the moment of intercourse but rather after the act had ended. It often takes months or years for them to realize that stealthing has happened and that it is sexual violence against their bodies. Sexual violence is defined as any act or attempt to consummate an unwanted sexual act through coercion, regardless of the victim’s relationship (WHO, 2022). In this context, we affirm that sexual violence occurs during stealthing due to the woman’s lack of consent to remove the condom, which limits and annuls the exercise of her sexual and reproductive rights. However, we understand that the lack of recognition of sexual violence during intercourse by some women may be linked to the continued representation that violence is only limited to physical violence (Brasil, 2023). A porosity of consent is observed as they consented to sexual intercourse but did not consent to remove the condom (Fernandes et al, 2020 ), which casts some “shadows” on autonomy in a sexual relationship consented to by both parties. However, removing condoms without consent is a situation in which the negotiation loses its initial transparency and causes a rupture that must be characterized as illegitimate and violent. Despite the lack of physical violence in cases of stealthing, sexual violence must be identified and named, either by the victim or by health professionals working in public services or education. Stealthing at different times in life and in different relationship statuses with the partner This theme emerges to deconstruct the stigma that a woman who suffers stealthing is probably young, single, transgressive, promiscuous, with several sexual partners, and lacking responsibility for managing her contraception: “I was 17. I lost my virginity to my first boyfriend. He took the condom off in the middle of intercourse without me realizing it! I always trusted him.” (Tamires, 19, dating). “I was 37 when it happened to me. I had agreed with my husband to use a condom because the contraceptive was doing me harm. I never thought I’d have to go through that at that age and with my husband, who I trusted!” (Isabela, 41, married) “I was already old when it happened to me, at 55. Even so, I was cheated on by a guy I’d known for months and trusted! He took the condom off without me realizing it in the middle of intercourse” (Teresa, 58, with a “casual date”). The concept of stigma can be understood in the light of anthropologist Erving Goffman (1963) as a process inherent in the social interaction established by the stigmatized and the stigmatizer through categories such as labeling, social status, deviant, and normal (Goffman, 1980 ). Eight of the women interviewed were in a stable relationship, with partners from their social circle and partners they said they trusted. As this is a heterogeneous universe in terms of age, they show that being a victim of stealthing is independent of age and relationship status, and it is impossible to establish a simplistic cause-effect relationship between stealthing, the victim’s young age, and casual sex with unknown partners. They show that the victim of stealthing is an ordinary woman who works, studies, has a religion, and has different kinds of affective-sexual relationships with varying ages, races, social classes, and territorialities. Conceptual analyses of stigma in health-related situations have attracted the attention of researchers and professionals because it contributes as a hidden burden and influences care effectiveness, becoming a public health problem (Adesse et al, 2016 ). The authors of this article understand the need to include, in public policies, measures to reduce the number of victims of stealthing and greater acceptance of victims after suffering such an act, regardless of the victim’s profile. The efforts of different international and national organizations and institutions are needed to expand access to care services after women suffer from this violence. There is a need to review laws that do not support women who have consented to sexual intercourse but not without a condom and more significant discussion on the subject among health professionals who provide care so that they do not run into multiple moral, judgment, and stigma-based conduct obstacles. Post-stealthing: the search for prevention and the morning-after pill After realizing that unprotected sex had occurred, six respondents sought Emergency Contraception (EC), popularly known as the morning-after pill. The morning-after pill is made up of concentrated doses of synthetic hormones already used in common contraceptive pills based on ethinylestradiol and levonorgestrel. It acts mainly by inhibiting or delaying ovulation and impairs sperm mobility in the uterus and should be taken up to 72 hours after unprotected sex (Vrettakos, 2023 ). Similarly, we mentioned that none of them sought Post-Exposure Prophylaxis (PEP). This prevention technology consists of using ARVs made available by the SUS for 28 days, which should also be started up to 72 hours after possible sexual exposure to HIV (World Health Organization, 2007 ): “I took the morning-after pill for the first time in my life. I never thought I’d have to take it like that. I had a lot of pain, cramps, abdominal pain, and vomiting, and my breasts were super sensitive. It was horrible!” (Carla, 25). “I didn’t go looking for disease prophylaxis. I think a woman’s biggest fear is getting pregnant, to be honest. If I catch any disease, there’s a way around it. I mean, except HIV. However, not a child. It’s desperation not to get pregnant. The thought of having to have an abortion. Then, the STD takes a back seat. I know it’s not right to think like that, but you run after the pill to feel relieved”. (Ana, 33). Six respondents had taken the morning-after pill, and the others reported that they had not sought the emergency pill because their partner had not ejaculated internally. One respondent (9) did not consider taking it because she was past menopause. Despite some difficulties in access (Brandão & Cabral, 2017 ) in Brazil, the morning-after pill has gained significant visibility in the country over the last two decades (WHO, 2021). It can be bought in pharmacies without a prescription, and its dissemination is a step forward in the country regarding health legislation and standards, which allows it to be officially recognized in Brazil as an alternative within the Ministry of Health’s broader family planning policy. It is also used in sexual violence cases (Brasil, 2021 ), which is a positive fact in this research. On the other hand, the lack of PEP-seeking is noteworthy. A brief historical overview of the relationship between HIV and women to discuss the fact that none of the women interviewed sought prophylaxis. At the start of the pandemic in the 1980s, men with homosexual practices and drug users were the groups most heavily affected (Dourado, 2006 ). The first public responses disseminated the idea of the “gay plague” and contributed to creating a symbology associating the disease with specific population groups, then called risk groups (Calazans, 2018 ). Besides stigmatizing homosexuals and drug users, this symbology dissociated HIV/AIDS from women (Brasil, 2014 ). The number of cases among heterosexual women became more widespread only in the mid-1990s and has been called the trend toward a “feminized epidemic” (Brito et al, 2000 ). Women have never been among the priority groups despite the extensive knowledge accumulated about the vulnerability of women to the epidemic in contexts marked by gender inequalities, as in Brazil. Research-based on these references showed that the main challenge for HIV prevention among women was the inequalities produced by the organization of gender relationships (Santos, 2016 ). The data shows that it is imperative to question how social vulnerability and risk groups are interpreted, invalidating other groups that should be considered vulnerable. More attention is still needed on how to interpret the challenges of the response to HIV/AIDS and the adherence of women in seeking prophylaxis after unprotected sex. Human rights-based analyses and their approaches to health must understand the epidemic beyond risk analysis (Ferraz, 2018 ). Consequences for sexual and reproductive health: pregnancy, abortion, and STIs We highlight some of the consequences of stealthing on their lives concerning their sexual and reproductive health. Reports of terminated pregnancies, abortions performed illegally, and Sexually Transmitted Infections (STIs) were mentioned: “A few weeks after it happened, my period was late. I went for a test, and it came back positive for pregnancy. I lost my ground! I got pregnant from a stealthing relationship! I was already 37 and had always wanted to be a mother, so I decided to have my child.” (Isabela, 41). “My period was late. I took the test, and it came back positive for pregnancy. I found myself pregnant at 25 from a stealthing relationship, and he had still blocked me from all social networks! At no point did I think about having this child. I spoke to a doctor friend, and she gave me the contact details of a guy who sold Cytotec. I took the tablets, and in the evening, several blood-red blisters came out in the toilet. It was terrible to see this. Then I took tests, and they came back negative. I did everything practically on my own, with no support from my partner or even the State.” (Daniela, 33). Abortion is illegal in Brazil except in three cases: when the woman’s life is in danger, when the fetus is diagnosed as encephalic, or in rape cases (Brasil, 1940 ). In Brazilian legislation, authors point out that stealthing could be included in Article 215 of the Penal Code and typified as a sexual violation by fraud: “Art. 215. Having carnal conjunction or practicing another libidinous act with someone, through fraud or other means that prevent or hinder the free expression of the victim’s will”, with a penalty of imprisonment of two to six years (Brasil, 1940 ). There is a lack of a specific article in the Brazilian Penal Code to typify the act, thus guaranteeing legal security for the victims of this sexual violence, discussing the preventive nature, and possibly ensuring the right to terminate a pregnancy because of stealthing if the victim so wishes. In Daniela’s case, stealthing brought her closer not only to illegal abortion but also to drug trafficking, which is how she obtained the abortion drug. More debate between stealthing and the right to abortion is essential and cases should be widely publicized to create greater legal and health security for victims of stealthing, given that, according to the ruling, the state should ensure the individual’s rights. The lack of public policies and an ideal structure for safe abortion in cases of stealthing is an actual attack on women’s lives and health, which is without considering that pregnancy resulting from sexual violence penalizes women twice over because besides having her body violated, the victim also runs the risk of not having her legally provided rights effectively guaranteed (Santana, 2023 ). Like unplanned pregnancy, STIs are also transmitted through unprotected sex (WHO, 2021). Considering that stealthing is an unprotected sexual practice, one of its possible consequences is the possibility of contracting an infection of this kind, as was the case with two respondents: “I went for tests and came back positive for syphilis. I’m sure I caught it from him at the time! I’d never had an STD in my life. I felt ashamed, dirty, and angry.” (Daniela, 33). “I got HPV from that relationship. I didn’t need any treatment because it was level 1, but today I have the virus inside me because of it!” (Mara, 27). It is even more necessary to develop education programs on sexuality and the training of professionals involved in several institutions, such as schools and health facilities, reducing vulnerability and promoting access to post-stealth medication, whether it be the morning-after pill or PEP. Addressing this issue as a reality in the affective-sexual trajectory preserves the subject’s autonomy and the exercise of sexual rights. Consequences for mental health In this theme, we highlight some of the consequences regarding their mental health after suffering stealthing. Mental health is a state of well-being in which the individual develops personal skills, copes with stress, and contributes to society. Mental health implies more than the absence of mental illness (Wren-Lewis & Alexandrova, 2021 ). Here are some reports: “It wasn’t just the stealthing. He lied and manipulated me into having sex with him. So, it was sexual and psychological violence. He manipulated me to seduce me. I even went to the psychiatrist to take anxiolytics, which was also the subject of my therapy. So, it’s powerful since what happened to me back then affects me today, especially how I relate to other men” (Mara, 27). “The psychological consequences were the worst. That’s what I needed most. Much more than just taking a drug and having a test. We need a reception that understands that we are going through violence and distress. Violence that exceeds pregnancy and STIs. Psychological issues are involved, and this harms people in future relationships and perhaps for the rest of their lives. Issues of self-esteem, trust, self-confidence, and trusting others. For me, it was psychological violence that affected my mental health. We need to be well received. We’re not just statistics”. (Natália, 32) “I started taking antidepressants and going to therapy because of that episode. I didn’t have sex with anyone for two years, and I’m even more suspicious of everything. I didn’t feel like going out, drinking, or masturbating. I was never the same after that!” (Daniela, 33). Violence is a diffuse, complex, multi-causal event with biological, social, cultural, economic, and political roots, whose definition cannot be limited to a scientific consensus but must also be understood as a subjective issue (World Health Organization, 2002 ). It is clear from the complexity of these reports that stealthing transcends sexual violence. It also reveals psychological violence. Authors (Signorini H,. Brandão E, 2004 ) argue that psychological violence is characterized by mental abuse through emotional manipulation by the perpetrator, affecting the sufferer emotionally and psychologically. Also, due to the lack of materiality of the act, which mainly affects the victim’s emotional field, and the lack of immediate evidence of mistreatment, this type of violence is one of the most difficult to identify (Minayo, 2004 ). Stealthing is a sexual and psychological violence that involves the appropriation of women’s bodies and the violation of their most basic rights. This violence can impact several domains of women’s lives and has a significantly negative influence on their quality of life. The impact of sexual violence on the mental health of victims is more substantial compared to other types of trauma (Dworkin et al, 2017 ). Stealthing had a central impact on the mental health of the respondents, resulting in reduced quality of life with adverse influence on their social and sexual lives. Social support network: the lack of support in institutions The social support network is the set of relationships that a subject perceives as significant in times of stress or situations of violence (Sluzki, 1997 ). In this way, depending on how they are established and their availability and effectiveness in everyday life, social support networks can strengthen protective ties to ensure sexual and reproductive rights and respond better to the complex demands brought about by violence perpetrated against young women (Deslandes, 2004 ). The respondents said: “I called the women’s police station and spoke to a man who answered. He talked to me and said that I could file a police report. However, he said that I would have to undergo a forensic medical examination, go to the hospital and the Legal Medical Institute, take a lot of medication and that it would be hard for me to prove anything. He scared me, discouraged me with so much bureaucracy, and made me ashamed, too” (Natália, 32). “I went to see a lawyer, but she didn’t support me to do anything about it. She said that’s just the way men are. She said the process was going to be very long. She said there was no way of proving it; it was my word against his. She said that there were no marks of violence and no lacerations on any organs. She told me several times that I was wasting my time. I gave up looking for help through the courts. She said it was my fault for trusting that person” (Daniela, 33). “The doctor listened to me with an indifferent face. She said I had to be more careful in choosing my partners. If I continued to stay with men who were partying or drunk, I would already have a sexually transmitted disease or become pregnant. I started crying right there; I felt judged. Someone who could have been receptive didn’t: it wasn’t my choice! The doctor was a woman! I went to ask for tests but ended up with a terrible moral lesson” (Carla, 25). “I told the nurse at the clinic that I started having pains all over again because of the emergency pill, and it was horrible. She judged me. I explained the situation to her, and she said I had to choose my partners better! I retorted by saying it was my husband, and then she said: “If it’s your husband, why are you complaining?” I cried, hating her. I went home crying, feeling even worse after everything I’d been through!” (Sílvia, 23). We can see that despite several uncertainties about stealthing violence, the respondents sought support from professionals and institutions in the legal field (lawyers and women’s police stations) and health fields (nurses, doctors, and health centers). Fragile and with doubts, they again found themselves disrespected and not listened to. Institutional violence against women is a public health challenge. It shows that gender inequality in society is manifested and reflected in the State’s formal structures and the criminal justice system, culminating in the blaming or discrediting of female sexual violence victims (Öhman et al, 2020 ). Sílvia’s statement is an example that illustrates normalized sexual relationships without the woman’s consent, even during marriage. They are socially normalized because they are still fixed in archaic customs, with immense difficulty in believing the sexual violence victim’s word, especially if the perpetrator is her husband (Trentin & Steffens, 2017 ). There is a strong representation that the husband has the “right” to enjoy his wife’s body. It is still believed that the violence employed by the husband does not constitute violence in itself (Noronha, 2002 ). Carla’s statement is also illustrative in this direction. The health service doctor asked a young 20-year-old stealthing victim whether her partner who had practiced stealthing was a “party guy” and if they were drunk in that situation. We can see how health professionals can reproduce culture’s patriarchal and sexist structure, expressing a path that divides and discriminates against allegedly “honest” women, deserving respect and social and legal protection, and the “others,” which can be abandoned for deviating from the standards of behavior imposed by the patriarchy (Machado & Dezanoski, 2013 ), questioning their clothing, alcohol use, and where they were when they met their partner. Stealthing occurred in all cases without the presence of eyewitnesses and in private settings, which prevents us from proving the violence’s materiality and authorship beyond the victim’s testimony (Prado & Nunes, 2016 ). Therefore, institutional violence in questioning women’s discourse can be exercised in hospital care, at the police station, or in the courts, with secondary victimization of the victim by the agencies that should guarantee their protection from sexual violence (Paulo & Roque 2019 ). Institutional violence is a system of selective and unequal social control for women, which exerts its power and affects their lives. Besides sexual violence committed by their partners, women are the victims of institutional violence - a reproduction of social patriarchal violence, reflected in the stance of agents in health and legal institutions, who unveil stereotypes visible in the field of dominant sexual morality (Silva & Andrade, 2019 ). There is a long way to go to stop blaming the victim, who ends up being judged for the sexual violence suffered. The (in)visibility of the term and the challenge of making violence visible Finally, this last category sheds light on the challenge of making stealthing visible in our society, whether from a legal, academic, or popular perspective. We affirm that the event is sexual and psychological violence and should be seen as a public health, public safety, justice, and educational problem, with consequences that affect the sexual, reproductive, and mental health of its victims, delimiting it as a complex situation with a limited discussion known, and therefore (in)visible: “I think I’ve suffered an invisible violence because there’s a lack of information and knowledge. If we knew, we’d do something right away. If I cannot recognize something and that I’m a victim of violence, I’m not going to do anything. It’s disinformation! Then you see stealthing, an English term almost nobody has heard of. There’s no research, nothing about it. It's invisible violence and impossible for us to defend ourselves”. (Tainá, 35) “I didn’t even know stealthing had a name then. This subject must be circulated more on the Internet and in the media. It’s not on people’s lips, and I think it should be. Nobody talks about stealthing. A lack of knowledge, talk, and a receptive attitude shows that this always happens and is not right. It’s a matter of education, knowledge, warning, and making it visible to everyone!” (Carla, 25). “Everyone should know that it exists and has a name, that people know what to do next when they suffer. When a woman suffers violence, she has to know what to do. Women don’t need to feel ashamed or guilty after suffering violence like this. We should talk about it, point it out, discuss it, and bring something out of the darkness that we barely know exists! It’s disrespectful and violent: we need to know about it to care for ourselves and not remain silent.” (Teresa, 58). The respondents show how society does not know about stealthing. None of them knew the term when they suffered such violence. Many of them only learned that the act “had a name” when they received this research, years after the event in their lives, which reveals the term’s invisibility, or as Teresa points out, the gloomy darkness of the lack of knowledge about it. They have critical views of what happened in their lives; they talk about the disrespect, discrimination, domination, shame and guilt, lack of support, doubts, and uncertainties, and the scars that accompany them to this day. They talk about sexuality, the negotiation of condom use, the significant asymmetry of power between genders, and the loneliness of practically not being recognized as victims. We conclude by pointing out the difficulty of treating stealthing as sexual violence precisely because of its invisibility. Despite some growth in empirical research at a global level, specificities in the debates on such violence in Brazil are urgently needed. However, more than a law, it is necessary to create ways to make stealthing visible and debate the fact that such violence exceeds the physical act, affects women’s bodies, and immediately impacts their sexual and mental health with devastating symbolic, material, or psychological consequences. This is the appeal of the women interviewed: stealthing should not be an invisible form of sexual violence. FINAL CONSIDERATIONS In Brazil, stealthing is a challenge that needs to be recognized, made visible, debated, and overcome. This is the first national study on the subject in Brazil. Based on the empirical material, the authors start from the premise that the act is sexual violence against women. The data show that stealthing is a common phenomenon in Brazil. The severity of this violence affects women of all ages, social classes, education levels, races, and women from large urban centers and inland regions, among many other social markers. The consequences of stealthing are not just limited to victims with sexually transmitted infections and unwanted pregnancies. They reported post-stealthing emotional, mental health, sexual, and reproductive outcomes. The aura of silence about stealthing makes its approach more complex, requiring particular local, regional, and national contours. These results provide evidence that stealthing must become an imperative component of public health efforts to ensure visibility regarding the act’s consequences on the sexual, reproductive, and mental health aspects of the victims. Finally, stealthing requires more empirical research and greater conceptual and theoretical attention, especially in the field of sexual and gender-based violence, showing how consensual sexual interactions can involve a breach of consent. In this way, stealthing is not only a punitive and criminal issue but also a public health issue. It needs greater legal, academic, and widespread involvement in Brazil and globally. Specifically, qualitative research could be significant in highlighting emerging analyses on how stealthing could be further discussed, and research with people who perpetuate stealthing could highlight preventive measures. Such an everyday event, with such significant health consequences, needs cross-sectoral efforts to put stealthing on the national and international public health and sexual education agenda. DECLARATIONS Ethics approval and consent to participate This study receveid two references approval: The Ethics Commitee of The University of Porto (CEUP) approved this research by the reference code (Ref.a 2023/04-05b) and by The Research Ethics Committee of the Fernandes Figueira National Institute of Women, Children and Adolescent Health (IFF/Fiocruz), reference code CAAE: 71648723.3.0000.5269. This study complies with the Declaration of Helsinki and was performed according to ethics committee approval Consent for publication All the participants of this study have given consent that ensures that the publisher has the author's permission to publish this research findings. Availability of data and materials All data generated or analysed during this study are included in this published article. Funding Inova-Fiocruz Program Author Contribution W. F: Conceptualization, methodology, validation, investigation, formal analysis, data curation, writing—original draft preparation, writing—review and editing. M. N: Validation, formal analysis, review and editing. L.R: Review, editing and approval of the final manuscript C. N: Review, editing and approval of the final manuscript. All authors have read and agreed to the published version of the manuscript. REFERENCES Brodsky, A. (2017). Rape-Adjacent: Imagining Legal Responses to Nonconsensual Condom Removal. Columbia Journal of Gender and Law. n. 2. p.183-210. Cabette, E. L. S., Cunha, R. S. (2017). Qual o tratamento penal para o “stealthing” no Brasil? Jus Brasil. Disponível em: https://eduardocabette.jusbrasil.com.br/artigos/454526857/qual-o-tratamento-penal-para-o-stealthing-no-brasil. Acesso em: 05 mar. 2021. Muniz, L. M. (2020). Stealthing e a Adequação ao Direito Penal Brasileiro. Âmbito jurídico, [S. l.], p. 1-20, 1 abr. Disponível em: https://ambitojuridico.com.br/cadernos/direito-penal/stealthing-e-a-adequacao-ao-direito-penal-brasileiro/. Acesso em: 10 abril. 2021. World Health Organization (2018). Report on global sexually transmitted infection surveillance, 2018. Available from: https://apps.who.int/iris/bitstream/handle/10665/277258/9789241565691-eng.pdf?ua=1 World Health Organization. (2022). Family Planning: a global handbook for providers: evidence-based guidance developed through worldwide collaboration, 3rd edition. Davis, K. C. (2019). “Stealthing”: Factors associated with young men’s nonconsensual condom removal. Health Psychology, 38(11), 997–1000. Bonar, E. E., Ngo, Q. M., Philyaw-Kotov, M. L., Walton, M. A., Kusunoki, Y. (2021). Stealthing Perpetration and Victimization: Prevalence and Correlates Among Emerging Adults. Journal of interpersonal violence, 36(21-22). Daroya, E. (2022). "I See Nothing Wrong with Stealthing in Anonymous Sexual Situations": Assemblages of Sexual Consent in Gay, Bisexual, and other Queer Men's Accounts of "Stealthing" in an Online Barebacking Forum. Sexuality & Culture 26, 1732–1749. Lévesque, S., Rousseau, C. (2021). Young women’s acknowledgment of reproductive coercion: A qualitative analysis. Journal of Interpersonal Violence, 36(15–16), NP8200– NP8223. https://doi.org/10.1177/0886260519842169 Alam, N., Alldred, P. (2021). Condoms, trust and stealthing: The meanings attributed to unprotected hetero-sex. International Journal of Environmental Research and Public Health, 18(8), 4257. https://doi.org/10.3390/ijerph18084257 Boadle, A., Gierer, C., Buzwell, S. (2021). Young women subjected to nonconsensual condom removal: Prevalence, risk factors, and sexual self-perceptions. Violence Against Women, 27(10), 1969–1715. https://doi.org/10.1177/1077801220947165 Bochenski, M., Zebracki, M. (2021). Stealthing as a form of rape - findings to date and future prospects for research. Problems of Forensic Sciences 2021, vol. 125, 29–50. Doi: 10.4467/12307483PFs.20.003.14783 Grace, K. T., Decker, M. R., Alexander, K. A., Campbell, J., Miller, E., Perrin, N., & Glass, N. (2022). Reproductive coercion, intimate partner violence, and unintended pregnancy among Latina women. Journal of Interpersonal Violence, 37(3–4), 1604–1636. https://doi.org/10.1177/0886260520922363 Nunes, D. H., Lehfeld, L. S. (2018). Stealthing: aspectos acerca da violência de gênero e afronta aos direitos fundamentais. Revista Libertas Direito UFOP; 3(2):93-108. Soares, R. (2017). Retirar o preservativo durante o ato sexual constitui crime? Stealthing analisado à luz do Código Penal Brasileiro [Internet]. JusBrasil [acessado 2020 mar 10]. Disponível em: https://renansoares7127.jusbrasil.com.br/artigos/455520761/retirar-o-preservativo-durante-o-ato-sexual-constitui-crime Lima, J. D de. (2017). Sobre o “stealthing”, a prática de retirar a camisinha durante a relação sem consentimento da parceira [Internet]. [Acessado 2020 mar 10]. Disponível em: https://arquivoradical.wordpress.com/2017/05/09/sobre-o-stealthing-a-pratica-de-retirar-a-camisinha-durante-a-relacao-sem-consentimento-da-parceira Costa, G., K. F., Silva, M. N., Arciprete, A. P. R., Monteiro, J. C. Santos. (2022). Stealthing among university students: associated factors. Revista da Escola de Enfermagem da USP, 56, e20210573. Brasil. Projeto de lei 965/2022, de 29 de setembro de 2022. Altera dispositivos do Decreto-Lei nº 2.848, de 7 de dezembro de 1940 - Código Penal, acrescentando o artigo 215-B, a fim de tipificar o ato de remoção proposital de preservativo, sem o consentimento do parceiro ou da parceira. Diário Oficial da União, Brasília, DF, 29 set, 2022. Clarke, V., Braun, V. Thematic analysis . The Journal of Positive Psychology, 12(3), 297–298, 2017. World Health Organization. (2020). WHO aborda consequências da violência sexual para a saúde das mulheres. Consultado a 25 de Abril de 2020, disponível em: https://nacoesunidas.org/oms-aborda-consequencias-da-violenciasexual-para-saude-das-mulheres Brasil. (2012). Ministério da Saúde Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Prevenção e tratamento dos agravos resultantes da violência sexual contra mulheres e adolescentes: norma técnica (3a ed.). Brasília, DF: Ministério da Saúde. Fernandes, C., Rangel, E., Díaz-Benítez, M. E., Zampiroli, O. (2020). Como porosidades de consentimento. Pensar sobre sentimentos e relações de intimidação. Sexualidad, Salud y Sociedad (Rio de Janeiro), (35), 165–193. https://doi.org/10.1590/1984-6487.sess.2020.35.09.a Goffman, E. Estigma: Notas sobre a Manipulação da Identidade Deteriorada. Rio de Janeiro: Zahar Editores, 1980. Adesse, L., Jannotti, C. B., Silva, K. S. da., Fonseca, V. M.. (2016). Aborto e estigma: uma análise da produção científica sobre a temática. Ciência & Saúde Coletiva, 21(12), 3819–3832. https://doi.org/10.1590/1413-812320152112.07282015 Vrettakos, C., Bajaj, T. (2023). Levonorgestrel. In StatPearls . StatPearls Publishing. World Health Organization. (2007). Post-exposure prophylaxis to prevent HIV infection: joint WHO/ILO guidelines on post-exposure prophylaxis (PEP) to prevent HIV infection. Geneva: World Health Organization. Brandão, E. R., Cabral, C. da S. (2017). Contracepção de emergência no Brasil: desafios para a assistência farmacêutica. Saúde E Sociedade, 26(4), 1087–1092. https://doi.org/10.1590/S0104-12902017000000 World Health Organization (WHO). (2021)Emergency Contraception [Internet]. [acesso em 05 jan 2022]. 9 Nov 2021. Disponível em: https://www.who.int/news-room/fact-sheets/detail/emergency-contraception Brasil. (2021). Ministério da Saúde. Secretaria de Atenção Primária à Saúde. Departamento de Ações Programáticas Estratégicas. Nota Técnica Nº 21/2021-DAPES/SAPS/MS. Disponível em: https://egestorab.saude.gov.br/image/?file=20211029_N_NTDIUenfermagem_5214792097250368643.pdf Dourado, I. Tendência da epidemia de Aids no Brasil após a terapia anti-retroviral. Rev Saúde Pública 2006; 40: 9-17. Calazans, G, J. Políticas públicas de saúde e reconhecimento: um estudo sobre prevenção da infecção pelo HIV para homens que fazem sexo com homens. 2018. Tese (Doutorado em Medicina Preventiva). Faculdade de Medicina, Universidade de São Paulo, São Paulo, 2018. Brasil. Aids: pergunta/ resposta – atualmente, ainda há a distinção entre grupo de risco e grupo de não risco?. Portal da Saúde, 2014. Disponível em: . Acesso em 12/02/2024. Brito, A. M., Castilho, E. A., Scwarcwald, C. L. (2000). AIDS e infecção pelo HIV no Brasil: Uma epidemia multifacetada. Revista da Sociedade Brasileira de Medicina Tropical , 32:207-217. Santos, N. J. S. Mulher e negra: dupla vulnerabilidade as DST/HIV/aids. Saúde soc, 2016; 25(3):602-618. Ferraz, D. A. S. Relatório Final de Estágio do Programa de Cooperação Técnica Brasil-França. Relatório de estágio apresentado ao Departamento de IST, Aids, Hepatites Virais, Ministério da Saúde. Paris, 2018. Brasil. (1940). Código Penal, 1964. Decreto-Lei n° 2.848 de 7 de dezembro de 1940. Disponível em: http://www.planalto.gov.br/ccivil_03/decreto-lei/del2848compilado.htm. Acesso em: 05 jan. 2024. Santana, M. C. T. Stealthing como violência de gênero: os limites do consentimento e a possibilidade jurídica do aborto por analogia in bonam partem. 2023. 36 f. TCC (Graduação) - Curso de Direito, Universidade Federal de Uberlândia, Uberlândia, 2023. Wren-Lewis, S., & Alexandrova, A. (2021). Mental Health Without Well-being. The Journal of medicine and philosophy , 46 (6), 684–703. https://doi.org/10.1093/jmp/jhab032 World Health Organization. (2002). World report on violence and health. Genebra: WHO. Signorini H,. Brandão E. (2004). Psicologia jurídica no Brasil. Rio de Janeiro: Nau. Minayo, M. C. de S. (2004). A difícil e lenta entrada da violência na agenda do setor saúde. Cadernos de Saúde Pública, 20 , 3, 646-647. Dworkin, E. R., Menon, S. V., Bystrynski, J., & Allen, N. E. (2017). Sexual assault victimization and psychopathology: A review and meta-analysis. Clinical psychology review , 56 , 65–81. https://doi.org/10.1016/j.cpr.2017.06.002 Sluzki, C. A rede social na prática sistêmica: Alternativas terapêuticas. São Paulo: Casa do Psicólogo; 1997. Deslandes, SF. Redes de proteção social e redes sociais: uma práxis integradora. In: Violência faz mal à saúde. Brasília: MS; 2004. Öhman, A., Burman, M., Carbin, M. et al. ‘The public health turn on violence against women’: analysing Swedish healthcare law, public health and gender-equality policies. BMC Public Health 20, 753 (2020). https://doi.org/10.1186/s12889-020-08766-7. Trentin, M. C,. Steffens SR. (2017). Violência sexual conjugal: Aspectos históricos, jurídicos e psicanalíticos. Unoesc Ciênc. [Internet];8(2):177-86. Noronha, E. (2002). Direito penal. 26ª. ed. São Paulo: Saraiva. Machado, I. V. Dezanoski, M. (2013). Violências psicológicas na lei penal brasileira: uma discussão sobre a demanda por leis assecuratórias de igualdade, inflação normativa e reconhecimento. In: Morais, C. A., Cardin, V. S. G. Novos direitos e direitos da personalidade. Maringá: Clichetec. Prado, A., Nunes, L. (2016). A vitimização secundária nos casos de estupro: a atualidade da representação da violência de gênero na vida e na obra de Artemisia Gentileschi. Prisma Jurídico, v. 15, n. 2, julho-dezembro, 2016, p. 49-74. Universidade Nove de Julho, São Paulo, Brasil. Paulo, B. G., Roque, A. C. (2019). Vitimização secundária de mulheres em delegacias de polícia: localizando as possíveis causas. Revista Jurídica Luso-Brasileira (1), 361-400. Silva, F., Andrade, M. (2019). A violência institucional contra crianças, adolescentes e suas famílias: contexto histórico e perspectivas para a psicologia brasileira. Revista Mosaico. 2019 Jul./Dez.; 10 (2): SUPLEMENTO 132-137. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4308238","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":298710296,"identity":"3c5c2a6e-20e2-49b9-8bf6-26e59c951e94","order_by":0,"name":"Wendell Ferrari","email":"","orcid":"","institution":"Oswaldo Cruz Foundation","correspondingAuthor":false,"prefix":"","firstName":"Wendell","middleName":"","lastName":"Ferrari","suffix":""},{"id":298710298,"identity":"41708d27-8b73-4563-8d98-f9fab4291271","order_by":1,"name":"Marcos Antonio Ferreira do Nascimento","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDUlEQVRIie3QsUrEMBjA8e8I9Jb0uqaDjyAUCjf5MA2FulQdbnEokkPoLSeuPQT7CvoG0Q86VbpWFPE46BxwPcTQrrlyo0P+QwiBH8kXAJvtvyf7dbr8HjZAjyMMKAbHE+gJiwMYI6ert61Se7j07nH72l5/3nj+biJV9sVL4VbKQOb1eehvcliwNgkwrTvmP8TwUlQLvhSzuDARmTjEFcBFSwEvcmTBx5VEV0T8Fmhoeti86RxC98DLptbkV5N3hJ7kh0irb6EO8CeZaiI0aclA1gdJR/QsjD/3s1Tob9b9LFFYkFlsflgy0T92xh8b3P2kGXreFIlSWXRSru7Q+MtDzHRIRoDNZrPZRvsDBnhokl8x8ZMAAAAASUVORK5CYII=","orcid":"","institution":"Oswaldo Cruz Foundation","correspondingAuthor":true,"prefix":"","firstName":"Marcos","middleName":"Antonio Ferreira do","lastName":"Nascimento","suffix":""},{"id":298710301,"identity":"5ccc7c60-6163-4bcc-8abb-6874066020fb","order_by":2,"name":"Liliana Rodrigues","email":"","orcid":"","institution":"University of Porto","correspondingAuthor":false,"prefix":"","firstName":"Liliana","middleName":"","lastName":"Rodrigues","suffix":""},{"id":298710304,"identity":"d56dc628-32fa-45b0-90b0-4cd3311e435c","order_by":3,"name":"Conceição Nogueira","email":"","orcid":"","institution":"University of Porto","correspondingAuthor":false,"prefix":"","firstName":"Conceição","middleName":"","lastName":"Nogueira","suffix":""}],"badges":[],"createdAt":"2024-04-22 21:54:44","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4308238/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4308238/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":72366804,"identity":"91f88647-b82c-4e55-b10b-890aa703b7f4","added_by":"auto","created_at":"2024-12-26 06:54:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":517774,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4308238/v1/d4a1f18b-cb2f-4bca-bd33-9369c96af30b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"(In)visible victims: stealthing and health consequences for Brazilian women","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eStealthing refers to condom removal without consent during sexual intercourse in the context of heterosexuality, thus breaking the pre-established agreement (Brodsky, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). The term is not translated to Portuguese, preventing understanding of this phenomenom in the Brazilian context and non-English-speaking countries (Cabette \u0026amp; Cunha, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Muniz, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCondom use is a well-known preventive method against Sexually Transmitted Infections (STIs), Human Immunodeficiency Virus (HIV), and pregnancy (WHO, 2018; WHO, 2022). In this context, stealthing can result in STI/HIV transmission or unplanned pregnancy, with significant personal sexual and reproductive health implications (Davus, 2019; Bonar at al, 2021).\u003c/p\u003e \u003cp\u003eThe term is recent and controversial, and its discussion has been scant in academic literature. American lawyer Alexandra Brodsky is considered the pioneer of these studies when she published the work \u003cem\u003eRape-Adjacent: Imagining Legal Responses to Nonconsensual Condom Removal\u003c/em\u003e in the \u003cem\u003eColumbia Journal of Gender and Law\u003c/em\u003e (Brodsky, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). In her article, Brodsky warned of the existence of several groups and communities on online platforms where men share information on how to remove the condom during sexual intercourse without the woman\u0026rsquo;s consent.\u003c/p\u003e \u003cp\u003eDespite attracting considerable attention from the popular media (Daroya, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) and a growing increase in scientific works on the event in recent years (Bonar et al, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; L\u0026eacute;vesque \u0026amp; Rousseau, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Alam \u0026amp; Alldred, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Boadle et al, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Bochenski \u0026amp; Zebracki, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Grace et al, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), the scarcity of empirical work on stealthing is a reality at a global level, especially in non-English-speaking countries (Davis, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Brazil, authors (Cebette \u0026amp; Cunha, 2017; Soares, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Lima, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Nunes \u0026amp; Lehfeld, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) recognize stealthing as an affront to fundamental rights. They mention that the unconsented removal of condoms bears a strong relationship with gender violence since men are the perpetrators and women are the victims. Thus, men dismiss women\u0026rsquo;s consent to sexual intercourse, showing disregard and negligence, constituting a form of sexual violence motivated by gender rules (Soares, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Nunes \u0026amp; Lehfeld, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOnly one empirical study on the subject was identified in Brazil (Costa et al, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The authors of this work aimed to understand the prevalence of unconsented condom removal and its impact among students \u0026ndash; of both sexes \u0026ndash; at a public university in the state of S\u0026atilde;o Paulo. Forty-three of the 380 participants in the survey reported that they had been victims of unconsented condom removal, totaling 40 women and three men.\u003c/p\u003e \u003cp\u003eIn legal terms, no State or federal law addresses this practice in Brazil. However, Bill N\u0026deg; 965/2022 was approved in September 2023 by the Constitution and Justice and Citizenship Committee (CCJC), which provides for the inclusion of the crime of stealthing in the Penal Code, with a penalty of up to four years in prison for those who practice it (Brasil, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Therefore, the discussion on condom removal without consent is a gap in the academic and legal literature in the Brazilian context. It is an emerging and necessary debate involving different fields of knowledge, such as the social and human sciences, law, and health field. To help make this issue more visible in Brazil, this study aimed to understand how women who experienced stealthing understand the impacts of this act in their lives.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThe research was divided into two parts to delimit stealthing in Brazil and its consequences for the victims\u0026rsquo; health. The first is the quantitative stage. From August 2022 to February 2023, an online questionnaire was applied to women from all regions of the country, regardless of their territoriality, class, age, sexual orientation, and schooling, among other social markers of difference, to understand the sociodemographic characterization and the aspects of the stealthing experience.\u003c/p\u003e\n\u003cp\u003eThe questionnaire also emphasized the answers\u0026rsquo; confidentiality to improve the reliability of the responses to such a delicate and little-studied topic. All the participants agreed to the Informed Consent Form. The Ethics Committee of the University of Porto approved the quantitative research. The universe consisted of 2,275 literate women aged 18\u0026ndash;58 living in urban Brazil, all of whom had been victims of stealthing.\u003c/p\u003e\n\u003cp\u003eThe second part was in-depth qualitative research. The latter refers to the aim of this article. Ten women who had experienced stealthing and had completed the online questionnaire mentioned above were interviewed. They left their contact details (e-mail and personal telephone number) and were contacted about the possibility of participating in the qualitative interview. The participants live in different regions of the country, and the interviews were held from September 2023 to February 2024. The Research Ethics Committee of the Fernandes Figueira Institute (IFF-Fiocruz) approved the qualitative research. Finally, the narratives were categorized using thematic analysis (Clarke \u0026amp; Braun, \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eAccording to Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e, the interviewed women\u0026rsquo;s age ranged from 19 to 58. Four women were aged 19\u0026ndash;27, four 32\u0026ndash;35, and two 41\u0026ndash;58. Four respondents self-declared white, four brown, and two Black. Almost all (nine) self-declared heterosexual, and all self-declared cisgender. Half of the respondents professed to be Catholic. Three respondents were from the Southeast, three from the North, two from the Northeast, one from the Midwest, and one from the South of Brazil. Two had no income, four had 1\u0026ndash;3 minimum wages, and four had 4\u0026ndash;6 minimum wages. All names used in this article are fictitious.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eSociodemographic characterization\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eName and age\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eEthnicity\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eReligion\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSexual orientation\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGender identity\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eResided in\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eIncome in minimum wages\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(1) Tain\u0026aacute;, 35 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBrown\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo religion\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHeterosexual\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCisgender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSoutheast\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFive\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(2) Ana, 33 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWhite\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEvangelical\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBisexual\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCisgender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMidwest\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eThree\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(3) Mara, 27 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWhite\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo religion\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHeterosexual\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCisgender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSoutheast\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFour\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(4) Isabela, 41 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWhite\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCatholic\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHeterosexual\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCisgender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNortheast\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUnemployed\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(5) Nat\u0026aacute;lia, 32 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBlack\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSpiritualist\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHeterosexual\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCisgender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSoutheast\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eThree\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(6) Daniela, 33 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBrown\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCatholic\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHeterosexual\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCisgender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNorth\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFour\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(7) Carla, 25 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBrown\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCatholic\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHeterosexual\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCisgender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNortheast\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUnemployed\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(8) S\u0026iacute;lvia, 23 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBrown\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCatholic\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHeterosexual\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCisgender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNorth\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOne and a half\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(9) Teresa, 58 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWhite\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSpiritist\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHeterosexual\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCisgender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSouth\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSix\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(10) Tamires, 19 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBlack\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCatholic\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHeterosexual\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCisgender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNorth\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTwo\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e"},{"header":"Analyzing and discussing the results","content":"\u003cp\u003eWe listed the following categories to discuss how stealthing occurred in the lives of the respondents and the act\u0026rsquo;s consequences on their sexual, reproductive, and mental health: 1) The perception of unprotected sex and contract breaching; 2) Stealthing at different times in life and different relationship statuses with the partner; 3) Post-stealthing: the search for prevention prophylaxis and the morning-after pill; 4) Consequences for sexual and reproductive health: pregnancy, abortion, and STIs; 5) Consequences for mental health; 6) The lack of support in institutions and finally; 7) The (in)visibility of the term and the challenge of making violence visible.\u003c/p\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n\u003ch3\u003eThe perception of unprotected sex and contract breaching\u003c/h3\u003e\n\u003cp\u003eWe should mention that all the women said that they had agreed to use condoms with their partners. None of them mentioned a supposed use of condoms that did not materialize afterward. Almost all of them demanded that the condom must be used before sexual intercourse began, while others said that their partner had the condom with him and put it on without any resistance. Therefore, there is a lack of respect for the initial agreement between the couple, in which sexual intercourse begins protected and becomes unprotected at some point through the partner\u0026rsquo;s choice:\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;When we were kissing, I asked him to put a condom on; he did just fine, and at no point did he complain. I can\u0026rsquo;t remember exactly how long it was before I noticed, but there was a moment when I realized he hadn\u0026rsquo;t put it on. I didn\u0026rsquo;t see it as violence at the time. I came to understand it years later.\u0026rdquo; (Tain\u0026aacute;, 35)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;He picked the condom from his drawer. I didn\u0026rsquo;t even have to ask. It was really quiet. I'm sure he took the condom and put it on him, and in the middle of the intercourse, I realized that he had taken it off without telling me! I didn\u0026rsquo;t say anything then. I only understood later that he had disrespected me and done something without my consent.\u0026rdquo; (Ana, 33)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I saw that he put it on, and we agreed he should wear it. It was all agreed! However, in the middle, I saw that he had taken it off, and I noticed. I was shocked! I consented to having sex with him, but I didn\u0026rsquo;t consent to having sex without a condom!\u0026rdquo; (Carla, 25).\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eOn this topic, some respondents perceived themselves as victims of violence during sexual intercourse, especially when they noticed that it was unprotected. Others, despite realizing that the condom had been removed without consent, did not see themselves as victims at the moment of intercourse but rather after the act had ended. It often takes months or years for them to realize that stealthing has happened and that it is sexual violence against their bodies.\u003c/p\u003e\n\u003cp\u003eSexual violence is defined as any act or attempt to consummate an unwanted sexual act through coercion, regardless of the victim\u0026rsquo;s relationship (WHO, 2022). In this context, we affirm that sexual violence occurs during stealthing due to the woman\u0026rsquo;s lack of consent to remove the condom, which limits and annuls the exercise of her sexual and reproductive rights.\u003c/p\u003e\n\u003cp\u003eHowever, we understand that the lack of recognition of sexual violence during intercourse by some women may be linked to the continued representation that violence is only limited to physical violence (Brasil, 2023). A porosity of consent is observed as they consented to sexual intercourse but did not consent to remove the condom (Fernandes et al, \u003cspan class=\"CitationRef\"\u003e2020\u003c/span\u003e), which casts some \u0026ldquo;shadows\u0026rdquo; on autonomy in a sexual relationship consented to by both parties. However, removing condoms without consent is a situation in which the negotiation loses its initial transparency and causes a rupture that must be characterized as illegitimate and violent. Despite the lack of physical violence in cases of stealthing, sexual violence must be identified and named, either by the victim or by health professionals working in public services or education.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eStealthing at different times in life and in different relationship statuses with the partner\u003c/h3\u003e\n\u003cp\u003eThis theme emerges to deconstruct the stigma that a woman who suffers stealthing is probably young, single, transgressive, promiscuous, with several sexual partners, and lacking responsibility for managing her contraception:\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I was 17. I lost my virginity to my first boyfriend. He took the condom off in the middle of intercourse without me realizing it! I always trusted him.\u0026rdquo; (Tamires, 19, dating).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I was 37 when it happened to me. I had agreed with my husband to use a condom because the contraceptive was doing me harm. I never thought I\u0026rsquo;d have to go through that at that age and with my husband, who I trusted!\u0026rdquo; (Isabela, 41, married)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I was already old when it happened to me, at 55. Even so, I was cheated on by a guy I\u0026rsquo;d known for months and trusted! He took the condom off without me realizing it in the middle of intercourse\u0026rdquo; (Teresa, 58, with a \u0026ldquo;casual date\u0026rdquo;).\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eThe concept of stigma can be understood in the light of anthropologist Erving Goffman (1963) as a process inherent in the social interaction established by the stigmatized and the stigmatizer through categories such as labeling, social status, deviant, and normal (Goffman, \u003cspan class=\"CitationRef\"\u003e1980\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eEight of the women interviewed were in a stable relationship, with partners from their social circle and partners they said they trusted. As this is a heterogeneous universe in terms of age, they show that being a victim of stealthing is independent of age and relationship status, and it is impossible to establish a simplistic cause-effect relationship between stealthing, the victim\u0026rsquo;s young age, and casual sex with unknown partners. They show that the victim of stealthing is an ordinary woman who works, studies, has a religion, and has different kinds of affective-sexual relationships with varying ages, races, social classes, and territorialities.\u003c/p\u003e\n\u003cp\u003eConceptual analyses of stigma in health-related situations have attracted the attention of researchers and professionals because it contributes as a hidden burden and influences care effectiveness, becoming a public health problem (Adesse et al, \u003cspan class=\"CitationRef\"\u003e2016\u003c/span\u003e). The authors of this article understand the need to include, in public policies, measures to reduce the number of victims of stealthing and greater acceptance of victims after suffering such an act, regardless of the victim\u0026rsquo;s profile.\u003c/p\u003e\n\u003cp\u003eThe efforts of different international and national organizations and institutions are needed to expand access to care services after women suffer from this violence. There is a need to review laws that do not support women who have consented to sexual intercourse but not without a condom and more significant discussion on the subject among health professionals who provide care so that they do not run into multiple moral, judgment, and stigma-based conduct obstacles.\u003c/p\u003e\n\u003ch3\u003ePost-stealthing: the search for prevention and the morning-after pill\u003c/h3\u003e\n\u003cp\u003eAfter realizing that unprotected sex had occurred, six respondents sought Emergency Contraception (EC), popularly known as the morning-after pill. The morning-after pill is made up of concentrated doses of synthetic hormones already used in common contraceptive pills based on ethinylestradiol and levonorgestrel. It acts mainly by inhibiting or delaying ovulation and impairs sperm mobility in the uterus and should be taken up to 72 hours after unprotected sex (Vrettakos, \u003cspan class=\"CitationRef\"\u003e2023\u003c/span\u003e). Similarly, we mentioned that none of them sought Post-Exposure Prophylaxis (PEP). This prevention technology consists of using ARVs made available by the SUS for 28 days, which should also be started up to 72 hours after possible sexual exposure to HIV (World Health Organization, \u003cspan class=\"CitationRef\"\u003e2007\u003c/span\u003e):\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I took the morning-after pill for the first time in my life. I never thought I\u0026rsquo;d have to take it like that. I had a lot of pain, cramps, abdominal pain, and vomiting, and my breasts were super sensitive. It was horrible!\u0026rdquo; (Carla, 25).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I didn\u0026rsquo;t go looking for disease prophylaxis. I think a woman\u0026rsquo;s biggest fear is getting pregnant, to be honest. If I catch any disease, there\u0026rsquo;s a way around it. I mean, except HIV. However, not a child. It\u0026rsquo;s desperation not to get pregnant. The thought of having to have an abortion. Then, the STD takes a back seat. I know it\u0026rsquo;s not right to think like that, but you run after the pill to feel relieved\u0026rdquo;. (Ana, 33).\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eSix respondents had taken the morning-after pill, and the others reported that they had not sought the emergency pill because their partner had not ejaculated internally. One respondent (9) did not consider taking it because she was past menopause.\u003c/p\u003e\n\u003cp\u003eDespite some difficulties in access (Brand\u0026atilde;o \u0026amp; Cabral, \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e) in Brazil, the morning-after pill has gained significant visibility in the country over the last two decades (WHO, 2021). It can be bought in pharmacies without a prescription, and its dissemination is a step forward in the country regarding health legislation and standards, which allows it to be officially recognized in Brazil as an alternative within the Ministry of Health\u0026rsquo;s broader family planning policy. It is also used in sexual violence cases (Brasil, \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e), which is a positive fact in this research.\u003c/p\u003e\n\u003cp\u003eOn the other hand, the lack of PEP-seeking is noteworthy. A brief historical overview of the relationship between HIV and women to discuss the fact that none of the women interviewed sought prophylaxis. At the start of the pandemic in the 1980s, men with homosexual practices and drug users were the groups most heavily affected (Dourado, \u003cspan class=\"CitationRef\"\u003e2006\u003c/span\u003e). The first public responses disseminated the idea of the \u0026ldquo;gay plague\u0026rdquo; and contributed to creating a symbology associating the disease with specific population groups, then called risk groups (Calazans, \u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e). Besides stigmatizing homosexuals and drug users, this symbology dissociated HIV/AIDS from women (Brasil, \u003cspan class=\"CitationRef\"\u003e2014\u003c/span\u003e). The number of cases among heterosexual women became more widespread only in the mid-1990s and has been called the trend toward a \u0026ldquo;feminized epidemic\u0026rdquo; (Brito et al, \u003cspan class=\"CitationRef\"\u003e2000\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eWomen have never been among the priority groups despite the extensive knowledge accumulated about the vulnerability of women to the epidemic in contexts marked by gender inequalities, as in Brazil. Research-based on these references showed that the main challenge for HIV prevention among women was the inequalities produced by the organization of gender relationships (Santos, \u003cspan class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe data shows that it is imperative to question how social vulnerability and risk groups are interpreted, invalidating other groups that should be considered vulnerable. More attention is still needed on how to interpret the challenges of the response to HIV/AIDS and the adherence of women in seeking prophylaxis after unprotected sex. Human rights-based analyses and their approaches to health must understand the epidemic beyond risk analysis (Ferraz, \u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eConsequences for sexual and reproductive health: pregnancy, abortion, and STIs\u003c/h3\u003e\n\u003cp\u003eWe highlight some of the consequences of stealthing on their lives concerning their sexual and reproductive health. Reports of terminated pregnancies, abortions performed illegally, and Sexually Transmitted Infections (STIs) were mentioned:\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;A few weeks after it happened, my period was late. I went for a test, and it came back positive for pregnancy. I lost my ground! I got pregnant from a stealthing relationship! I was already 37 and had always wanted to be a mother, so I decided to have my child.\u0026rdquo; (Isabela, 41).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;My period was late. I took the test, and it came back positive for pregnancy. I found myself pregnant at 25 from a stealthing relationship, and he had still blocked me from all social networks! At no point did I think about having this child. I spoke to a doctor friend, and she gave me the contact details of a guy who sold Cytotec. I took the tablets, and in the evening, several blood-red blisters came out in the toilet. It was terrible to see this. Then I took tests, and they came back negative. I did everything practically on my own, with no support from my partner or even the State.\u0026rdquo; (Daniela, 33).\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eAbortion is illegal in Brazil except in three cases: when the woman\u0026rsquo;s life is in danger, when the fetus is diagnosed as encephalic, or in rape cases (Brasil, \u003cspan class=\"CitationRef\"\u003e1940\u003c/span\u003e). In Brazilian legislation, authors point out that stealthing could be included in Article 215 of the Penal Code and typified as a sexual violation by fraud: \u0026ldquo;Art. 215. Having carnal conjunction or practicing another libidinous act with someone, through fraud or other means that prevent or hinder the free expression of the victim\u0026rsquo;s will\u0026rdquo;, with a penalty of imprisonment of two to six years (Brasil, \u003cspan class=\"CitationRef\"\u003e1940\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThere is a lack of a specific article in the Brazilian Penal Code to typify the act, thus guaranteeing legal security for the victims of this sexual violence, discussing the preventive nature, and possibly ensuring the right to terminate a pregnancy because of stealthing if the victim so wishes. In Daniela\u0026rsquo;s case, stealthing brought her closer not only to illegal abortion but also to drug trafficking, which is how she obtained the abortion drug. More debate between stealthing and the right to abortion is essential and cases should be widely publicized to create greater legal and health security for victims of stealthing, given that, according to the ruling, the state should ensure the individual\u0026rsquo;s rights.\u003c/p\u003e\n\u003cp\u003eThe lack of public policies and an ideal structure for safe abortion in cases of stealthing is an actual attack on women\u0026rsquo;s lives and health, which is without considering that pregnancy resulting from sexual violence penalizes women twice over because besides having her body violated, the victim also runs the risk of not having her legally provided rights effectively guaranteed (Santana, \u003cspan class=\"CitationRef\"\u003e2023\u003c/span\u003e). Like unplanned pregnancy, STIs are also transmitted through unprotected sex (WHO, 2021). Considering that stealthing is an unprotected sexual practice, one of its possible consequences is the possibility of contracting an infection of this kind, as was the case with two respondents:\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I went for tests and came back positive for syphilis. I\u0026rsquo;m sure I caught it from him at the time! I\u0026rsquo;d never had an STD in my life. I felt ashamed, dirty, and angry.\u0026rdquo; (Daniela, 33).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I got HPV from that relationship. I didn\u0026rsquo;t need any treatment because it was level 1, but today I have the virus inside me because of it!\u0026rdquo; (Mara, 27).\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eIt is even more necessary to develop education programs on sexuality and the training of professionals involved in several institutions, such as schools and health facilities, reducing vulnerability and promoting access to post-stealth medication, whether it be the morning-after pill or PEP. Addressing this issue as a reality in the affective-sexual trajectory preserves the subject\u0026rsquo;s autonomy and the exercise of sexual rights.\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch3\u003eConsequences for mental health\u003c/h3\u003e\n\u003cp\u003eIn this theme, we highlight some of the consequences regarding their mental health after suffering stealthing. Mental health is a state of well-being in which the individual develops personal skills, copes with stress, and contributes to society. Mental health implies more than the absence of mental illness (Wren-Lewis \u0026amp; Alexandrova, \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e). Here are some reports:\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;It wasn\u0026rsquo;t just the stealthing. He lied and manipulated me into having sex with him. So, it was sexual and psychological violence. He manipulated me to seduce me. I even went to the psychiatrist to take anxiolytics, which was also the subject of my therapy. So, it\u0026rsquo;s powerful since what happened to me back then affects me today, especially how I relate to other men\u0026rdquo; (Mara, 27).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The psychological consequences were the worst. That\u0026rsquo;s what I needed most. Much more than just taking a drug and having a test. We need a reception that understands that we are going through violence and distress. Violence that exceeds pregnancy and STIs. Psychological issues are involved, and this harms people in future relationships and perhaps for the rest of their lives. Issues of self-esteem, trust, self-confidence, and trusting others. For me, it was psychological violence that affected my mental health. We need to be well received. We\u0026rsquo;re not just statistics\u0026rdquo;. (Nat\u0026aacute;lia, 32)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I started taking antidepressants and going to therapy because of that episode. I didn\u0026rsquo;t have sex with anyone for two years, and I\u0026rsquo;m even more suspicious of everything. I didn\u0026rsquo;t feel like going out, drinking, or masturbating. I was never the same after that!\u0026rdquo; (Daniela, 33).\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eViolence is a diffuse, complex, multi-causal event with biological, social, cultural, economic, and political roots, whose definition cannot be limited to a scientific consensus but must also be understood as a subjective issue (World Health Organization, \u003cspan class=\"CitationRef\"\u003e2002\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eIt is clear from the complexity of these reports that stealthing transcends sexual violence. It also reveals psychological violence. Authors (Signorini H,. Brand\u0026atilde;o E, \u003cspan class=\"CitationRef\"\u003e2004\u003c/span\u003e) argue that psychological violence is characterized by mental abuse through emotional manipulation by the perpetrator, affecting the sufferer emotionally and psychologically. Also, due to the lack of materiality of the act, which mainly affects the victim\u0026rsquo;s emotional field, and the lack of immediate evidence of mistreatment, this type of violence is one of the most difficult to identify (Minayo, \u003cspan class=\"CitationRef\"\u003e2004\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eStealthing is a sexual and psychological violence that involves the appropriation of women\u0026rsquo;s bodies and the violation of their most basic rights. This violence can impact several domains of women\u0026rsquo;s lives and has a significantly negative influence on their quality of life. The impact of sexual violence on the mental health of victims is more substantial compared to other types of trauma (Dworkin et al, \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e). Stealthing had a central impact on the mental health of the respondents, resulting in reduced quality of life with adverse influence on their social and sexual lives.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eSocial support network: the lack of support in institutions\u003c/h3\u003e\n\u003cp\u003eThe social support network is the set of relationships that a subject perceives as significant in times of stress or situations of violence (Sluzki, \u003cspan class=\"CitationRef\"\u003e1997\u003c/span\u003e). In this way, depending on how they are established and their availability and effectiveness in everyday life, social support networks can strengthen protective ties to ensure sexual and reproductive rights and respond better to the complex demands brought about by violence perpetrated against young women (Deslandes, \u003cspan class=\"CitationRef\"\u003e2004\u003c/span\u003e). The respondents said:\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I called the women\u0026rsquo;s police station and spoke to a man who answered. He talked to me and said that I could file a police report. However, he said that I would have to undergo a forensic medical examination, go to the hospital and the Legal Medical Institute, take a lot of medication and that it would be hard for me to prove anything. He scared me, discouraged me with so much bureaucracy, and made me ashamed, too\u0026rdquo; (Nat\u0026aacute;lia, 32).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I went to see a lawyer, but she didn\u0026rsquo;t support me to do anything about it. She said that\u0026rsquo;s just the way men are. She said the process was going to be very long. She said there was no way of proving it; it was my word against his. She said that there were no marks of violence and no lacerations on any organs. She told me several times that I was wasting my time. I gave up looking for help through the courts. She said it was my fault for trusting that person\u0026rdquo; (Daniela, 33).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The doctor listened to me with an indifferent face. She said I had to be more careful in choosing my partners. If I continued to stay with men who were partying or drunk, I would already have a sexually transmitted disease or become pregnant. I started crying right there; I felt judged. Someone who could have been receptive didn\u0026rsquo;t: it wasn\u0026rsquo;t my choice! The doctor was a woman! I went to ask for tests but ended up with a terrible moral lesson\u0026rdquo; (Carla, 25).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I told the nurse at the clinic that I started having pains all over again because of the emergency pill, and it was horrible. She judged me. I explained the situation to her, and she said I had to choose my partners better! I retorted by saying it was my husband, and then she said: \u0026ldquo;If it\u0026rsquo;s your husband, why are you complaining?\u0026rdquo; I cried, hating her. I went home crying, feeling even worse after everything I\u0026rsquo;d been through!\u0026rdquo; (S\u0026iacute;lvia, 23).\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eWe can see that despite several uncertainties about stealthing violence, the respondents sought support from professionals and institutions in the legal field (lawyers and women\u0026rsquo;s police stations) and health fields (nurses, doctors, and health centers). Fragile and with doubts, they again found themselves disrespected and not listened to.\u003c/p\u003e\n\u003cp\u003eInstitutional violence against women is a public health challenge. It shows that gender inequality in society is manifested and reflected in the State\u0026rsquo;s formal structures and the criminal justice system, culminating in the blaming or discrediting of female sexual violence victims (\u0026Ouml;hman et al, \u003cspan class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eS\u0026iacute;lvia\u0026rsquo;s statement is an example that illustrates normalized sexual relationships without the woman\u0026rsquo;s consent, even during marriage. They are socially normalized because they are still fixed in archaic customs, with immense difficulty in believing the sexual violence victim\u0026rsquo;s word, especially if the perpetrator is her husband (Trentin \u0026amp; Steffens, \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e). There is a strong representation that the husband has the \u0026ldquo;right\u0026rdquo; to enjoy his wife\u0026rsquo;s body. It is still believed that the violence employed by the husband does not constitute violence in itself (Noronha, \u003cspan class=\"CitationRef\"\u003e2002\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eCarla\u0026rsquo;s statement is also illustrative in this direction. The health service doctor asked a young 20-year-old stealthing victim whether her partner who had practiced stealthing was a \u0026ldquo;party guy\u0026rdquo; and if they were drunk in that situation. We can see how health professionals can reproduce culture\u0026rsquo;s patriarchal and sexist structure, expressing a path that divides and discriminates against allegedly \u0026ldquo;honest\u0026rdquo; women, deserving respect and social and legal protection, and the \u0026ldquo;others,\u0026rdquo; which can be abandoned for deviating from the standards of behavior imposed by the patriarchy (Machado \u0026amp; Dezanoski, \u003cspan class=\"CitationRef\"\u003e2013\u003c/span\u003e), questioning their clothing, alcohol use, and where they were when they met their partner.\u003c/p\u003e\n\u003cp\u003eStealthing occurred in all cases without the presence of eyewitnesses and in private settings, which prevents us from proving the violence\u0026rsquo;s materiality and authorship beyond the victim\u0026rsquo;s testimony (Prado \u0026amp; Nunes, \u003cspan class=\"CitationRef\"\u003e2016\u003c/span\u003e). Therefore, institutional violence in questioning women\u0026rsquo;s discourse can be exercised in hospital care, at the police station, or in the courts, with secondary victimization of the victim by the agencies that should guarantee their protection from sexual violence (Paulo \u0026amp; Roque \u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eInstitutional violence is a system of selective and unequal social control for women, which exerts its power and affects their lives. Besides sexual violence committed by their partners, women are the victims of institutional violence - a reproduction of social patriarchal violence, reflected in the stance of agents in health and legal institutions, who unveil stereotypes visible in the field of dominant sexual morality (Silva \u0026amp; Andrade, \u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e). There is a long way to go to stop blaming the victim, who ends up being judged for the sexual violence suffered.\u003c/p\u003e\n\u003ch3\u003eThe (in)visibility of the term and the challenge of making violence visible\u003c/h3\u003e\n\u003cp\u003eFinally, this last category sheds light on the challenge of making stealthing visible in our society, whether from a legal, academic, or popular perspective. We affirm that the event is sexual and psychological violence and should be seen as a public health, public safety, justice, and educational problem, with consequences that affect the sexual, reproductive, and mental health of its victims, delimiting it as a complex situation with a limited discussion known, and therefore (in)visible:\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I think I\u0026rsquo;ve suffered an invisible violence because there\u0026rsquo;s a lack of information and knowledge. If we knew, we\u0026rsquo;d do something right away. If I cannot recognize something and that I\u0026rsquo;m a victim of violence, I\u0026rsquo;m not going to do anything. It\u0026rsquo;s disinformation! Then you see stealthing, an English term almost nobody has heard of. There\u0026rsquo;s no research, nothing about it. It's invisible violence and impossible for us to defend ourselves\u0026rdquo;. (Tain\u0026aacute;, 35)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I didn\u0026rsquo;t even know stealthing had a name then. This subject must be circulated more on the Internet and in the media. It\u0026rsquo;s not on people\u0026rsquo;s lips, and I think it should be. Nobody talks about stealthing. A lack of knowledge, talk, and a receptive attitude shows that this always happens and is not right. It\u0026rsquo;s a matter of education, knowledge, warning, and making it visible to everyone!\u0026rdquo; (Carla, 25).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Everyone should know that it exists and has a name, that people know what to do next when they suffer. When a woman suffers violence, she has to know what to do. Women don\u0026rsquo;t need to feel ashamed or guilty after suffering violence like this. We should talk about it, point it out, discuss it, and bring something out of the darkness that we barely know exists! It\u0026rsquo;s disrespectful and violent: we need to know about it to care for ourselves and not remain silent.\u0026rdquo; (Teresa, 58).\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eThe respondents show how society does not know about stealthing. None of them knew the term when they suffered such violence. Many of them only learned that the act \u0026ldquo;had a name\u0026rdquo; when they received this research, years after the event in their lives, which reveals the term\u0026rsquo;s invisibility, or as Teresa points out, the gloomy darkness of the lack of knowledge about it. They have critical views of what happened in their lives; they talk about the disrespect, discrimination, domination, shame and guilt, lack of support, doubts, and uncertainties, and the scars that accompany them to this day. They talk about sexuality, the negotiation of condom use, the significant asymmetry of power between genders, and the loneliness of practically not being recognized as victims.\u003c/p\u003e\n\u003cp\u003eWe conclude by pointing out the difficulty of treating stealthing as sexual violence precisely because of its invisibility. Despite some growth in empirical research at a global level, specificities in the debates on such violence in Brazil are urgently needed. However, more than a law, it is necessary to create ways to make stealthing visible and debate the fact that such violence exceeds the physical act, affects women\u0026rsquo;s bodies, and immediately impacts their sexual and mental health with devastating symbolic, material, or psychological consequences. This is the appeal of the women interviewed: stealthing should not be an invisible form of sexual violence.\u003c/p\u003e"},{"header":"FINAL CONSIDERATIONS","content":"\u003cp\u003eIn Brazil, stealthing is a challenge that needs to be recognized, made visible, debated, and overcome. This is the first national study on the subject in Brazil. Based on the empirical material, the authors start from the premise that the act is sexual violence against women. The data show that stealthing is a common phenomenon in Brazil.\u003c/p\u003e\n\u003cp\u003eThe severity of this violence affects women of all ages, social classes, education levels, races, and women from large urban centers and inland regions, among many other social markers. The consequences of stealthing are not just limited to victims with sexually transmitted infections and unwanted pregnancies. They reported post-stealthing emotional, mental health, sexual, and reproductive outcomes. The aura of silence about stealthing makes its approach more complex, requiring particular local, regional, and national contours.\u003c/p\u003e\n\u003cp\u003eThese results provide evidence that stealthing must become an imperative component of public health efforts to ensure visibility regarding the act\u0026rsquo;s consequences on the sexual, reproductive, and mental health aspects of the victims.\u003c/p\u003e\n\u003cp\u003eFinally, stealthing requires more empirical research and greater conceptual and theoretical attention, especially in the field of sexual and gender-based violence, showing how consensual sexual interactions can involve a breach of consent. In this way, stealthing is not only a punitive and criminal issue but also a public health issue. It needs greater legal, academic, and widespread involvement in Brazil and globally.\u003c/p\u003e\n\u003cp\u003eSpecifically, qualitative research could be significant in highlighting emerging analyses on how stealthing could be further discussed, and research with people who perpetuate stealthing could highlight preventive measures. Such an everyday event, with such significant health consequences, needs cross-sectoral efforts to put stealthing on the national and international public health and sexual education agenda.\u003c/p\u003e"},{"header":"DECLARATIONS","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eThis study receveid two references approval: The Ethics Commitee of The University of Porto (CEUP) approved this research by the reference code (Ref.a 2023/04-05b) and by The Research Ethics Committee of the Fernandes Figueira National Institute of Women, Children and Adolescent Health (IFF/Fiocruz), reference code CAAE: 71648723.3.0000.5269. This study complies with the Declaration of Helsinki and was performed according to ethics committee approval\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eAll the participants of this study have given consent that ensures that the publisher has the author\u0026apos;s permission to publish this research findings.\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eInova-Fiocruz Program\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eW. F: Conceptualization, methodology, validation, investigation, formal analysis, data curation, writing\u0026mdash;original draft preparation, writing\u0026mdash;review and editing. M. N: Validation, formal analysis, review and editing. L.R: Review, editing and approval of the final manuscript C. N: Review, editing and approval of the final manuscript. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e"},{"header":"REFERENCES","content":"\u003col\u003e\n\u003cli\u003eBrodsky, A. (2017). Rape-Adjacent: Imagining Legal Responses to Nonconsensual Condom Removal. Columbia Journal of Gender and Law. n. 2. p.183-210.\u003c/li\u003e\n\u003cli\u003eCabette, E. L. S., Cunha, R. S. (2017). Qual o tratamento penal para o \u0026ldquo;stealthing\u0026rdquo; no Brasil? Jus Brasil. Dispon\u0026iacute;vel em: https://eduardocabette.jusbrasil.com.br/artigos/454526857/qual-o-tratamento-penal-para-o-stealthing-no-brasil. Acesso em: 05 mar. 2021.\u003c/li\u003e\n\u003cli\u003eMuniz, L. M. (2020). Stealthing e a Adequa\u0026ccedil;\u0026atilde;o ao Direito Penal Brasileiro. \u0026Acirc;mbito jur\u0026iacute;dico, [S. l.], p. 1-20, 1 abr. Dispon\u0026iacute;vel em: https://ambitojuridico.com.br/cadernos/direito-penal/stealthing-e-a-adequacao-ao-direito-penal-brasileiro/. Acesso em: 10 abril. 2021.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization (2018). Report on global sexually transmitted infection surveillance, 2018. Available from: https://apps.who.int/iris/bitstream/handle/10665/277258/9789241565691-eng.pdf?ua=1\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. (2022). Family Planning: a global handbook for providers: evidence-based guidance developed through worldwide collaboration, 3rd edition. \u003c/li\u003e\n\u003cli\u003eDavis, K. C. (2019). \u0026ldquo;Stealthing\u0026rdquo;: Factors associated with young men\u0026rsquo;s nonconsensual condom removal. Health Psychology, 38(11), 997\u0026ndash;1000.\u003c/li\u003e\n\u003cli\u003eBonar, E. E., Ngo, Q. M., Philyaw-Kotov, M. L., Walton, M. A., Kusunoki, Y. (2021). Stealthing Perpetration and Victimization: Prevalence and Correlates Among Emerging Adults. Journal of interpersonal violence, 36(21-22).\u003c/li\u003e\n\u003cli\u003eDaroya, E. (2022). \u0026quot;I See Nothing Wrong with Stealthing in Anonymous Sexual Situations\u0026quot;: Assemblages of Sexual Consent in Gay, Bisexual, and other Queer Men\u0026apos;s Accounts of \u0026quot;Stealthing\u0026quot; in an Online Barebacking Forum. Sexuality \u0026amp; Culture 26, 1732\u0026ndash;1749.\u003c/li\u003e\n\u003cli\u003eL\u0026eacute;vesque, S., Rousseau, C. (2021). Young women\u0026rsquo;s acknowledgment of reproductive coercion: A qualitative analysis. Journal of Interpersonal Violence, 36(15\u0026ndash;16), NP8200\u0026ndash; NP8223. https://doi.org/10.1177/0886260519842169\u003c/li\u003e\n\u003cli\u003eAlam, N., Alldred, P. (2021). Condoms, trust and stealthing: The meanings attributed to unprotected hetero-sex. International Journal of Environmental Research and Public Health, 18(8), 4257. https://doi.org/10.3390/ijerph18084257\u003c/li\u003e\n\u003cli\u003eBoadle, A., Gierer, C., Buzwell, S. (2021). Young women subjected to nonconsensual condom removal: Prevalence, risk factors, and sexual self-perceptions. Violence Against Women, 27(10), 1969\u0026ndash;1715. https://doi.org/10.1177/1077801220947165\u003c/li\u003e\n\u003cli\u003eBochenski, M., Zebracki, M. (2021). Stealthing as a form of rape - findings to date and future prospects for research. Problems of Forensic Sciences 2021, vol. 125, 29\u0026ndash;50. Doi: 10.4467/12307483PFs.20.003.14783\u003c/li\u003e\n\u003cli\u003eGrace, K. T., Decker, M. R., Alexander, K. A., Campbell, J., Miller, E., Perrin, N., \u0026amp; Glass, N. (2022). Reproductive coercion, intimate partner violence, and unintended pregnancy among Latina women. Journal of Interpersonal Violence, 37(3\u0026ndash;4), 1604\u0026ndash;1636. https://doi.org/10.1177/0886260520922363\u003c/li\u003e\n\u003cli\u003eNunes, D. H., Lehfeld, L. S. (2018). Stealthing: aspectos acerca da viol\u0026ecirc;ncia de g\u0026ecirc;nero e afronta aos direitos fundamentais. Revista Libertas Direito UFOP; 3(2):93-108.\u003c/li\u003e\n\u003cli\u003eSoares, R. (2017). \u003cem\u003eRetirar o preservativo durante o ato sexual constitui crime? Stealthing analisado \u0026agrave; luz do C\u0026oacute;digo Penal Brasileiro\u003c/em\u003e [Internet]. JusBrasil [acessado 2020 mar 10]. Dispon\u0026iacute;vel em: https://renansoares7127.jusbrasil.com.br/artigos/455520761/retirar-o-preservativo-durante-o-ato-sexual-constitui-crime\u003c/li\u003e\n\u003cli\u003eLima, J. D de. (2017). Sobre o \u0026ldquo;stealthing\u0026rdquo;, a pr\u0026aacute;tica de retirar a camisinha durante a rela\u0026ccedil;\u0026atilde;o sem consentimento da parceira [Internet]. [Acessado 2020 mar 10]. Dispon\u0026iacute;vel em: https://arquivoradical.wordpress.com/2017/05/09/sobre-o-stealthing-a-pratica-de-retirar-a-camisinha-durante-a-relacao-sem-consentimento-da-parceira\u003c/li\u003e\n\u003cli\u003eCosta, G., K. F., Silva, M. N., Arciprete, A. P. R., Monteiro, J. C. Santos. (2022). Stealthing among university students: associated factors. Revista da Escola de Enfermagem da USP, 56, e20210573. \u003c/li\u003e\n\u003cli\u003eBrasil. Projeto de lei 965/2022, de 29 de setembro de 2022. Altera dispositivos do Decreto-Lei n\u0026ordm; 2.848, de 7 de dezembro de 1940 - C\u0026oacute;digo Penal, acrescentando o artigo 215-B, a fim de tipificar o ato de remo\u0026ccedil;\u0026atilde;o proposital de preservativo, sem o consentimento do parceiro ou da parceira. Di\u0026aacute;rio Oficial da Uni\u0026atilde;o, Bras\u0026iacute;lia, DF, 29 set, 2022.\u003c/li\u003e\n\u003cli\u003eClarke, V., Braun, V. Thematic analysis\u003cstrong\u003e. \u003c/strong\u003eThe Journal of Positive Psychology, 12(3), 297\u0026ndash;298, 2017.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. (2020). WHO aborda consequ\u0026ecirc;ncias da viol\u0026ecirc;ncia sexual para a sa\u0026uacute;de das mulheres. Consultado a 25 de Abril de 2020, dispon\u0026iacute;vel em: https://nacoesunidas.org/oms-aborda-consequencias-da-violenciasexual-para-saude-das-mulheres\u003c/li\u003e\n\u003cli\u003eBrasil. (2012). Minist\u0026eacute;rio da Sa\u0026uacute;de Secretaria de Aten\u0026ccedil;\u0026atilde;o \u0026agrave; Sa\u0026uacute;de. Departamento de A\u0026ccedil;\u0026otilde;es Program\u0026aacute;ticas Estrat\u0026eacute;gicas. Preven\u0026ccedil;\u0026atilde;o e tratamento dos agravos resultantes da viol\u0026ecirc;ncia sexual contra mulheres e adolescentes: norma t\u0026eacute;cnica (3a ed.). Bras\u0026iacute;lia, DF: Minist\u0026eacute;rio da Sa\u0026uacute;de. \u003c/li\u003e\n\u003cli\u003eFernandes, C., Rangel, E., D\u0026iacute;az-Ben\u0026iacute;tez, M. E., Zampiroli, O. (2020). Como porosidades de consentimento. Pensar sobre sentimentos e rela\u0026ccedil;\u0026otilde;es de intimida\u0026ccedil;\u0026atilde;o. Sexualidad, Salud y Sociedad (Rio de Janeiro), (35), 165\u0026ndash;193. https://doi.org/10.1590/1984-6487.sess.2020.35.09.a\u003c/li\u003e\n\u003cli\u003eGoffman, E. Estigma: Notas sobre a Manipula\u0026ccedil;\u0026atilde;o da Identidade Deteriorada. Rio de Janeiro: Zahar Editores, 1980. \u003c/li\u003e\n\u003cli\u003eAdesse, L., Jannotti, C. B., Silva, K. S. da., Fonseca, V. M.. (2016). Aborto e estigma: uma an\u0026aacute;lise da produ\u0026ccedil;\u0026atilde;o cient\u0026iacute;fica sobre a tem\u0026aacute;tica. Ci\u0026ecirc;ncia \u0026amp; Sa\u0026uacute;de Coletiva, 21(12), 3819\u0026ndash;3832. https://doi.org/10.1590/1413-812320152112.07282015\u003c/li\u003e\n\u003cli\u003eVrettakos, C., Bajaj, T. (2023). Levonorgestrel. In \u003cem\u003eStatPearls\u003c/em\u003e. StatPearls Publishing.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. (2007). Post-exposure prophylaxis to prevent HIV infection: joint WHO/ILO guidelines on post-exposure prophylaxis (PEP) to prevent HIV infection. Geneva: World Health Organization.\u003c/li\u003e\n\u003cli\u003eBrand\u0026atilde;o, E. R., Cabral, C. da S. (2017). Contracep\u0026ccedil;\u0026atilde;o de emerg\u0026ecirc;ncia no Brasil: desafios para a assist\u0026ecirc;ncia farmac\u0026ecirc;utica. Sa\u0026uacute;de E Sociedade, 26(4), 1087\u0026ndash;1092. https://doi.org/10.1590/S0104-12902017000000\u003c/li\u003e\n\u003cli\u003eWorld Health Organization (WHO). (2021)Emergency Contraception [Internet]. [acesso em 05 jan 2022]. 9 Nov 2021. Dispon\u0026iacute;vel em: https://www.who.int/news-room/fact-sheets/detail/emergency-contraception\u003c/li\u003e\n\u003cli\u003eBrasil. (2021). Minist\u0026eacute;rio da Sa\u0026uacute;de. Secretaria de Aten\u0026ccedil;\u0026atilde;o Prim\u0026aacute;ria \u0026agrave; Sa\u0026uacute;de. Departamento de A\u0026ccedil;\u0026otilde;es Program\u0026aacute;ticas Estrat\u0026eacute;gicas. Nota T\u0026eacute;cnica N\u0026ordm; 21/2021-DAPES/SAPS/MS. Dispon\u0026iacute;vel em: https://egestorab.saude.gov.br/image/?file=20211029_N_NTDIUenfermagem_5214792097250368643.pdf\u003c/li\u003e\n\u003cli\u003eDourado, I. Tend\u0026ecirc;ncia da epidemia de Aids no Brasil ap\u0026oacute;s a terapia anti-retroviral. Rev Sa\u0026uacute;de P\u0026uacute;blica 2006; 40: 9-17. \u003c/li\u003e\n\u003cli\u003eCalazans, G, J. Pol\u0026iacute;ticas p\u0026uacute;blicas de sa\u0026uacute;de e reconhecimento: um estudo sobre preven\u0026ccedil;\u0026atilde;o da infec\u0026ccedil;\u0026atilde;o pelo HIV para homens que fazem sexo com homens. 2018. Tese (Doutorado em Medicina Preventiva). Faculdade de Medicina, Universidade de S\u0026atilde;o Paulo, S\u0026atilde;o Paulo, 2018.\u003c/li\u003e\n\u003cli\u003eBrasil. Aids: pergunta/ resposta \u0026ndash; atualmente, ainda h\u0026aacute; a distin\u0026ccedil;\u0026atilde;o entre grupo de risco e grupo de n\u0026atilde;o risco?. Portal da Sa\u0026uacute;de, 2014. Dispon\u0026iacute;vel em: \u0026lt;http://portalsaude.saude.gov.br/index.php/links-de-interesse/286-aids/9048-atualmente-ainda-haa-distincao-entre-grupo-de-risco-e-grupo-de-naorisco\u0026gt;. Acesso em 12/02/2024.\u003c/li\u003e\n\u003cli\u003eBrito, A. M., Castilho, E. A., Scwarcwald, C. L. (2000). AIDS e infec\u0026ccedil;\u0026atilde;o pelo HIV no Brasil: Uma epidemia multifacetada. \u003cem\u003eRevista da Sociedade Brasileira de Medicina Tropical\u003c/em\u003e, 32:207-217. \u003c/li\u003e\n\u003cli\u003eSantos, N. J. S. Mulher e negra: dupla vulnerabilidade as DST/HIV/aids. Sa\u0026uacute;de soc, 2016; 25(3):602-618.\u003c/li\u003e\n\u003cli\u003eFerraz, D. A. S. Relat\u0026oacute;rio Final de Est\u0026aacute;gio do Programa de Coopera\u0026ccedil;\u0026atilde;o T\u0026eacute;cnica Brasil-Fran\u0026ccedil;a. Relat\u0026oacute;rio de est\u0026aacute;gio apresentado ao Departamento de IST, Aids, Hepatites Virais, Minist\u0026eacute;rio da Sa\u0026uacute;de. Paris, 2018.\u003c/li\u003e\n\u003cli\u003eBrasil. (1940). C\u0026oacute;digo Penal, 1964. Decreto-Lei n\u0026deg; 2.848 de 7 de dezembro de 1940. Dispon\u0026iacute;vel em: http://www.planalto.gov.br/ccivil_03/decreto-lei/del2848compilado.htm. Acesso em: 05 jan. 2024.\u003c/li\u003e\n\u003cli\u003eSantana, M. C. T. Stealthing como viol\u0026ecirc;ncia de g\u0026ecirc;nero: os limites do consentimento e a possibilidade jur\u0026iacute;dica do aborto por analogia in bonam partem. 2023. 36 f. TCC (Gradua\u0026ccedil;\u0026atilde;o) - Curso de Direito, Universidade Federal de Uberl\u0026acirc;ndia, Uberl\u0026acirc;ndia, 2023.\u003c/li\u003e\n\u003cli\u003eWren-Lewis, S., \u0026amp; Alexandrova, A. (2021). Mental Health Without Well-being. \u003cem\u003eThe Journal of medicine and philosophy\u003c/em\u003e, \u003cem\u003e46\u003c/em\u003e(6), 684\u0026ndash;703. https://doi.org/10.1093/jmp/jhab032\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. (2002). World report on violence and health. Genebra: WHO.\u003c/li\u003e\n\u003cli\u003eSignorini H,. Brand\u0026atilde;o E. (2004). Psicologia jur\u0026iacute;dica no Brasil. Rio de Janeiro: Nau.\u003c/li\u003e\n\u003cli\u003eMinayo, M. C. de S. (2004). A dif\u0026iacute;cil e lenta entrada da viol\u0026ecirc;ncia na agenda do setor sa\u0026uacute;de. \u003cem\u003eCadernos de Sa\u0026uacute;de P\u0026uacute;blica, 20\u003c/em\u003e, 3, 646-647. \u003c/li\u003e\n\u003cli\u003eDworkin, E. R., Menon, S. V., Bystrynski, J., \u0026amp; Allen, N. E. (2017). Sexual assault victimization and psychopathology: A review and meta-analysis. \u003cem\u003eClinical psychology review\u003c/em\u003e, \u003cem\u003e56\u003c/em\u003e, 65\u0026ndash;81. https://doi.org/10.1016/j.cpr.2017.06.002\u003c/li\u003e\n\u003cli\u003eSluzki, C. A rede social na pr\u0026aacute;tica sist\u0026ecirc;mica: Alternativas terap\u0026ecirc;uticas. S\u0026atilde;o Paulo: Casa do Psic\u0026oacute;logo; 1997. \u003c/li\u003e\n\u003cli\u003eDeslandes, SF. Redes de prote\u0026ccedil;\u0026atilde;o social e redes sociais: uma pr\u0026aacute;xis integradora. In: Viol\u0026ecirc;ncia faz mal \u0026agrave; sa\u0026uacute;de. Bras\u0026iacute;lia: MS; 2004.\u003c/li\u003e\n\u003cli\u003e\u0026Ouml;hman, A., Burman, M., Carbin, M. \u003cem\u003eet al.\u003c/em\u003e \u0026lsquo;The public health turn on violence against women\u0026rsquo;: analysing Swedish healthcare law, public health and gender-equality policies. \u003cem\u003eBMC Public Health\u003c/em\u003e 20, 753 (2020). https://doi.org/10.1186/s12889-020-08766-7.\u003c/li\u003e\n\u003cli\u003eTrentin, M. C,. Steffens SR. (2017). Viol\u0026ecirc;ncia sexual conjugal: Aspectos hist\u0026oacute;ricos, jur\u0026iacute;dicos e psicanal\u0026iacute;ticos. Unoesc Ci\u0026ecirc;nc. [Internet];8(2):177-86.\u003c/li\u003e\n\u003cli\u003eNoronha, E. (2002). Direito penal. 26\u0026ordf;. ed. S\u0026atilde;o Paulo: Saraiva.\u003c/li\u003e\n\u003cli\u003eMachado, I. V. Dezanoski, M. (2013). Viol\u0026ecirc;ncias psicol\u0026oacute;gicas na lei penal brasileira: uma discuss\u0026atilde;o sobre a demanda por leis assecurat\u0026oacute;rias de igualdade, infla\u0026ccedil;\u0026atilde;o normativa e reconhecimento. In: Morais, C. A., Cardin, V. S. G. Novos direitos e direitos da personalidade. Maring\u0026aacute;: Clichetec. \u003c/li\u003e\n\u003cli\u003ePrado, A., Nunes, L. (2016). A vitimiza\u0026ccedil;\u0026atilde;o secund\u0026aacute;ria nos casos de estupro: a atualidade da representa\u0026ccedil;\u0026atilde;o da viol\u0026ecirc;ncia de g\u0026ecirc;nero na vida e na obra de Artemisia Gentileschi. Prisma Jur\u0026iacute;dico, v. 15, n. 2, julho-dezembro, 2016, p. 49-74. Universidade Nove de Julho, S\u0026atilde;o Paulo, Brasil. \u003c/li\u003e\n\u003cli\u003ePaulo, B. G., Roque, A. C. (2019). Vitimiza\u0026ccedil;\u0026atilde;o secund\u0026aacute;ria de mulheres em delegacias de pol\u0026iacute;cia: localizando as poss\u0026iacute;veis causas. Revista Jur\u0026iacute;dica Luso-Brasileira (1), 361-400.\u003c/li\u003e\n\u003cli\u003eSilva, F., Andrade, M. (2019). A viol\u0026ecirc;ncia institucional contra crian\u0026ccedil;as, adolescentes e suas fam\u0026iacute;lias: contexto hist\u0026oacute;rico e perspectivas para a psicologia brasileira. Revista Mosaico. 2019 Jul./Dez.; 10 (2): SUPLEMENTO 132-137.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Stealthing, Sexual violence, Consent, Sexual and Reproductive Health","lastPublishedDoi":"10.21203/rs.3.rs-4308238/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4308238/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eStealthing refers to the practice in which a man removes a condom without the woman\u0026rsquo;s consent during sexual intercourse. This article is an investigation that portrays stealthing as an event within the broader framework of the exercise of heterosexual sexuality, intergender power relationships, and contraceptive negotiation between peers. This research aimed to highlight the web of social relationships that engender processes around unprotected sexual intercourse without mutual agreement. In-depth interviews were conducted with ten women who had been victims of stealthing. This article focuses on the sexual, reproductive, and mental health consequences of the act in their lives. The empirical material comprises ten in-depth interviews with women aged 19\u0026ndash;58 living in Brazilian urban areas. Data were analyzed using thematic analysis. The complex power relationships established in the couple engender different outcomes: respondents reported a search for post-intercourse emergency contraception, stories of pregnancy, abortion, STIs, the lack of support from professionals and institutions sought, different consequences for their mental health and the challenges of debating stealthing more clearly due to its invisibility in the Brazilian context. Stealthing is a gap in the scientific, legal, and popular literature that needs to be addressed. Taking on the intergender tension on the issue of stealthing, between female autonomy and male responsibility, is a central theme for those researching gender inequality in the field of sexuality in the social sciences and health.\u003c/p\u003e","manuscriptTitle":"(In)visible victims: stealthing and health consequences for Brazilian women","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-07 18:00:07","doi":"10.21203/rs.3.rs-4308238/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8cef658c-a99d-4796-9a98-1efa19ee6d28","owner":[],"postedDate":"May 7th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-12-26T06:53:52+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-07 18:00:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4308238","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4308238","identity":"rs-4308238","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}