Inequalities Among Homeless Populations During the Covid-19 Pandemic: A Mixed Methods Study

Inequalities Among Homeless Populations During the Covid-19 Pandemic: A Mixed Methods Study | 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 Inequalities Among Homeless Populations During the Covid-19 Pandemic: A Mixed Methods Study Giovanna Marina Fernandes Marini, Heriederson Sávio Dias Moura, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4457258/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 Background With the onset of the COVID-19 pandemic, there has been a discernible amplification of inherent vulnerabilities in the global population, with the most susceptible segments exemplified by the Homeless Population experiencing exacerbated adverse impacts.. This study aims to analyze the intersection of vulnerabilities among homeless populations aggravated by the COVID-19 pandemic. Methods This is a parallel convergent mixed methods study, incorporating a cross-sectional quantitative study and a qualitative study. A survey-type questionnaire was employed in the quantitative approach, analyzed using descriptive and inferential techniques, and a semi-structured interview in the qualitative aspect, with interviews analyzed using Minayo's thematic analysis methodology. Results Significant associations were identified between the vulnerabilities faced by the homeless population, which were further compounded with the advent of the COVID-19 pandemic. This period witnessed a critical intersection of these vulnerabilities, resulting in an even deeper social destabilization for this group. Conclusions Individuals experiencing homelessness confront a complex accumulation of intertwined inequalities, intensifying their social vulnerability. This scenario underscores the intersection of vulnerabilities within this group and emphasizes the urgent need for an integrated approach to understand their health and the pandemic's impact on these individuals. Homeless Persons COVID-19 Access to Information Social Vulnerability Health Inequality Figures Figure 1 1. BACKGROUND COVID-19 is a notifiable disease caused by the SARS-CoV-2 coronavirus, affecting humans and ranging from asymptomatic infections to severe respiratory conditions ( 1 ) . When interpreting the pandemic in a context far from its peak incidence, it is possible to understand its syndemic nature. Syndemics are characterized by the interaction of two or more epidemically occurring diseases, which collaborate to amplify their impact on community health ( 2 ) . According to theory, social, economic, and environmental scenarios influencing the life circumstances of populations intensify the interaction between coexisting diseases and the burden of resulting consequences. Thus, diseases tend to cluster disproportionately influenced by factors such as poverty, social exclusion, stigmatization, structural violence, and environmental issues, among others ( 3 ) . Therefore, COVID-19 has presented itself as a syndemic health challenge, and the lack of recognition of this aspect contributes to weakening both policy development and the effectiveness of public health measures ( 4 ) . In the Brazilian context, the public health sphere faced challenges due to the rapid strain on hospital services and difficulties in containing the virus's spread. These complexities were particularly associated with the unequal way in which the pandemic impacted and continues to impact different segments of society, exacerbating the risk for those in situations of social vulnerability. A particularly critical example is evident in the case of people experiencing homelessness, a people for whom the adoption of biosafety preventive measures comes with significant obstacles ( 5 ) . People experiencing homelessness (PEH) have a constant presence in urban spaces, and according to the National Policy for the Population in Street Situation (PNPSR), PEH is defined as a heterogeneous population group, sharing characteristics such as extreme poverty, disrupted or fragile family ties, and lack of regular housing ( 6 ) . Given that PEH is a population experiencing numerous vulnerabilities, during the pandemic, there was a worsening that intersected these vulnerabilities, amplifying situations of suffering, death, and violation of basic human rights ( 5 ) . In the literature, we observe few studies that have analyzed the intersection of vulnerabilities, revealing a knowledge gap. Scholars understand the intersection of vulnerability as the set of interrelated and interdependent violence and inequities, creating a hazardscape that aids researchers in understanding variations in the effects of hazards and disasters within communities and among individuals residing in them ( 7 ) . These vulnerabilities include both physical and social vulnerabilities, which are visible in the Brazilian context and encompass social, economic, and urban infrastructure processes related to the precarious conditions of life, seen through work, education, income, sanitation, mobility, among other conditions; and in the face of environmental, health, and public safety conditions, such as hunger, racism, institutional violence, lack of access to information, and violation of basic human rights ( 8 ) . 2. METHODS 2.1 Objective To analyze the intersection of vulnerabilities among homeless populations exacerbated by the COVID-19 pandemic. 2.2 Design This is a parallel convergent mixed methods study, comprising a cross-sectional quantitative study and a qualitative study. The parallel convergent design involves the researcher independently collecting and analyzing two sets of data - quantitative and qualitative - and then combining them with the aim of comparing or merging findings ( 9 ) .. The tool used for this mixed methods study was MMR (Mixed Methods Research) ( 10 , 11 ) . Figure 1 depicts the flowchart of the mixed methods approach utilized in the study: 2.3 Setting This study was conducted between December 2020 and July 2021 in the city of Ribeirão Preto, located in the interior of the state of São Paulo, Southeast Region of Brazil. The municipality is situated northeast of the state, approximately 315 km from the capital. It has an estimated population of 698,259 people, with a territorial area of 650.916 km², of which 226.35 km² are in urban areas ( 12 ) . According to an informal census conducted by the Municipal Social Assistance Secretariat (SEMAS) of Ribeirão Preto, in conjunction with non-governmental organizations (NGOs) ( 13 ) , it was estimated that three to seven thousand (3,000–7,000) people of the 698,259 people were experiencing homelessness in Ribeirão Preto in the year 2018. In response to the demands of the People experiencing homelessness (PEH), in April 2020, as a measure of physical isolation for COVID-19 cases, the municipality provided an Emergency Shelter ( 14 ) , in addition to pre-existing shelters directed at this population, such as the Central of Screening and Referral for Migrants, Itinerants, and Homeless Individuals of Ribeirão Preto (CETREM) and the Specialized Reference Center for People in Homeless Situations (Centro Pop). 2.4 Population and Study Sample The study included individuals aged 18 and above, regardless of gender, sexual orientation, race, color, ethnicity, who were either living on the streets and/or in public places in the municipality or in shelter locations provided for isolation and/or physical distancing. Participants who did not complete the questionnaire in its entirety were excluded. The study sample was based on sequential sampling ( 15 ) , involving variable-sized samples through the use of this non-probabilistic technique that takes into account the restricted access to populations that are challenging to reach, in order to include individuals encountered throughout the study. This approach was chosen due to the population's invisibility to the eyes of the State and public policies .i.e. those residing in city streets and shelters, who are readily available to participate in the research when approached. 2.5 Instruments and Data Collection In the quantitative phase, an originally created, validated, and published survey-type questionnaire ( 16 , 17 , 18 ) by researchers from the National School of Public Health at Nova University of Lisbon (ENSP-UNL) was used. The questionnaire underwent cultural adaptation for use in Brazil and validation by researchers affiliated with the National School of Public Health Sergio Arouca of the Oswaldo Cruz Foundation (ENSP-Fiocruz), Ribeirão Preto College of Nursing at the University of São Paulo (EERP-USP), and Ribeirão Preto Medical School at the University of São Paulo (FMRP-USP). It was named "COVID-19 Social Thermometer: Social Opinion." The questionnaire was administered offline via researchers' smartphones enlisted in the study, with an approximate duration of 20 to 30 minutes. Additionally, interviewers were equally trained for instrument administration to avoid measurement bias. The data were collected using the REDCap platform ( 19 ) sponsored by EERP-USP. Before starting the questionnaire administration, the Informed Consent Form (ICF) was read to study participants, and only after agreement and signature was the interview initiated. The ICF was structured in duplicate, read in its entirety, and signed on each page by the participant and the responsible interviewer. The instrument was administered only once for each person. In cases of illiteracy, fingerprint impressions were collected, with each party retaining a copy, and participants were informed of the document's importance. It is noteworthy that participation in the research was voluntary. In the qualitative phase, a semi-structured interview script consisting of three open-ended questions was used to identify vulnerabilities among people experiencing homelessness, to assess their knowledge of information about COVID-19 and social protection measures in the Ribeirão Preto context, namely: 1) " When did you first see someone wearing a mask on the street? At that time, did you already know about coronavirus? "; 2) " Did you receive emergency aid? If yes, did you need help from someone to do so? "; 3) " If you or someone you know have symptoms [cough, fever, and shortness of breath], do you know what to do? Where should you go or take someone with symptoms? ". The questions were designed to be easily understood by the interviewees. The qualitative instrument's application had an approximate duration of 15 minutes, and the interview was recorded on researchers' smartphones. Participants' statements were transcribed verbatim and checked twice by researchers to ensure fidelity. 2.6 Data Analysis 2.6.1 Quantitative Phase For the analysis of quantitative data, after verifying the consistency and standardization of the database, study participants were characterized through descriptive analyses with the calculation of absolute frequency (n) and relative frequency (%), considering variables related to sociodemographic characteristics, sources of information, and situations of vulnerabilities experienced by people experiencing homelessness (PEH) in their place of residence, neighborhood, or community during the COVID-19 pandemic. The data were tabulated in spreadsheets using Microsoft Office Excel 2013 and imported and analyzed using R software (R Core Team, 2021) ( 20 ) version 4.1.1. Binary logistic regression was used to identify factors associated with dependent variables, namely; situations of vulnerabilities experienced by participants in their place of residence, neighborhood, or community, each classified as Yes or No, including drug trafficking, police violence, racism, and families experiencing hunger or lack of food. Pearson's Chi-Square or Fisher's exact tests were used as association tests ( 21 ) . The independent study variables used for all outcomes were: Gender (Male/Other), Race (White, Black, Brown), Occupation (Unemployed, Other), Education (No Education/Incomplete Elementary School, Complete Elementary School/Incomplete High School, Complete High School or more), Housing (Shelter/Other, Street), Receives any Aid (Yes, No), Uses the Unified Health System - SUS (Yes, No), Receives visits from Community Health Agent - ACS (Yes, No), Uses the following Sources of Information: Friends and/or family (Yes, No), Digital Social Networks (Yes, No), Social Support Networks (Yes, No), Internet (Yes, No), Television News (Yes, No), and Radio (Yes, No). The automatic variable selection procedure called "Stepwise," through the Bayesian Information Criterion (BIC) ( 22 ) , was used to select independent variables. The Likelihood Ratio test was used to assess the possibility of including additional variables by comparing the complete model (all variables) with the simplified model (variables chosen by BIC). From the chosen model, Odds Ratios (OR) were calculated for each of the variables present in the model. All analyses were conducted with a significance level of 5% (α = 0.05) using R software version 4.1.1. 2.6.2 Qualitative Stage For the qualitative data analysis, the thematic analysis method ( 23 ) was employed- one of the forms of content analysis that involves identifying cores of meanings present in communication by examining the presence or frequency of these cores for articulation with the research objective. The analysis of this study unfolded in three distinct and interconnected stages. Initially, a careful reading of the material collected in the interviews was conducted, a phase that allowed for the correction of interpretative directions and prompted the emergence of new relevant questions. Subsequently, there was an in-depth exploration of this material. Finally, efforts were made to identify and group the emerging thematic categories that permeated the research. To support our conclusions, the results obtained in this analytical process were substantiated by the theoretical frameworks found in the specialized literature on the investigated themes. It is worth noting that this analysis methodology is based on the principles of thematic analysis developed by Minayo ( 24 ) . 3. RESULTS 3.1 Quantitative Results In the quantitative stage, 71 individuals participated in the study (Table 1 ). The average age of the participants was 43.9 years (SD = 10.9), predominantly male (n = 62; 87.32%), of mixed race/color (n = 39; 54.93%), unemployed (n = 51; 71.83%), with homelessness as their form of residence (n = 50; 70.42%), with incomplete elementary education (n = 27; 38.03%), receiving pandemic emergency aid (n = 36; 50.70%), using the Unified Health System (SUS) (n = 63; 88.73%), and not receiving visits from the Community Health Agent (n = 59; 83.10%) (Table 1 ). Regarding the sources of information used to stay informed about COVID-19, there was a prevalence of television news usage (n = 50; 70.42%). Concerning the situations experienced in the place of residence, neighborhood, or community, a slight emphasis was observed on drug trafficking (n = 26; 36.62%) and families experiencing hunger or lack of food (n = 23; 32.39%). Table 1 Frequency of sociodemographic characteristics, sources of information, and situations experienced in the place of residence, neighborhood, or community by the homeless population. Ribeirão Preto, 2020–2021 (n = 71). Variables n % Sex/Gender Male 62 87.32 Female 3 4.23 Transgender 2 2.82 Other 4 5.63 Race/Ethnicity Mixed race 39 54.93 White 17 23.94 Black 15 21.13 Occupation Unemployed 51 71.83 Informal jobs/gigs 13 18.31 Self-employed 3 4.23 Retired 2 2.82 Student 1 1.41 Other 1 1.41 Type of housing Street 50 70.42 Shelter 20 28.17 Other 1 1.41 Education Incomplete elementary education 27 38.03 Complete elementary education 14 19.72 Incomplete high school education 12 16.90 Complete high school education 9 12.68 Incomplete higher education 5 7.04 Complete higher education 3 4.23 No formal education 1 1.41 Receives government aid Pandemic emergency aid 36 50.70 Does not receive government aid 21 29.58 Family stipend 11 15.49 Continuons benefit program 1 1.41 Other 1 1.41 NR (not reported) 1 1.41 Uses the Unified Health System (SUS) Yes 63 88.73 No 8 11.27 Receives visits from the Community Health Agent (ACS) Yes 12 16.90 No 59 83.10 Information Sources = Universities (scientists or researchers/projects developed by the university community) Yes 2 2.82 No 69 97.18 Information Sources = Friends and/or Family Yes 13 18.31 No 58 81.69 Information Sources = Religious institutions/religious leaders (churches, temples, spiritual centers, pastors, etc.) Yes 1 1.41 No 70 98.59 Information Sources = Healthcare Professionals Yes 14 19.72 No 57 80.28 Information Sources = Digital Social Networks (Twitter, Facebook, Instagram, WhatsApp, etc.) Yes 11 15.49 No 60 84.51 Information Sources = Social Support Networks (NGOs, street clinics, community leaders, etc.) Yes 16 22.54 No 55 77.46 Information Sources = Internet (Google, Youtube, Podcasts, etc.) Yes 17 23.94 No 54 76.06 Information Sources = Television News Yes 50 70.42 No 21 29.58 Information Sources = Radio Yes 27 38.03 No 44 61.97 Experienced situations of drug trafficking in the place of residence, neighborhood, or community Yes 26 36.62 No 45 63.38 Experienced situations of police violence in the place of residence, neighborhood, or community Yes 16 22.54 No 55 77.46 Experienced situations of racism in the place of residence, neighborhood, or community Yes 17 23.94 No 54 76.06 Experienced situations of families in a state of hunger or lack of food in the place of residence, neighborhood, or community Yes 23 32.39 No 48 67.61 In Table 2 , binary logistic regression analyses are presented. In the first regression, it was identified that individuals who sought healthcare professionals (OR: 0.02; 95% CI: <0.01–0.19) as a source to stay informed about COVID-19 had a lower probability of experiencing situations of drug trafficking in their place of residence, neighborhood, or community. On the other hand, those who turned to social support networks (OR: 39.452; 95% CI: 4.652-1013.275) and television news (OR: 5.275; 95% CI: 1.376–27.350) had higher probabilities of experiencing this situation. In the second regression, it was identified that individuals of mixed race (OR: 49.03; 95% CI: 3.76-2305.25), unemployed individuals (OR: 42.48; 95% CI: 4.14-1265.60), those who reported the street as their place of residence (OR: 78.35; 95% CI: 6.28-3320.83), and those who relied on the internet (OR: 18.98; 95% CI: 2.00-456.51) as a source to stay informed about COVID-19 had higher probabilities of experiencing situations of police violence in their place of residence, neighborhood, or community. On the other hand, those who turned to friends and/or family (OR: 0.03; 95% CI: <0.01–0.41) as a source to stay informed about COVID-19 had a lower probability (Table 2 ). In the third regression, it was identified that individuals who relied on television news (OR: 8.44; 95% CI: 1.54-158.17) as a source to stay informed about COVID-19 had higher probabilities of experiencing situations of racism in their place of residence, neighborhood, or community. Finally, in the fourth regression, it was identified that individuals who reported the street as their place of residence (OR: 3.87; 95% CI: 1.13–18.05) had higher probabilities of experiencing situations of families in a state of hunger or lack of food in their place of residence, neighborhood, or community. Table 2 Association between sociodemographic variables and information sources used by the homeless population with situations of vulnerabilities experienced in the place of residence, neighborhood, or community: drug trafficking, police violence, racism, and families in a state of hunger or lack of food. Ribeirão Preto, 2020–2021. Variable OR 95%CI p-value Drug Trafficking Information Source = Healthcare Professionals 0.02 < 0.01–0.19 0.005* Information Source = Social Support Networks 39.45 4.65-1013.27 0.005* Information Source = Internet 0.11 < 0.01–0.72 0.053 Information Source = Television News 5.27 1.38–27.35 0.025* Police Violence Mixed race 49.03 3.76-2305.25 0.013* Black 1.27 0.07–21.01 0.861 Unemployed 42.48 4.14-1265.60 0.007* Housing = Street 78.35 6.28-3320.83 0.004* No Education/Incomplete Elementary Education 1.47 0.15–18.56 0.740 Complete Elementary Education/Incomplete High School Education 0.08 < 0.01–1.46 0.104 Information Source = Friends and/or Family 0.03 < 0.01–0.41 0.026* Information Source = Internet 18.98 2.00-456.51 0.022* Racism Information Source = Television News 8.44 1.54-158.17 0.046* Families in a State of Hunger or Lack of Food Housing = Street 3.87 1.13–18.05 0.049* OR = Odds ratio ; 95% CI = 95% Confidence Interval. 3.2 Qualitative Results Thirty-one semi-structured interviews were conducted with the Homeless Population of Ribeirão Preto. Thematic axes were derived from the semi-structured interview questions, highlighting the following themes based on the respondents' accounts. The interviewee accounts are identified and coded with the letter E followed by sequential numbers according to the order of the interviews. 3.2.1 Access to Initial Information Regarding the COVID-19 Pandemic Within this theme, the majority of respondents were already aware of the pandemic when they observed the widespread use of masks by the population, primarily obtaining information through television. Yes, I saw it on TV. (E1) I don't know when the news really came; it was in February, on TV. It was still in China. (E15) No. (E6) About one-third of the interviewees did not know about the pandemic when they encountered people wearing masks on the streets. It is worth noting that the use of masks in Ribeirão Preto became mandatory at the end of April 2020 25) , the first case of COVID-19 in the world occurred on 31/12/2019 (26) , and the first confirmed case in Brazil was at the end of February 2020 ( 27 ) . Considering that the interviews took place from December 2020 to June 2021, there is a significant gap between the emergence of information and its reach to the Homeless Population (PEH). 3.2.2 Access to Emergency Aid and the Need for Assistance in Registering About one-third of the interviewees were unable to obtain emergency aid, with reports such as: I didn't go after it. (E1) I tried, and it didn't work. (E3) I went after it [to get aid] straight away, but it never worked. I tried several times. (E5) They told me that those with sickness benefits are not entitled to emergency aid [Interviewee reports receiving a sickness benefit of R$1,274.00]. (E16) No. I didn't go after it, you know. At the time, I was giving private dance lessons. I preferred not to go after it because many people need it more. (E20) Most interviewees said they obtained emergency aid, and a large part of this group said they needed help to complete the registration. I needed help to do it on the phone because I didn't have a phone. (E2) I needed help; my sister did it for me. (E14) I needed help from the Social Worker. (E27) Among those who said they didn't need help, there are the following reports: I already had Bolsa Família; I was already registered in CadÚnico. (E6) No, I just filled out the form. I had a cell phone at the time. (E23) An important piece of information reported by those interviewees who answered that they obtained emergency aid and did not need help pertains to those who already had a Unified Registry (Cadastro Único) and received Bolsa Família (The program is a cash transfer program for families in extreme poverty provided by the Brazilian Federal Government), as they automatically received emergency aid. In a complementary sense, people who reported obtaining emergency aid but needed help reported difficulties related to lack of access to a cell phone and not understanding the filling steps. Another relevant piece of information reported is that those who were in a situation of deprivation of liberty during the Emergency Aid registration were not entitled to registration. This was the case for one of the interviewees: I was in jail. I tried to go for it, but it said that only those who registered would receive it. Those who didn't register would receive nothing. (E4) It is worth adding that there were interviewees who could not get aid due to a lack of documents: I couldn't because I lost my documents. (E5) Another point also raised by the interviewees is the lack of continuity of the installments. Among the responses of people who obtained Emergency Aid, there are some individuals who reported being able to withdraw the 1st or 2nd installment of the aid but could not withdraw the others: No, oh, I got it, and I only received the first installment; all the others were blocked. It was blocked because the Government claimed on the 'dataprev' website screen that I was in a penitentiary, detained, and for this reason, I didn't have the profile to receive it [According to the interviewee, he was not in jail during this period]. (E30) The last two were missing; I didn't get them. I got there, and it was canceled, with no explanation. (E16) 3.2.3 Information on Sanitary Measures in the Face of COVID-19 Symptoms: What to Do and Where to Go? This thematic axis comes from identifying the interviewees' knowledge of how to act if they or people close to them showed symptoms described as those of COVID-19 and which services they should seek in the face of symptoms. The reference locations provided by the Municipal Health Department were the COVID-19 Centers in the city of Ribeirão Preto, namely; an Emergency Care Unit (UPA) and a Basic Health Unit (UBDS). A little over a third of the interviewees reported that they would take them to the Covid centers in Ribeirão Preto: Yes. I would take them to one of the centers. (E16) Yes. I would take them to the central PS, which is now a Covid center. And I would do the whole procedure that I more or less understood: not getting too close, gloves on hand, mask, being as covered as possible so that there is not so much contact. (E20) Some refer to other locations, not those provided: Call SAMU (emergency medical services). (E7) At the nearest health center. (E10) Take them to the emergency room, to the health center. (E11) I would take them to the UPA or to Santa Casa, right? (E26) And about a fifth of the interviewees just said they didn't know where to go. No. (E3) 4. DISCUSSION Based on the results, it was possible to observe the extreme vulnerability of the People experiencing homelessness (PEH), which was exacerbated by the advent of the COVID-19 syndemic. This vulnerability had an intimate connection with the variables examined in this study: drug trafficking, police violence, racism, and families experiencing hunger or a lack of food. The study also highlighted the limited access and/or delayed arrival of information about COVID-19 for this population, underscoring the hindered access to Special Protection measures and Emergency Aid. Analyzing the data related to drug trafficking revealed that the homeless population, relying on social support networks and television as sources of information about the pandemic, had a higher likelihood of having experienced or been involved in drug trafficking. The connection between drug trafficking and life on the streets is long-standing, with the use and/or abuse of alcohol and drugs becoming integral to the cultural dimensions of street life ( 28 ) . During the pandemic, this reality intensified, with an increase in drug consumption ( 29 ) and, consequently, an escalation in drug trafficking. Therefore, the group of individuals ensnared in the context of drug trafficking experienced heightened vulnerability due to COVID-19. Vulnerable populations often depend on support networks for shelter, protection, legal assistance, and resilience promotion ( 30 ) . Nonprofit organizations and community groups constitute these support networks, offering information on healthcare, disease prevention, and access to medical resources (31) . Thus, people in extremely vulnerable situations, such as those involved in drug trafficking, rely on support networks as their primary source of information. In relation to television news, this is the primary and most significant means of information for a large portion of the Brazilian population. Television news acts as knowledge (re)producers, disseminating information to the people that producers deem relevant to be reproduced and shared ( 32 ) . Moreover, coupled with the widespread presence of television sets throughout Brazil ( 33 ) , found in thousands of bars, restaurants, snack bars, shops, and meeting places for collective groups, such as the CENTRO POP (a public unit specialized in providing specialized assistance to the homeless population), there is facilitated access to television news for the Brazilian public, a reality that persists even among vulnerable population groups. In the context of drug trafficking, it was also observed that only a minimal fraction of this vulnerable population had access to information from healthcare professionals. Prejudice and discrimination against vulnerable populations affect healthcare delivery, leading to a lack of access and dehumanization of health services ( 34 ) . The supposed most appropriate and reliable information channel, - professionals in healthcare, do not reach these fragile populations, facilitating misinformation and further exposing them to vulnerability. The individuals who receive guidance from healthcare professionals, particularly through health promotion initiatives, are more likely to be aware and capable of avoiding risky behaviors ( 35 ) , such as situations and places with a high prevalence of drugs and other forms of violence. Moving on to the thematic axis of police violence, other interesting data were observed. Among those who experienced police violence, there was an association with the probability of being of mixed race, unemployed, homeless, and, notably, using the internet as a source of information. Additionally, there was a negative association with the means of friends and family as sources of information. Police violence against poor, mixed-race, and homeless individuals is a daily occurrence ( 36 ) . Instances include police officers confiscating belongings, including documents, and destroying them in front of individuals experiencing homelessness ( 37 ) . In a scenario marked by poverty, unemployment, and the breakdown of non-formal social regulation systems, police presence elicits conflicting reactions, illustrating the community's hesitation when confronting a force perceived as both aggressive and protective ( 36 ) . The internet has emancipated users from the need for intermediary sources of information, providing direct access to informational resources at any time and place, autonomously ( 38 ) . The increased accessibility of the internet, facilitated by the widespread use of smartphones ( 39 ) , reached even the extremely vulnerable population affected by police violence in Brazil. Conversely, the use of information sources from friends and family was minimal among those vulnerable to police violence. Considering the profile of individuals victimized by police violence in this study—predominantly mixed-race, unemployed, and homeless individuals, often struggling with substance abuse—the breakdown of family and social bonds becomes evident. The daily burden placed on the families of these individuals is perceived as an economic, social, and personal hardship, contributing to the rupture of familial ties. This burden, coupled with physical and emotional exhaustion, transforms caregiving into a continuous burden for family members. Consequently, this strain tends to undermine emotional bonds and reciprocity between the individual experiencing homelessness, often grappling with substance abuse, and their family, resulting in the rupture of family ties ( 40 ) . This idea extends to friendships, explaining why family and friends serve as a minimal source of information for individuals vulnerable to police violence. Analyzing the thematic axis of racism revealed a positive association with information sources from television. Racism, deeply rooted in historical inequalities, restricts access for Black individuals to certain spaces, relegating them to socially disadvantaged positions. While the media landscape perpetuates racial biases, there are Black journalists tirelessly fighting against disparities. The research on the experiences of these professionals is crucial in combating racism, revealing how they navigate the media industry and construct their identities amid racial prejudice. This effort involves the use of their Black bodies, hair, voices, activism, and resistance strategies within media organizations ( 41 ) . Therefore, the use of television as an information source is associated with the likelihood of experiencing vulnerability to racism, as this media platform sheds light on racial prejudice and its impact on various aspects of life, including social, financial, and cultural realms. Finally, the thematic axis of vulnerability: families in a situation of hunger or lack of food. In Brazil, a developing country, we are confronted with a reality marked by deep socioeconomic inequalities, a scenario that repeats itself in various forms, including the presence of people living on the streets. One of the most alarming problems persisting amid this process of development is the continuous presence of hunger among the population. It is undeniable that hunger is intrinsically linked to poverty, and the extent of this poverty can be assessed by the prevalence rate of hunger in the country ( 42 ) . This reality of hunger and deprivation is exacerbated when it comes to the quality and quantity of food available to the homeless population. Many of them face the harsh reality of insufficient food, both in terms of quantity and quality. The lack of access to adequate meals is one of the crucial challenges these individuals face amid the adversities of their lives on the streets ( 43 ) . Therefore, the data presented by this study describes the sad reality of the strong relationship between life on the streets and hunger and/or lack of food for people living in this condition. Regarding information access at the beginning of the pandemic, the study found that the homeless population had limited access to information during this period, primarily through television. This suggests that homeless individuals obtained information about COVID-19 mainly in locations allowing access to television, such as bakeries, bars, and shelters like the CENTRO POP (a public unit specialized in assisting the homeless). It is noteworthy that a negligible fraction of the respondents received information from government institutions, underscoring the neglect of information access for the homeless population by government agencies. Additionally, this population demonstrated deficient information about the measures to be taken when experiencing symptoms. The delayed access to accurate information about the pandemic and containment measures for the homeless population indicates a higher level of social vulnerability compared to other impoverished populations ( 5 ) . Without proper guidance from the government, information about the new coronavirus took much longer to reach the homeless population than the rest of the community. Regarding Social Protection, the study found that homeless individuals who gained access were assisted by relatives and social assistance services. They lacked the necessary means to register, such as a cellphone or computer, and often lacked the instructions needed for registration. Due to social isolation, Brazil faced a financial crisis that deeply affected the population. In this context of growing social inequality, Law No. 13,982/2020 was enacted in April 2020, giving rise to the much-needed Emergency Aid. Emergency Aid became a vital lifeline for numerous Brazilian families ( 44 ) . In this sense, Emergency Aid is rooted in the concept of the minimum living standard ( 45 ) , ensuring that vulnerable populations have access to these fundamental rights. However, the vulnerable population faced numerous challenges in accessing this benefit, from initial application obstacles to misguided rejections ( 44 ) . Therefore, the data from this study show that both the government fell short in conveying official information and Social Protection was deficient in adequately assisting access to a social assistance benefit namely, Emergency Aid., which is a right of the vulnerable population, Another relevant piece of information for interpretation was gathered during the interviews. Individuals who were incarcerated in a closed regime during the registration for Emergency Aid were not eligible for registration ( 46 ) , and if released after the registration deadline, 07/02/2020 (47) , they were unable to register for the Aid. The study also observes that individuals lacking documents were also unable to register for the aid. Furthermore, it is important to highlight in this study that the homeless population had limited access to information that symptomatic individuals should be treated at the Covid Hub, a location better structured to receive patients in this situation, as most interviewers would not take symptomatic individuals to the Covid Hubs in Ribeirão Preto. Finally, it is emphasized that individuals in homeless situations accumulate a set of inequities that interrelate, potentially intensifying a situation of extreme social vulnerability. The majority of the homeless population consists of individuals of black race/color (48) and areliving in conditions of extreme poverty, more intense than in any other population stratum ( 49 ) . Additionally, this population demonstrates the highest levels of institutional violence, including from police forces ( 50 ) , and is in a situation of greater exposure to drug trafficking (51) , which increases the risk of experiencing violence. Similarly, public policies are insufficient, and even the Social Protection System does not adequately reach this population, keeping them in a situation of rights violation, with the role of this same Social Protection System being to provide this population with access to fundamental rights. Finally, the COVID-19 pandemic represented a devastating intersection for the homeless population, exacerbating their already intense vulnerabilities. Issues that have long plagued these individuals, such as police violence, drug trafficking, racism, food scarcity, lack of access to information, the ineffectiveness of the Special Protection System, the lack of information on health, and the insufficiency of Social Assistance, converged during this critical period. This accumulation of challenges resulted in a situation of extreme social exclusion, highlighting the urgent need for actions aimed at the protection and support of this population, not only in times of crisis but continuously and comprehensively. 4.1 Study Limitations The limitations of the study included access to participants who experienced the pandemic in a state ofsocial isolation. Another limitation was the presentation of a lengthy quantitative instrument, which occasionally led to participant- dropout during data collection. Despite these limitations, the study presents valuable data showing how the intersection of vulnerabilities intensifies an existential process by which inequities reveal an uneven social fabric, supported by an strong structure of social injustice perpetuated in the country. 4.2 Contribution to the Field The scientific knowledge produced in this study provides robust elements for the formulation and implementation of public policies and coping measures, effective and credited, to be understood and followed by the homeless population. Additionally, this produced knowledge can guide government actions, contributing to decision-making, as well as supporting actions by NGOs and health extension projects in the formulation of information delivery methodologies for prevention and education regarding COVID-19 and other aspects related to the health of people in homeless situations. Another important contribution of the study is to show how, through the analysis of the intersection of vulnerabilities experienced by the homeless population, it is possible to appropriately produce intersectional and intersectoral public policies that can respond to the complexity of the homeless situation. 5. CONCLUSIONS Given the intricate web of interactions among the vulnerabilities of the homeless populations, exacerbated by the COVID-19 pandemic, it is crucial to recognize the syndemic nature of this health challenge. The syndemic, as well as the interaction of multiple epidemic-prone diseases, worsened the health impacts on these communities, making the need for integrated approaches to protect the most vulnerable, more evident. The lack of recognition of this aspect by public health policies not only weakens the development of effective strategies but also perpetuates the cycle of vulnerability and worsens social conditions. In particular, individuals experiencing homelessness, already subject to numerous vulnerabilities, underwent an intensification and intersection of these factors during the pandemic, resulting in situations of suffering, death, and violation of basic human rights. Therefore, understanding and addressing this syndemic is of paramount importance to ensure that the health and dignity of all are preserved amid the unprecedented challenges faced by society. The results of this study reveal a complex interaction between sources of information about COVID-19 and the vulnerability experiences of different population groups. Notably, those who sought information directly from healthcare professionals had a lower likelihood of having experienced drug trafficking situations in their living areas, neighborhoods, or communities. However, people who turned to social support networks and television news had a higher chance of having experienced such situations. Additionally, it was identified that individuals of mixed race, unemployed individuals, and those who declared living in homeless situations were more likely to have experienced instances of police violence in their locations. On the other hand, those who sought information from friends and/or family had a lower likelihood of facing this type of violence. In the context of racism, those who relied on television news as a source of information had a higher chance of having experienced racism in their living areas, neighborhoods, or communities. Finally, individuals who declared living in homeless situations had a higher probability of having experienced situations of families facing hunger or lack of food in their locations. Furthermore, there is a delay and inefficiency in the arrival of information about the pandemic to the homeless population, as the information reaching this population is incomplete and takes time to reach them, confirming that the homeless population has no priority from public agencies and society in accessing information. These findings highlight the importance of information sources in shaping vulnerability experiences. Understanding these complex connections is essential for the formulation of effective public policies and intervention approaches that address the specific needs of at-risk groups during public health crises. The intersection of vulnerabilities in the homeless population during the coronavirus pandemic substantially worsened their already precarious condition. Persistent challenges that deeply impacted these individuals amalgamated at this crucial moment. The result was an exacerbated social exclusion and aggravated lack of rights, pushing this population into an even more critical state of vulnerability. In summary, it can be concluded that individuals experiencing homelessness face a complex accumulation of interconnected inequalities, amplifying their profound social vulnerability. This population is predominantly composed of individuals in conditions of extreme poverty, experiencing hunger as a pervasive condition in their daily lives, facing high levels of institutional and social violence, and having significant exposure to social risk factors such as drug trafficking. Additionally, existing public policies prove to be insufficient, including the Social Protection System. It was also evident that the People experiencing homelessness (PEH) faces a significant delay in receiving information compared to other population groups. This scenario highlights the intersection of vulnerabilities in this group and underscores the vital need for a convergence of information for a more comprehensive understanding of health and how the pandemic affected these individuals. Ultimately, this study reflects the absence of effective government measures and social support for the PEH. Abbreviations PEH People experiencing homelessness PNPSR National Policy for the Population in Street Situation MMR Mixed Methods Research SEMAS Municipal Social Assistance Secretariat NGOs non-governmental organizations CETREM Central of Screening and Referral for Migrants, Itinerants, and Homeless Individuals of Ribeirão Preto CENTRO POP Specialized Reference Center for People in Homeless Situations ENSP-UNL National School of Public Health at Nova University of Lisbon ENSP-Fiocruz National School of Public Health Sergio Arouca of the Oswaldo Cruz Foundation EERP-USP Ribeirão Preto College of Nursing at the University of São Paulo FMRP-USP Ribeirão Preto Medical School at the University of São Paulo ICF Informed Consent Form BIC Bayesian Information Criterion OR Odds Ratio CEP Research Ethics Committee Declarations Ethical Approval and Informed Consent The entire conduct of the research complies with Resolution No. 466/12 and Resolution No. 510/16, adhering to relevant ethical and scientific principles. The research received approval from the Research Ethics Committee (CEP) of the School Health Center at FMRP-USP, under opinion No. 4.750.095 (CAAE: 42240621.9.0000.5414), and from the CEP of EERP-USP, under opinion No. 5.512.199 (CAAE: 57933622.4.1001.5393). Consent for Publication All participants provided consent for publication by signing the Free and Informed Consent Form (ICF) and had their identity preserved. Consent to Participate Informed consent was obtained from all individual participants included in the study. Consent to Publish The authors affirm that human participants in the research provided consent for publication. Data and Materials Availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing Interests The authors declare no conflicting interests. Funding This work was carried out with the support and funding from the São Paulo Research Foundation (FAPESP) – Scientific Initiation Scholarship – process 2020/10079-7. Author Contributions GMFM significantly contributed to the study's design, data collection, analysis and interpretation of data, manuscript drafting, and has responsibility for the accuracy and integrity of all aspects of the research. JCN participated in data collection. JHSC was involved in manuscript drafting. HSDM and LPF contributed to the study's design, analysis and interpretation of data, and manuscript drafting and revision. TKAT contributed to language editing and proofreading RAA contributed to the study's design and manuscript revision. RCF supervised the research, participating in the study's design and manuscript drafting and revision. All authors read and approved the final manuscript. Acknowledgments : None. Financial interests : None Not-financial interests : None References Majumder J, Minko T. 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PESSOAS EM SITUAÇÃO DE RUA E VIOLÊNCIA: ENTRELAÇADOS EM NOME DA SUPOSTA GARANTIA DE SEGURANÇA PÚBLICA : eixo temático: violência, cidadania e direitos humanos. Eixo temático: Violência, Cidadania e Direitos humanos. Available in: https://direitopenaledemocracia.ufpa.br/wp-content/uploads/2019/02/SEGURAN%C3%87A-P%C3%9ABLI CA-E-PESSOAS-EM-SITUA%C3%87%C3%83O-DE-RUA.pdf. Accessed: 30 ago. 2023. MENDES, Kíssila Teixeira; RONZANI, Telmo Mota; PAIVA, Fernando Santana de. "Tudo por causa do crack": um estudo sobre as percepções e sentidos das drogas na população em situação de rua. Periódicos Eletrônicos em Psicologia , Natal, v. 3, n. 26, ju/set 2021. DOI: 10.22491/1678-4669.20210029. Available in: http://pepsic.bvsalud.org/scielo.php?pid=S1413-294X2021000300008&script=sci_arttext. Accessed: 30 ago. 2023. Additional Declarations No competing interests reported. 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BACKGROUND","content":"\u003cp\u003eCOVID-19 is a notifiable disease caused by the SARS-CoV-2 coronavirus, affecting humans and ranging from asymptomatic infections to severe respiratory conditions\u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/sup\u003e. When interpreting the pandemic in a context far from its peak incidence, it is possible to understand its syndemic nature. Syndemics are characterized by the interaction of two or more epidemically occurring diseases, which collaborate to amplify their impact on community health\u003csup\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAccording to theory, social, economic, and environmental scenarios influencing the life circumstances of populations intensify the interaction between coexisting diseases and the burden of resulting consequences. Thus, diseases tend to cluster disproportionately influenced by factors such as poverty, social exclusion, stigmatization, structural violence, and environmental issues, among others \u003csup\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/sup\u003e. Therefore, COVID-19 has presented itself as a syndemic health challenge, and the lack of recognition of this aspect contributes to weakening both policy development and the effectiveness of public health measures \u003csup\u003e(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn the Brazilian context, the public health sphere faced challenges due to the rapid strain on hospital services and difficulties in containing the virus's spread. These complexities were particularly associated with the unequal way in which the pandemic impacted and continues to impact different segments of society, exacerbating the risk for those in situations of social vulnerability. A particularly critical example is evident in the case of people experiencing homelessness, a people for whom the adoption of biosafety preventive measures comes with significant obstacles \u003csup\u003e(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/sup\u003e. People experiencing homelessness (PEH) have a constant presence in urban spaces, and according to the National Policy for the Population in Street Situation (PNPSR), PEH is defined as a heterogeneous population group, sharing characteristics such as extreme poverty, disrupted or fragile family ties, and lack of regular housing\u003csup\u003e(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eGiven that PEH is a population experiencing numerous vulnerabilities, during the pandemic, there was a worsening that intersected these vulnerabilities, amplifying situations of suffering, death, and violation of basic human rights\u003csup\u003e(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn the literature, we observe few studies that have analyzed the intersection of vulnerabilities, revealing a knowledge gap. Scholars understand the intersection of vulnerability as the set of interrelated and interdependent violence and inequities, creating a hazardscape that aids researchers in understanding variations in the effects of hazards and disasters within communities and among individuals residing in them \u003csup\u003e(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/sup\u003e. These vulnerabilities include both physical and social vulnerabilities, which are visible in the Brazilian context and encompass social, economic, and urban infrastructure processes related to the precarious conditions of life, seen through work, education, income, sanitation, mobility, among other conditions; and in the face of environmental, health, and public safety conditions, such as hunger, racism, institutional violence, lack of access to information, and violation of basic human rights\u003csup\u003e(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e"},{"header":"2. METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Objective\u003c/h2\u003e \u003cp\u003eTo analyze the intersection of vulnerabilities among homeless populations exacerbated by the COVID-19 pandemic.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Design\u003c/h2\u003e \u003cp\u003eThis is a parallel convergent mixed methods study, comprising a cross-sectional quantitative study and a qualitative study. The parallel convergent design involves the researcher independently collecting and analyzing two sets of data - quantitative and qualitative - and then combining them with the aim of comparing or merging findings\u003csup\u003e(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/sup\u003e.. The tool used for this mixed methods study was MMR (Mixed Methods Research) \u003csup\u003e(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/sup\u003e. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e depicts the flowchart of the mixed methods approach utilized in the study:\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Setting\u003c/h2\u003e \u003cp\u003eThis study was conducted between December 2020 and July 2021 in the city of Ribeir\u0026atilde;o Preto, located in the interior of the state of S\u0026atilde;o Paulo, Southeast Region of Brazil. The municipality is situated northeast of the state, approximately 315 km from the capital. It has an estimated population of 698,259 people, with a territorial area of 650.916 km\u0026sup2;, of which 226.35 km\u0026sup2; are in urban areas\u003csup\u003e(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAccording to an informal census conducted by the Municipal Social Assistance Secretariat (SEMAS) of Ribeir\u0026atilde;o Preto, in conjunction with non-governmental organizations (NGOs)\u003csup\u003e(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/sup\u003e, it was estimated that three to seven thousand (3,000\u0026ndash;7,000) people of the 698,259 people were experiencing homelessness in Ribeir\u0026atilde;o Preto in the year 2018.\u003c/p\u003e \u003cp\u003eIn response to the demands of the People experiencing homelessness (PEH), in April 2020, as a measure of physical isolation for COVID-19 cases, the municipality provided an Emergency Shelter \u003csup\u003e(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/sup\u003e, in addition to pre-existing shelters directed at this population, such as the Central of Screening and Referral for Migrants, Itinerants, and Homeless Individuals of Ribeir\u0026atilde;o Preto\u003c/p\u003e \u003cp\u003e(CETREM) and the Specialized Reference Center for People in Homeless Situations (Centro Pop).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Population and Study Sample\u003c/h2\u003e \u003cp\u003eThe study included individuals aged 18 and above, regardless of gender, sexual orientation, race, color, ethnicity, who were either living on the streets and/or in public places in the municipality or in shelter locations provided for isolation and/or physical distancing. Participants who did not complete the questionnaire in its entirety were excluded.\u003c/p\u003e \u003cp\u003eThe study sample was based on sequential sampling \u003csup\u003e(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/sup\u003e, involving variable-sized samples through the use of this non-probabilistic technique that takes into account the restricted access to populations that are challenging to reach, in order to include individuals encountered throughout the study. This approach was chosen due to the population's invisibility to the eyes of the State and public policies .i.e. those residing in city streets and shelters, who are readily available to participate in the research when approached.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Instruments and Data Collection\u003c/h2\u003e \u003cp\u003eIn the quantitative phase, an originally created, validated, and published survey-type questionnaire\u003csup\u003e(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/sup\u003e by researchers from the National School of Public Health at Nova University of Lisbon (ENSP-UNL) was used. The questionnaire underwent cultural adaptation for use in Brazil and validation by researchers affiliated with the National School of Public Health Sergio Arouca of the Oswaldo Cruz Foundation (ENSP-Fiocruz), Ribeir\u0026atilde;o Preto College of Nursing at the University of S\u0026atilde;o Paulo (EERP-USP), and Ribeir\u0026atilde;o Preto Medical School at the University of S\u0026atilde;o Paulo (FMRP-USP). It was named \"COVID-19 Social Thermometer: Social Opinion.\" The questionnaire was administered offline via researchers' smartphones enlisted in the study, with an approximate duration of 20 to 30 minutes.\u003c/p\u003e \u003cp\u003eAdditionally, interviewers were equally trained for instrument administration to avoid measurement bias. The data were collected using the REDCap platform \u003csup\u003e(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/sup\u003e sponsored by EERP-USP. Before starting the questionnaire administration, the Informed Consent Form (ICF) was read to study participants, and only after agreement and signature was the interview initiated. The ICF was structured in duplicate, read in its entirety, and signed on each page by the participant and the responsible interviewer. The instrument was administered only once for each person. In cases of illiteracy, fingerprint impressions were collected, with each party retaining a copy, and participants were informed of the document's importance. It is noteworthy that participation in the research was voluntary.\u003c/p\u003e \u003cp\u003eIn the qualitative phase, a semi-structured interview script consisting of three open-ended questions was used to identify vulnerabilities among people experiencing homelessness, to assess their knowledge of information about COVID-19 and social protection measures in the Ribeir\u0026atilde;o Preto context, namely: 1) \"\u003cem\u003eWhen did you first see someone wearing a mask on the street? At that time, did you already know about coronavirus?\u003c/em\u003e\"; 2) \"\u003cem\u003eDid you receive emergency aid? If yes, did you need help from someone to do so?\u003c/em\u003e\"; 3) \"\u003cem\u003eIf you or someone you know have symptoms [cough, fever, and shortness of breath], do you know what to do? Where should you go or take someone with symptoms?\u003c/em\u003e\". The questions were designed to be easily understood by the interviewees. The qualitative instrument's application had an approximate duration of 15 minutes, and the interview was recorded on researchers' smartphones. Participants' statements were transcribed verbatim and checked twice by researchers to ensure fidelity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Data Analysis\u003c/h2\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2.6.1 \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eQuantitative Phase\u003c/span\u003e\u003c/h2\u003e \u003cp\u003eFor the analysis of quantitative data, after verifying the consistency and standardization of the database, study participants were characterized through descriptive analyses with the calculation of absolute frequency (n) and relative frequency (%), considering variables related to sociodemographic characteristics, sources of information, and situations of vulnerabilities experienced by people experiencing homelessness (PEH) in their place of residence, neighborhood, or community during the COVID-19 pandemic. The data were tabulated in spreadsheets using Microsoft Office Excel 2013 and imported and analyzed using R software (R Core Team, 2021)\u003csup\u003e(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/sup\u003e version 4.1.1.\u003c/p\u003e \u003cp\u003eBinary logistic regression was used to identify factors associated with dependent variables, namely; situations of vulnerabilities experienced by participants in their place of residence, neighborhood, or community, each classified as Yes or No, including drug trafficking, police violence, racism, and families experiencing hunger or lack of food. Pearson's Chi-Square or Fisher's exact tests were used as association tests \u003csup\u003e(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe independent study variables used for all outcomes were: Gender (Male/Other), Race\u003c/p\u003e \u003cp\u003e(White, Black, Brown), Occupation (Unemployed, Other), Education (No Education/Incomplete Elementary School, Complete Elementary School/Incomplete High School, Complete High School or more), Housing (Shelter/Other, Street), Receives any Aid (Yes, No), Uses the Unified Health System - SUS (Yes, No), Receives visits from Community Health Agent - ACS (Yes, No), Uses the following Sources of Information: Friends and/or family (Yes, No), Digital Social Networks (Yes,\u003c/p\u003e \u003cp\u003eNo), Social Support Networks (Yes, No), Internet (Yes, No), Television News (Yes, No), and Radio (Yes, No).\u003c/p\u003e \u003cp\u003eThe automatic variable selection procedure called \"Stepwise,\" through the Bayesian Information Criterion (BIC) \u003csup\u003e(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/sup\u003e, was used to select independent variables. The Likelihood Ratio test was used to assess the possibility of including additional variables by comparing the complete model (all variables) with the simplified model (variables chosen by BIC).\u003c/p\u003e \u003cp\u003eFrom the chosen model, \u003cem\u003eOdds Ratios\u003c/em\u003e (OR) were calculated for each of the variables present in the model. All analyses were conducted with a significance level of 5% (α\u0026thinsp;=\u0026thinsp;0.05) using R software version 4.1.1.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e2.6.2 \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eQualitative Stage\u003c/span\u003e\u003c/h2\u003e \u003cp\u003eFor the qualitative data analysis, the thematic analysis method\u003csup\u003e(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/sup\u003e was employed- one of the forms of content analysis that involves identifying cores of meanings present in communication by examining the presence or frequency of these cores for articulation with the research objective.\u003c/p\u003e \u003cp\u003eThe analysis of this study unfolded in three distinct and interconnected stages. Initially, a careful reading of the material collected in the interviews was conducted, a phase that allowed for the correction of interpretative directions and prompted the emergence of new relevant questions. Subsequently, there was an in-depth exploration of this material. Finally, efforts were made to identify and group the emerging thematic categories that permeated the research. To support our conclusions, the results obtained in this analytical process were substantiated by the theoretical frameworks found in the specialized literature on the investigated themes. It is worth noting that this analysis methodology is based on the principles of thematic analysis developed by Minayo \u003csup\u003e(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"3. RESULTS","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Quantitative Results\u003c/h2\u003e \u003cp\u003eIn the quantitative stage, 71 individuals participated in the study (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The average age of the participants was 43.9 years (SD\u0026thinsp;=\u0026thinsp;10.9), predominantly male (n\u0026thinsp;=\u0026thinsp;62; 87.32%), of mixed race/color (n\u0026thinsp;=\u0026thinsp;39; 54.93%), unemployed (n\u0026thinsp;=\u0026thinsp;51; 71.83%), with homelessness as their form of residence (n\u0026thinsp;=\u0026thinsp;50; 70.42%), with incomplete elementary education (n\u0026thinsp;=\u0026thinsp;27; 38.03%), receiving pandemic emergency aid (n\u0026thinsp;=\u0026thinsp;36; 50.70%), using the Unified Health System (SUS) (n\u0026thinsp;=\u0026thinsp;63;\u003c/p\u003e \u003cp\u003e88.73%), and not receiving visits from the Community Health Agent (n\u0026thinsp;=\u0026thinsp;59; 83.10%) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Regarding the sources of information used to stay informed about COVID-19, there was a prevalence of television news usage (n\u0026thinsp;=\u0026thinsp;50; 70.42%). Concerning the situations experienced in the place of residence, neighborhood, or community, a slight emphasis was observed on drug trafficking (n\u0026thinsp;=\u0026thinsp;26; 36.62%) and families experiencing hunger or lack of food (n\u0026thinsp;=\u0026thinsp;23; 32.39%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFrequency of sociodemographic characteristics, sources of information, and situations experienced in the place of residence, neighborhood, or community by the homeless population. Ribeir\u0026atilde;o Preto, 2020\u0026ndash;2021 (n\u0026thinsp;=\u0026thinsp;71).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex/Gender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e87.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransgender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRace/Ethnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMixed race\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInformal jobs/gigs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of housing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStreet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70.42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShelter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncomplete elementary education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplete elementary education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncomplete high school education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplete high school education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncomplete higher education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplete higher education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo formal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReceives government aid\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePandemic emergency aid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50.70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDoes not receive government aid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily stipend\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContinuons benefit program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNR (not reported)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUses the Unified Health System (SUS)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e88.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReceives visits from the Community Health Agent (ACS)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInformation Sources\u0026thinsp;=\u0026thinsp;Universities (scientists or researchers/projects developed by the university community)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInformation Sources\u0026thinsp;=\u0026thinsp;Friends and/or Family\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e81.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInformation Sources\u0026thinsp;=\u0026thinsp;Religious institutions/religious leaders (churches, temples, spiritual centers, pastors, etc.)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e98.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInformation Sources\u0026thinsp;=\u0026thinsp;Healthcare Professionals\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInformation Sources\u0026thinsp;=\u0026thinsp;Digital Social Networks (Twitter, Facebook, Instagram, WhatsApp, etc.)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84.51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInformation Sources\u0026thinsp;=\u0026thinsp;Social Support Networks (NGOs, street clinics, community leaders, etc.)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInformation Sources\u0026thinsp;=\u0026thinsp;Internet (Google, Youtube, Podcasts, etc.)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInformation Sources\u0026thinsp;=\u0026thinsp;Television News\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70.42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInformation Sources\u0026thinsp;=\u0026thinsp;Radio\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExperienced situations of drug trafficking in the place of residence, neighborhood, or community\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExperienced situations of police violence in the place of residence, neighborhood, or community\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExperienced situations of racism in the place of residence, neighborhood, or community\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExperienced situations of families in a state of hunger or lack of food in the place of residence, neighborhood, or community\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, binary logistic regression analyses are presented. In the first regression, it was identified that individuals who sought healthcare professionals (OR: 0.02; 95% CI: \u0026lt;0.01\u0026ndash;0.19) as a source to stay informed about COVID-19 had a lower probability of experiencing situations of drug trafficking in their place of residence, neighborhood, or community. On the other hand, those who turned to social support networks (OR: 39.452; 95% CI: 4.652-1013.275) and television news (OR: 5.275; 95% CI: 1.376\u0026ndash;27.350) had higher probabilities of experiencing this situation.\u003c/p\u003e \u003cp\u003eIn the second regression, it was identified that individuals of mixed race (OR: 49.03; 95% CI: 3.76-2305.25), unemployed individuals (OR: 42.48; 95% CI: 4.14-1265.60), those who reported the street as their place of residence (OR: 78.35; 95% CI: 6.28-3320.83), and those who relied on the internet (OR: 18.98; 95% CI: 2.00-456.51) as a source to stay informed about COVID-19 had higher probabilities of experiencing situations of police violence in their place of residence, neighborhood, or community. On the other hand, those who turned to friends and/or family (OR:\u003c/p\u003e \u003cp\u003e0.03; 95% CI: \u0026lt;0.01\u0026ndash;0.41) as a source to stay informed about COVID-19 had a lower probability (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the third regression, it was identified that individuals who relied on television news (OR: 8.44; 95% CI: 1.54-158.17) as a source to stay informed about COVID-19 had higher probabilities of experiencing situations of racism in their place of residence, neighborhood, or community.\u003c/p\u003e \u003cp\u003eFinally, in the fourth regression, it was identified that individuals who reported the street as their place of residence (OR: 3.87; 95% CI: 1.13\u0026ndash;18.05) had higher probabilities of experiencing situations of families in a state of hunger or lack of food in their place of residence, neighborhood, or community.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between sociodemographic variables and information sources used by the homeless population with situations of vulnerabilities experienced in the place of residence, neighborhood, or community: drug trafficking, police violence, racism, and families in a state of hunger or lack of food. Ribeir\u0026atilde;o Preto, 2020\u0026ndash;2021.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrug Trafficking\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInformation Source\u0026thinsp;=\u0026thinsp;Healthcare Professionals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.01\u0026ndash;0.19\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.005*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInformation Source\u0026thinsp;=\u0026thinsp;Social Support Networks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e39.45\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e4.65-1013.27\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.005*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInformation Source\u0026thinsp;=\u0026thinsp;Internet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u0026ndash;0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInformation Source\u0026thinsp;=\u0026thinsp;Television News\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e5.27\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.38\u0026ndash;27.35\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.025*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePolice Violence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMixed race\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e49.03\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e3.76-2305.25\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.013*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.07\u0026ndash;21.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.861\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e42.48\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e4.14-1265.60\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.007*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousing\u0026thinsp;=\u0026thinsp;Street\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e78.35\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e6.28-3320.83\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.004*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo Education/Incomplete Elementary Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.15\u0026ndash;18.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.740\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplete Elementary Education/Incomplete High School Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u0026ndash;1.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.104\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInformation Source\u0026thinsp;=\u0026thinsp;Friends and/or Family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.03\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.01\u0026ndash;0.41\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.026*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInformation Source\u0026thinsp;=\u0026thinsp;Internet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e18.98\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2.00-456.51\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.022*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRacism\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInformation Source\u0026thinsp;=\u0026thinsp;Television News\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e8.44\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.54-158.17\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.046*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamilies in a State of Hunger or Lack of Food\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousing\u0026thinsp;=\u0026thinsp;Street\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e3.87\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.13\u0026ndash;18.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.049*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOR\u0026thinsp;=\u0026thinsp;\u003cem\u003eOdds ratio\u003c/em\u003e; 95% CI\u0026thinsp;=\u0026thinsp;95% Confidence Interval.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Qualitative Results\u003c/h2\u003e \u003cp\u003eThirty-one semi-structured interviews were conducted with the Homeless Population of Ribeir\u0026atilde;o Preto. Thematic axes were derived from the semi-structured interview questions, highlighting the following themes based on the respondents' accounts. The interviewee accounts are identified and coded with the letter E followed by sequential numbers according to the order of the interviews.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003e3.2.1 Access to Initial Information Regarding the COVID-19 Pandemic\u003c/h2\u003e \u003cp\u003eWithin this theme, the majority of respondents were already aware of the pandemic when they observed the widespread use of masks by the population, primarily obtaining information through television.\u003c/p\u003e \u003cp\u003e \u003cem\u003eYes, I saw it on TV. (E1)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eI don't know when the news really came; it was in February, on TV. It was still in China.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e(E15)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eNo. (E6)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAbout one-third of the interviewees did not know about the pandemic when they encountered people wearing masks on the streets. It is worth noting that the use of masks in Ribeir\u0026atilde;o Preto became mandatory at the end of April 2020\u003csup\u003e25)\u003c/sup\u003e, the first case of COVID-19 in the world occurred on 31/12/2019\u003csup\u003e(26)\u003c/sup\u003e, and the first confirmed case in Brazil was at the end of February 2020\u003csup\u003e(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e27\u003c/span\u003e)\u003c/sup\u003e. Considering that the interviews took place from December 2020 to June 2021, there is a significant gap between the emergence of information and its reach to the Homeless Population (PEH).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003e3.2.2 Access to Emergency Aid and the Need for Assistance in Registering\u003c/h2\u003e \u003cp\u003eAbout one-third of the interviewees were unable to obtain emergency aid, with reports such\u003c/p\u003e \u003cp\u003eas:\u003c/p\u003e \u003cp\u003e \u003cem\u003eI didn't go after it. (E1)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eI tried, and it didn't work. (E3)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eI went after it [to get aid] straight away, but it never worked. I tried several times. (E5)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eThey told me that those with sickness benefits are not entitled to emergency aid\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e[Interviewee reports receiving a sickness benefit of R$1,274.00]. (E16)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eNo. I didn't go after it, you know. At the time, I was giving private dance lessons. I preferred not to go after it because many people need it more. (E20)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eMost interviewees said they obtained emergency aid, and a large part of this group said they needed help to complete the registration.\u003c/p\u003e \u003cp\u003e \u003cem\u003eI needed help to do it on the phone because I didn't have a phone. (E2)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eI needed help; my sister did it for me. (E14)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eI needed help from the Social Worker. (E27)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAmong those who said they didn't need help, there are the following reports:\u003c/p\u003e \u003cp\u003e \u003cem\u003eI already had Bolsa Fam\u0026iacute;lia; I was already registered in Cad\u0026Uacute;nico. (E6)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eNo, I just filled out the form. I had a cell phone at the time. (E23)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAn important piece of information reported by those interviewees who answered that they obtained emergency aid and did not need help pertains to those who already had a Unified Registry (Cadastro \u0026Uacute;nico) and received Bolsa Fam\u0026iacute;lia (The program is a cash transfer program for families in extreme poverty provided by the Brazilian Federal Government), as they automatically received emergency aid. In a complementary sense, people who reported obtaining emergency aid but needed help reported difficulties related to lack of access to a cell phone and not understanding the\u003c/p\u003e \u003cp\u003efilling steps.\u003c/p\u003e \u003cp\u003eAnother relevant piece of information reported is that those who were in a situation of deprivation of liberty during the Emergency Aid registration were not entitled to registration. This was the case for one of the interviewees:\u003c/p\u003e \u003cp\u003e \u003cem\u003eI was in jail. I tried to go for it, but it said that only those who registered would receive it.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eThose who didn't register would receive nothing. (E4)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eIt is worth adding that there were interviewees who could not get aid due to a lack of documents:\u003c/p\u003e \u003cp\u003e \u003cem\u003eI couldn't because I lost my documents. (E5)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAnother point also raised by the interviewees is the lack of continuity of the installments. Among the responses of people who obtained Emergency Aid, there are some individuals who reported being able to withdraw the 1st or 2nd installment of the aid but could not withdraw the\u003c/p\u003e \u003cp\u003eothers:\u003c/p\u003e \u003cp\u003e \u003cem\u003eNo, oh, I got it, and I only received the first installment; all the others were blocked. It was blocked because the Government claimed on the 'dataprev' website screen that I was in a penitentiary, detained, and for this reason, I didn't have the profile to receive it\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e[According to the interviewee, he was not in jail during this period]. (E30)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eThe last two were missing; I didn't get them. I got there, and it was canceled, with no explanation. (E16)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e3.2.3 Information on Sanitary Measures in the Face of COVID-19 Symptoms: What to Do and Where to Go?\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis thematic axis comes from identifying the interviewees' knowledge of how to act if they or people close to them showed symptoms described as those of COVID-19 and which services they should seek in the face of symptoms. The reference locations provided by the Municipal\u003c/p\u003e \u003cp\u003eHealth Department were the COVID-19 Centers in the city of Ribeir\u0026atilde;o Preto, namely; an Emergency Care Unit (UPA) and a Basic Health Unit (UBDS).\u003c/p\u003e \u003cp\u003eA little over a third of the interviewees reported that they would take them to the Covid centers in Ribeir\u0026atilde;o Preto:\u003c/p\u003e \u003cp\u003e \u003cem\u003eYes. I would take them to one of the centers. (E16)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eYes. I would take them to the central PS, which is now a Covid center. And I would do the whole procedure that I more or less understood: not getting too close, gloves on hand, mask, being as covered as possible so that there is not so much contact. (E20)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSome refer to other locations, not those provided:\u003c/p\u003e \u003cp\u003e \u003cem\u003eCall SAMU (emergency medical services). (E7)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eAt the nearest health center. (E10)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eTake them to the emergency room, to the health center. (E11)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eI would take them to the UPA or to Santa Casa, right? (E26)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAnd about a fifth of the interviewees just said they didn't know where to go.\u003c/p\u003e \u003cp\u003e \u003cem\u003eNo. (E3)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"4. DISCUSSION","content":"\u003cp\u003eBased on the results, it was possible to observe the extreme vulnerability of the People experiencing homelessness (PEH), which was exacerbated by the advent of the COVID-19 syndemic. This vulnerability had an intimate connection with the variables examined in this study: drug trafficking, police violence, racism, and families experiencing hunger or a lack of food. The study also highlighted the limited access and/or delayed arrival of information about COVID-19 for this population, underscoring the hindered access to Special Protection measures and Emergency Aid.\u003c/p\u003e \u003cp\u003eAnalyzing the data related to drug trafficking revealed that the homeless population, relying on social support networks and television as sources of information about the pandemic, had a higher likelihood of having experienced or been involved in drug trafficking. The connection between drug trafficking and life on the streets is long-standing, with the use and/or abuse of alcohol and drugs becoming integral to the cultural dimensions of street life \u003csup\u003e(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e28\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eDuring the pandemic, this reality intensified, with an increase in drug consumption \u003csup\u003e(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e29\u003c/span\u003e)\u003c/sup\u003e and, consequently, an escalation in drug trafficking. Therefore, the group of individuals ensnared in the context of drug trafficking experienced heightened vulnerability due to COVID-19.\u003c/p\u003e \u003cp\u003eVulnerable populations often depend on support networks for shelter, protection, legal assistance, and resilience promotion \u003csup\u003e(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/sup\u003e. Nonprofit organizations and community groups constitute these support networks, offering information on healthcare, disease prevention, and access to medical resources \u003csup\u003e(31)\u003c/sup\u003e. Thus, people in extremely vulnerable situations, such as those involved in drug trafficking, rely on support networks as their primary source of information.\u003c/p\u003e \u003cp\u003eIn relation to television news, this is the primary and most significant means of information for a large portion of the Brazilian population. Television news acts as knowledge (re)producers, disseminating information to the people that producers deem relevant to be reproduced and shared \u003csup\u003e(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e32\u003c/span\u003e)\u003c/sup\u003e. Moreover, coupled with the widespread presence of television sets throughout Brazil \u003csup\u003e(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e33\u003c/span\u003e)\u003c/sup\u003e, found in thousands of bars, restaurants, snack bars, shops, and meeting places for collective groups, such as the CENTRO POP (a public unit specialized in providing specialized assistance to the homeless population), there is facilitated access to television news for the Brazilian public, a reality that persists even among vulnerable population groups.\u003c/p\u003e \u003cp\u003eIn the context of drug trafficking, it was also observed that only a minimal fraction of this vulnerable population had access to information from healthcare professionals. Prejudice and discrimination against vulnerable populations affect healthcare delivery, leading to a lack of access and dehumanization of health services \u003csup\u003e(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e34\u003c/span\u003e)\u003c/sup\u003e. The supposed most appropriate and reliable information channel, - professionals in healthcare, do not reach these fragile populations, facilitating misinformation and further exposing them to vulnerability. The individuals who receive guidance from healthcare professionals, particularly through health promotion initiatives, are more likely to be aware and capable of avoiding risky behaviors \u003csup\u003e(\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e35\u003c/span\u003e)\u003c/sup\u003e, such as situations and places with a high prevalence of drugs and other forms of violence.\u003c/p\u003e \u003cp\u003eMoving on to the thematic axis of police violence, other interesting data were observed. Among those who experienced police violence, there was an association with the probability of being of mixed race, unemployed, homeless, and, notably, using the internet as a source of information. Additionally, there was a negative association with the means of friends and family as sources of information.\u003c/p\u003e \u003cp\u003ePolice violence against poor, mixed-race, and homeless individuals is a daily occurrence \u003csup\u003e(\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e36\u003c/span\u003e)\u003c/sup\u003e. Instances include police officers confiscating belongings, including documents, and destroying them in front of individuals experiencing homelessness \u003csup\u003e(\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e37\u003c/span\u003e)\u003c/sup\u003e. In a scenario marked by poverty, unemployment, and the breakdown of non-formal social regulation systems, police presence elicits conflicting reactions, illustrating the community's hesitation when confronting a force perceived as both aggressive and protective\u003csup\u003e(\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e36\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe internet has emancipated users from the need for intermediary sources of information, providing direct access to informational resources at any time and place, autonomously \u003csup\u003e(\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e38\u003c/span\u003e)\u003c/sup\u003e. The increased accessibility of the internet, facilitated by the widespread use of smartphones \u003csup\u003e(\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e39\u003c/span\u003e)\u003c/sup\u003e, reached even the extremely vulnerable population affected by police violence in Brazil.\u003c/p\u003e \u003cp\u003eConversely, the use of information sources from friends and family was minimal among those vulnerable to police violence. Considering the profile of individuals victimized by police violence in this study\u0026mdash;predominantly mixed-race, unemployed, and homeless individuals, often struggling with substance abuse\u0026mdash;the breakdown of family and social bonds becomes evident. The daily burden placed on the families of these individuals is perceived as an economic, social, and personal hardship, contributing to the rupture of familial ties. This burden, coupled with physical and emotional exhaustion, transforms caregiving into a continuous burden for family members. Consequently, this strain tends to undermine emotional bonds and reciprocity between the individual experiencing homelessness, often grappling with substance abuse, and their family, resulting in the rupture of family ties \u003csup\u003e(\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e40\u003c/span\u003e)\u003c/sup\u003e. This idea extends to friendships, explaining why family and friends serve as a minimal source of information for individuals vulnerable to police violence.\u003c/p\u003e \u003cp\u003eAnalyzing the thematic axis of racism revealed a positive association with information sources from television. Racism, deeply rooted in historical inequalities, restricts access for Black individuals to certain spaces, relegating them to socially disadvantaged positions. While the media landscape perpetuates racial biases, there are Black journalists tirelessly fighting against disparities. The research on the experiences of these professionals is crucial in combating racism, revealing how they navigate the media industry and construct their identities amid racial prejudice. This effort involves the use of their Black bodies, hair, voices, activism, and resistance strategies within media organizations \u003csup\u003e(\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e41\u003c/span\u003e)\u003c/sup\u003e. Therefore, the use of television as an information source is associated with the likelihood of experiencing vulnerability to racism, as this media platform sheds light on racial prejudice and its impact on various aspects of life, including social, financial, and cultural realms.\u003c/p\u003e \u003cp\u003eFinally, the thematic axis of vulnerability: families in a situation of hunger or lack of food. In Brazil, a developing country, we are confronted with a reality marked by deep socioeconomic inequalities, a scenario that repeats itself in various forms, including the presence of people living on the streets. One of the most alarming problems persisting amid this process of development is the continuous presence of hunger among the population. It is undeniable that hunger is intrinsically linked to poverty, and the extent of this poverty can be assessed by the prevalence rate of hunger in the country \u003csup\u003e(\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e42\u003c/span\u003e)\u003c/sup\u003e. This reality of hunger and deprivation is exacerbated when it comes to the quality and quantity of food available to the homeless population. Many of them face the harsh reality of insufficient food, both in terms of quantity and quality. The lack of access to adequate meals is one of the crucial challenges these individuals face amid the adversities of their lives on the streets \u003csup\u003e(\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e43\u003c/span\u003e)\u003c/sup\u003e. Therefore, the data presented by this study describes the sad reality of the strong relationship between life on the streets and hunger and/or lack of food for people living in this condition.\u003c/p\u003e \u003cp\u003eRegarding information access at the beginning of the pandemic, the study found that the homeless population had limited access to information during this period, primarily through television. This suggests that homeless individuals obtained information about COVID-19 mainly in locations allowing access to television, such as bakeries, bars, and shelters like the CENTRO POP (a public unit specialized in assisting the homeless). It is noteworthy that a negligible fraction of the respondents received information from government institutions, underscoring the neglect of information access for the homeless population by government agencies. Additionally, this population demonstrated deficient information about the measures to be taken when experiencing symptoms. The delayed access to accurate information about the pandemic and containment measures for the homeless population indicates a higher level of social vulnerability compared to other impoverished populations\u003csup\u003e(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/sup\u003e. Without proper guidance from the government, information about the new coronavirus took much longer to reach the homeless population than the rest of the community.\u003c/p\u003e \u003cp\u003eRegarding Social Protection, the study found that homeless individuals who gained access were assisted by relatives and social assistance services. They lacked the necessary means to register, such as a cellphone or computer, and often lacked the instructions needed for registration. Due to social isolation, Brazil faced a financial crisis that deeply affected the population. In this context of growing social inequality, Law No. 13,982/2020 was enacted in April 2020, giving rise to the much-needed Emergency Aid. Emergency Aid became a vital lifeline for numerous Brazilian families \u003csup\u003e(\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e44\u003c/span\u003e)\u003c/sup\u003e. In this sense, Emergency Aid is rooted in the concept of the minimum living standard \u003csup\u003e(\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e45\u003c/span\u003e)\u003c/sup\u003e, ensuring that vulnerable populations have access to these fundamental rights. However, the vulnerable population faced numerous challenges in accessing this benefit, from initial application obstacles to misguided rejections \u003csup\u003e(\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e44\u003c/span\u003e)\u003c/sup\u003e. Therefore, the data from this study show that both the government fell short in conveying official information and Social Protection was deficient in adequately assisting access to a social assistance benefit namely, Emergency Aid., which is a right of the vulnerable population,\u003c/p\u003e \u003cp\u003eAnother relevant piece of information for interpretation was gathered during the interviews. Individuals who were incarcerated in a closed regime during the registration for Emergency Aid were not eligible for registration \u003csup\u003e(\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e46\u003c/span\u003e)\u003c/sup\u003e, and if released after the registration deadline, 07/02/2020\u003csup\u003e(47)\u003c/sup\u003e, they were unable to register for the Aid. The study also observes that individuals lacking documents were also unable to register for the aid.\u003c/p\u003e \u003cp\u003eFurthermore, it is important to highlight in this study that the homeless population had limited access to information that symptomatic individuals should be treated at the Covid Hub, a location better structured to receive patients in this situation, as most interviewers would not take symptomatic individuals to the Covid Hubs in Ribeir\u0026atilde;o Preto.\u003c/p\u003e \u003cp\u003eFinally, it is emphasized that individuals in homeless situations accumulate a set of inequities that interrelate, potentially intensifying a situation of extreme social vulnerability. The majority of the homeless population consists of individuals of black race/color \u003csup\u003e(48)\u003c/sup\u003e and areliving in conditions of extreme poverty, more intense than in any other population stratum \u003csup\u003e(\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e49\u003c/span\u003e)\u003c/sup\u003e. Additionally, this population demonstrates the highest levels of institutional violence, including from police forces \u003csup\u003e(\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e50\u003c/span\u003e)\u003c/sup\u003e, and is in a situation of greater exposure to drug trafficking \u003csup\u003e(51)\u003c/sup\u003e, which increases the risk of experiencing violence. Similarly, public policies are insufficient, and even the Social Protection System does not adequately reach this population, keeping them in a situation of rights violation, with the role of this same Social Protection System being to provide this population with access to fundamental rights.\u003c/p\u003e \u003cp\u003eFinally, the COVID-19 pandemic represented a devastating intersection for the homeless population, exacerbating their already intense vulnerabilities. Issues that have long plagued these individuals, such as police violence, drug trafficking, racism, food scarcity, lack of access to information, the ineffectiveness of the Special Protection System, the lack of information on health, and the insufficiency of Social Assistance, converged during this critical period. This accumulation of challenges resulted in a situation of extreme social exclusion, highlighting the urgent need for actions aimed at the protection and support of this population, not only in times of crisis but continuously and comprehensively.\u003c/p\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Study Limitations\u003c/h2\u003e \u003cp\u003eThe limitations of the study included access to participants who experienced the pandemic in a state ofsocial isolation. Another limitation was the presentation of a lengthy quantitative instrument, which occasionally led to participant- dropout during data collection.\u003c/p\u003e \u003cp\u003eDespite these limitations, the study presents valuable data showing how the intersection of vulnerabilities intensifies an existential process by which inequities reveal an uneven social fabric, supported by an strong structure of social injustice perpetuated in the country.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Contribution to the Field\u003c/h2\u003e \u003cp\u003eThe scientific knowledge produced in this study provides robust elements for the formulation and implementation of public policies and coping measures, effective and credited, to be understood and followed by the homeless population.\u003c/p\u003e \u003cp\u003eAdditionally, this produced knowledge can guide government actions, contributing to decision-making, as well as supporting actions by NGOs and health extension projects in the formulation of information delivery methodologies for prevention and education regarding COVID-19 and other aspects related to the health of people in homeless situations. Another important contribution of the study is to show how, through the analysis of the intersection of vulnerabilities experienced by the homeless population, it is possible to appropriately produce intersectional and intersectoral public policies that can respond to the complexity of the homeless\u003c/p\u003e \u003cp\u003esituation.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. CONCLUSIONS","content":"\u003cp\u003eGiven the intricate web of interactions among the vulnerabilities of the homeless populations, exacerbated by the COVID-19 pandemic, it is crucial to recognize the syndemic nature of this health challenge. The syndemic, as well as the interaction of multiple epidemic-prone diseases, worsened the health impacts on these communities, making the need for integrated approaches to protect the most vulnerable, more evident. The lack of recognition of this aspect by public health policies not only weakens the development of effective strategies but also perpetuates the cycle of vulnerability and worsens social conditions. In particular, individuals experiencing homelessness, already subject to numerous vulnerabilities, underwent an intensification and intersection of these factors during the pandemic, resulting in situations of suffering, death, and violation of basic human rights. Therefore, understanding and addressing this syndemic is of paramount importance to ensure that the health and dignity of all are preserved amid the unprecedented challenges faced by society.\u003c/p\u003e \u003cp\u003eThe results of this study reveal a complex interaction between sources of information about COVID-19 and the vulnerability experiences of different population groups. Notably, those who sought information directly from healthcare professionals had a lower likelihood of having experienced drug trafficking situations in their living areas, neighborhoods, or communities. However, people who turned to social support networks and television news had a higher chance of having experienced such situations. Additionally, it was identified that individuals of mixed race, unemployed individuals, and those who declared living in homeless situations were more likely to have experienced instances of police violence in their locations. On the other hand, those who sought information from friends and/or family had a lower likelihood of facing this type of violence. In the context of racism, those who relied on television news as a source of information had a higher chance of having experienced racism in their living areas, neighborhoods, or communities. Finally, individuals who declared living in homeless situations had a higher probability of having experienced situations of families facing hunger or lack of food in their locations. Furthermore, there is a delay and inefficiency in the arrival of information about the pandemic to the homeless population, as the information reaching this population is incomplete and takes time to reach them, confirming that the homeless population has no priority from public agencies and society in accessing information. These findings highlight the importance of information sources in shaping vulnerability experiences. Understanding these complex connections is essential for the formulation of effective public policies and intervention approaches that address the specific needs of at-risk groups during public health crises.\u003c/p\u003e \u003cp\u003eThe intersection of vulnerabilities in the homeless population during the coronavirus pandemic substantially worsened their already precarious condition. Persistent challenges that deeply impacted these individuals amalgamated at this crucial moment. The result was an exacerbated social exclusion and aggravated lack of rights, pushing this population into an even more critical state of vulnerability.\u003c/p\u003e \u003cp\u003eIn summary, it can be concluded that individuals experiencing homelessness face a complex accumulation of interconnected inequalities, amplifying their profound social vulnerability. This population is predominantly composed of individuals in conditions of extreme poverty, experiencing hunger as a pervasive condition in their daily lives, facing high levels of institutional and social violence, and having significant exposure to social risk factors such as drug trafficking. Additionally, existing public policies prove to be insufficient, including the Social Protection System. It was also evident that the People experiencing homelessness (PEH) faces a significant delay in receiving information compared to other population groups. This scenario highlights the intersection of vulnerabilities in this group and underscores the vital need for a convergence of information for a more comprehensive understanding of health and how the pandemic affected these individuals. Ultimately, this study reflects the absence of effective government measures and social support for the PEH.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePEH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePeople experiencing homelessness\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePNPSR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Policy for the Population in Street Situation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMMR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMixed Methods Research\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSEMAS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMunicipal Social Assistance Secretariat\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNGOs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003enon-governmental organizations\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCETREM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCentral of Screening and Referral for Migrants, Itinerants, and Homeless Individuals of Ribeir\u0026atilde;o Preto\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCENTRO POP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSpecialized Reference Center for People in Homeless Situations\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eENSP-UNL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational School of Public Health at Nova University of Lisbon\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eENSP-Fiocruz\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational School of Public Health Sergio Arouca of the Oswaldo Cruz Foundation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEERP-USP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRibeir\u0026atilde;o Preto College of Nursing at the University of S\u0026atilde;o Paulo\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFMRP-USP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRibeir\u0026atilde;o Preto Medical School at the University of S\u0026atilde;o Paulo\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInformed Consent Form\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBIC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBayesian Information Criterion\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOdds Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCEP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eResearch Ethics Committee\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval and Informed Consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe entire conduct of the research complies with Resolution No. 466/12 and Resolution No. 510/16, adhering to relevant ethical and scientific principles. The research received approval from the Research Ethics Committee (CEP) of the School Health Center at FMRP-USP, under opinion No. 4.750.095 (CAAE: 42240621.9.0000.5414), and from the CEP of EERP-USP, under opinion No. 5.512.199 (CAAE: 57933622.4.1001.5393).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants provided consent for publication by signing the Free and Informed Consent Form (ICF) and had their identity preserved.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors affirm that human participants in the research provided consent for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData and Materials Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicting interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was carried out with the support and funding from the S\u0026atilde;o Paulo Research Foundation (FAPESP) \u0026ndash; Scientific Initiation Scholarship \u0026ndash; process 2020/10079-7.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGMFM significantly contributed to the study\u0026apos;s design, data collection, analysis and interpretation of data, manuscript drafting, and has responsibility for the accuracy and integrity of all aspects of the research. JCN participated in data collection. JHSC was involved in manuscript drafting. HSDM and LPF contributed to the study\u0026apos;s design, analysis and interpretation of data, and manuscript drafting and revision. TKAT contributed to language editing and proofreading RAA contributed to the study\u0026apos;s design and manuscript revision. RCF supervised the research, participating in the study\u0026apos;s design and manuscript drafting and revision. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e:\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancial interests\u003c/strong\u003e: None\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNot-financial interests\u003c/strong\u003e: None\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMajumder J, Minko T. 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Accessed: 30 ago. 2023.\u003c/li\u003e\n\u003cli\u003eMENDES, K\u0026iacute;ssila Teixeira; RONZANI, Telmo Mota; PAIVA, Fernando Santana de. \u0026quot;Tudo por causa do crack\u0026quot;: um estudo sobre as percep\u0026ccedil;\u0026otilde;es e sentidos das drogas na popula\u0026ccedil;\u0026atilde;o em situa\u0026ccedil;\u0026atilde;o de rua. \u003cstrong\u003ePeri\u0026oacute;dicos Eletr\u0026ocirc;nicos em Psicologia\u003c/strong\u003e, Natal, v. 3, n. 26, ju/set 2021. DOI: 10.22491/1678-4669.20210029. Available in: http://pepsic.bvsalud.org/scielo.php?pid=S1413-294X2021000300008\u0026amp;script=sci_arttext. Accessed: 30 ago. 2023.\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":"Homeless Persons, COVID-19, Access to Information, Social Vulnerability, Health Inequality","lastPublishedDoi":"10.21203/rs.3.rs-4457258/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4457258/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eWith the onset of the COVID-19 pandemic, there has been a discernible amplification of inherent vulnerabilities in the global population, with the most susceptible segments exemplified by the Homeless Population experiencing exacerbated adverse impacts.. This study aims to analyze the intersection of vulnerabilities among homeless populations aggravated by the COVID-19 pandemic.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis is a parallel convergent mixed methods study, incorporating a cross-sectional quantitative study and a qualitative study. A survey-type questionnaire was employed in the quantitative approach, analyzed using descriptive and inferential techniques, and a semi-structured interview in the qualitative aspect, with interviews analyzed using Minayo's thematic analysis methodology.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eSignificant associations were identified between the vulnerabilities faced by the homeless population, which were further compounded with the advent of the COVID-19 pandemic. This period witnessed a critical intersection of these vulnerabilities, resulting in an even deeper social destabilization for this group.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eIndividuals experiencing homelessness confront a complex accumulation of intertwined inequalities, intensifying their social vulnerability. This scenario underscores the intersection of vulnerabilities within this group and emphasizes the urgent need for an integrated approach to understand their health and the pandemic's impact on these individuals.\u003c/p\u003e","manuscriptTitle":"Inequalities Among Homeless Populations During the Covid-19 Pandemic: A Mixed Methods Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-10 18:18:58","doi":"10.21203/rs.3.rs-4457258/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":"ed747dbe-0b83-4117-8fff-54cf3012ca1b","owner":[],"postedDate":"June 10th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-04-29T10:23:37+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-10 18:18:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4457258","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4457258","identity":"rs-4457258","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}