Between favor and right: Policies to Assist the Homeless Population in Latin America

ABSTRACT.

The present study analyzed the scientific literature on social policies and the homeless population in Latin American countries. We analyzed a total of 51 articles from a search in the databases Scielo, Lilacs and Redalyc using the keyword ‘População em Situação de Rua’, presenting experiences and reflections about the service to this segment in Argentina, Brazil, Chile, Colombia and Cuba. Despite similar profiles, it is a very heterogeneous segment. The main emphases on social policies were in the areas of social assistance and healthcare, and these still tend towards welfarism. However, progress has been made in the creation of legislation, services and policies for guaranteeing rights. Finally, there is a need to deepen the discussion about the productive determination of social inequality and the progress in the implementation of social policies that aim to enable real access to social rights by this population.

Keywords:
Population in street situation; social policies; Latin America

RESUMO

O presente trabalho analisou a literatura científica sobre políticas sociais e população em situação de rua nos países latino-americanos. Foram analisados 51 artigos buscados nas bases de dados Scielo, Lilacs e Redalyc, a partir da palavra-chave ‘População em Situação de Rua’, que apresentam experiências e reflexões acerca do atendimento a esse segmento na Argentina, Brasil, Chile, Colômbia e Cuba. Identificou-se que, apesar de perfis semelhantes, trata-se de um segmento bastante heterogêneo. As principais ênfases sobre as políticas sociais foram nas áreas da assistência social e saúde, e estas ainda tendem para o assistencialismo. Contudo, houve avanços na criação de legislações, serviços e políticas para a garantia de direitos. Enfim, nota-se a necessidade de aprofundar a discussão acerca da determinação produtora da desigualdade social e o avanço na implementação de políticas sociais que visem possibilitar o real acesso aos direitos sociais por esta população.

Palavras-chave:
População em situação de rua; políticas sociais; América Latina

Keywords:
Population in street situation; social policies; Latin America

RESUMEN

En el estudio se analizó la literatura científica sobre políticas sociales y población en situación de calle en los países latinoamericanos. Se analizaron 51 artículos buscados en las bases Scielo, Lilacs y Redalyc, a partir de la palabra clave ‘Población en Situación de Calle’, presentando experiencias y reflexiones acerca de la atención a ese segmento en Argentina, Brasil, Chile, Colombia y Cuba. A pesar de perfiles similares, se trata de un segmento bastante heterogéneo. Los principales énfasis fueron en las áreas de la asistencia social y salud, y éstas todavía tienden hacia el asistencialismo. Hubo avances en la creación de legislaciones, servicios y políticas para la garantía de derechos. En fin, se nota la necesidad de profundizar la discusión sobre la determinación productora de la desigualdad social y el avance en la implementación de políticas sociales que apunte a permitir el verdadero acceso a los derechos sociales por esta población.

Palabras clave:
Población en situación de calle; políticas sociales; Latinoamérica

Introduction

Poverty and income concentration are phenomena rooted in the capitalist mode of production, which intensify in certain historical periods and reach even worse conditions in peripheral countries. Data from the international organization Oxfam (2017), for the year 2016, point out that only eight billionaire men had the same wealth as the world’s 3.6 billion poorest people. Such data explain the ‘social issue’⁵, arising from the process of inequality in the distribution of socially produced goods, intensified in the capitalist mode of production with the expansion and generalization of poverty, at the same time that there is an increase in the capacity to produce wealth (Netto, 2006).

A reflection of this is how the history of Latin America has been marked by exploitation and violence since the colonization by Europeans over native peoples, generating socioeconomic and cultural political exclusion, concentration of land and income, expulsion and massacre of enslaved Indians and Africans. According to Mattei (2015), European colonists assigned to this geographical space only the function of production and supply of primary goods necessary to serve the interests of the metropolises. Such colonizing logic, in addition to forming and establishing a socioeconomic structure turned to abroad, left economic and social marks still present in Latin American countries, among them poverty and social inequality.

Throughout the twentieth century, Latin America experienced violent dictatorial processes that contributed to consolidating economic elites closely linked to the political representation system and the bureaucratic apparatus of the State. Pase and Melo (2017) point out that after the period of re-democratization of Latin American countries in the 1990s and 2000s, with the election of reformist presidents and, with more popular policies, the possibility of building public policies such as materialization of the correlation of political forces present in society.

Faced with this context, among the various expressions of the ‘social issue’ that mark life in Latin American cities, there is the phenomenon of Population living on the street (PLS), a population group that lives under extreme poverty and experiences a series of violence and violations of social rights in their daily lives. Silva (2009) points out that PLS is a radical expression of the social issue, one of the groups that most strongly expresses the materialization of violence imposed by the capitalist system on human lives.

It is a complex, urban, international phenomenon that has multiple determinations. The history of PLS is not recent, but parallel to the history of cities. In order to reveal such a complex phenomenon, it is necessary to consider the economic, political and social factors that determine its historicity. Bursztyn (2000, p. 19) states that “[…] living on the street is not a new problem. If it is not as old as the very existence of streets in urban life, it goes back, at least, to the revival of cities, at the beginning of capitalism”.

In Brazil, as in most Latin American countries, actions have been created since the colonial period to care for the populations living on the streets, especially mixed-race children and young people, illegitimate children of mill masters with indigenous people or enslaved African women, who were abandoned and embraced by Catholic institutions, which followed the logic of docilization and domestication of native peoples through the conversion to Christianity (Faleiros, 2004). In addition to philanthropic actions, repression over the centuries has marked the history of actions aimed at PLS.

On the streets of large and medium-sized cities in several countries in Latin America there are increasing numbers of people who, due to different situations, find the most significant space for sociability, work and/or housing on the streets. Men, women, the elderly, children and adolescents, whole families, unemployed, former prisoners, subjects with mental distress and/or disorder, representatives of ethnic groups, migrants, sex workers, among other populations who are socially invisible, who compose the heterogeneous group of homeless people.

Regarding the situation on the street, Prates, Prates and Machado (2011) show the existence of the rualização process, which explains the character of diversity, plurality and movement experienced on the streets. The authors explain that rualização is not a state, but a movement of approximation/connection with the street, a continuous process of imbrication in this space, making it an important reference element for the constitution of identity, which is gradually built up in the street.

In the face of such diversity and the seriousness of rights violations experienced by the PLS, it is possible to measure the challenge posed to the creation and execution of social policies to serve this segment, as well as to guarantee access for people living on the streets to public policies and their rights. Although there are some philanthropic actions aimed at assisting the PLS since the colonization of Latin American countries, attention to this segment by policies implemented by the State from a perspective of recognizing them as subjects of rights is recent. Likewise, research and studies on such policies are recent, even though the population segment to which they are intended constitutes an old phenomenon. Silva (2009, p. 32-33) states that the PLS phenomenon, not yet quantitatively scaled by official censuses, draws attention and worries governments, researchers and ordinary citizens. “However, despite causing concerns, research and theoretical production on the theme are still incipient. Surrounding it theoretically, to understand it, is still a challenge”.

Thus, this article aimed to analyze the scientific production on social policies to assist PLS in Latin America, aiming to unveil the concept of PLS underlying the discussions undertaken, the main actions and articulations in serving this population segment and the similarities, divergences and key challenges in the implementation of these policies in Latin American countries.

Method

The present study consists of an integrative literature review about the social policies of care to the PLS in Latin America. The integrative literature review intends to gather and synthesize results of empirical and theoretical studies in a systematic way, aiming at the synthesis of the state of knowledge about the researched theme.

The integrative literature review, according to Mendes, Silveira and Galvão (2008), has been reported in studies since the 1980s, and consists of six main steps: identification of the theme and selection of the research question, establishment of criteria for inclusion/exclusion of studies, categorization of studies, evaluation of research included in the integrative review, interpretation of results and presentation of the review/synthesis of knowledge.

For this integrative review on the care to the PLS in Latin American countries, scientific articles were selected from the databases Scielo, Lilacs and Redalyc. The descriptor used was the keyword população em situação de rua.

Thus, the inclusion criteria used were as follows: articles available in full texts and free of charge, dealing with actions and policies aimed at the adult population living on the streets in Latin American countries, in journals indexed in the databases where they were searches were carried out and in Portuguese or Spanish language. The exclusion criteria, on the other hand, were articles repeated in the databases, dealing with homeless children or elderly, since these segments have specific laws and policies in most Latin American countries, and articles with an exclusively biological or epidemiological approach.

From the research carried out in September 2017, in the databases with the mentioned keyword, 239 articles were found. After the application of the exclusion criteria, 51 articles were selected, which were read and analyzed in this integrative literature review. In the selection of articles, publications were found between the years 2007 to 2017. Among the selected articles, empirical and theorical studies were contemplated, using quantitative, qualitative and mixed methodologies. The selected articles present experiences and reflections on assistance to PLS in five Latin American countries: Argentina, Brazil, Chile, Colombia and Cuba.

Subsequently, the articles were read and interpreted, and the data were grouped into analytical categories. From the reading, compilation and interpretation of data from the 51 articles on the care to the PLS by social policies in Latin America, three analytical categories emerged: ‘Who are these people who live on the street?’, ‘On the periphery of downtown or at downtown of the periphery?’ and ‘On the razor’s edge: between guaranteeing rights and social hygiene in serving the homeless population’. Such categories will be presented below.

Results and discussions

Who are these people who live on the street?

The search found 14 articles discussing the PLS’s sociodemographic profile. Most of the articles selected for this literature review introduce experiences or theoretical reflections on the policies for attending PLS from the context of this population segment. In this sense, the main characteristics and definitions found in these articles are presented, with emphasis on the studies carried out in São Paulo (Brazil), Cali (Colombia) and Havana (Cuba), which show in detail the reality of this population.

Barata, Ribeiro, Carneiro Júnior and Silveira (2015) conducted a sociodemographic study on the PLS in the city of São Paulo and reported the following profile: men, non-white, low education, informal and casual workers, income below half a monthly minimum wage. The authors pointed out that people living on the street are among the most marginalized groups in society and that their problems go beyond people living on the street.

Regarding the reality of the Colombian population living on the streets, Hernandéz-Carrilo, Alvaréz-Claros and Osório-Sabogal (2015) observed the following profile in an empirical study developed in the city of Cali: men, with an average age of 40, single, low education, informal work (mainly with recycling), half attended rehabilitation services, use/abuse of psychoactive substances. Barroso and Lopes (2014), in a survey carried out in Cuba, point out that PLS in that country presents social vulnerability with lack of productivity, housing problems, family conflicts and mental health disorders. In addition, a significant part of these people use/abuse psychoactive substances, mainly alcohol.

In these three studies, it is clear that the phenomenon has a face, and it is ugly: the face of poverty, unemployment, isolation, the most perverse face of the ‘social issue’. Raupp and Adorno (2015) explain that due to the history of poverty and the precarious living conditions, this segment becomes more exposed to diseases and violence, which ends up reducing the group’s life expectancy. Still on the profile of the PLS, Serafino and Luz (2015) highlight the precariousness of the social, family and employment dimensions, isolation and loneliness.

Despite the heterogeneity that marks the PLS, such a group generally faces common problems, which in many cases are intertwined and end up in the street situation. Flores, Contreras, Hernandez, Levicoi and Vargas (2015) classify such problems between structural causes - the country’s economic situation, work, legislation, and social institutionality, policies for the reintegration of former prisoners, etc., and biographical causes - which generally are based on a history of poverty and social vulnerability. Nascimento and Justo (2014), in a study carried out with road walkers and users of social assistance services in Brazil, point out socioeconomic, socio-affective, and psychosocial factors in determining the phenomenon of PLS, including unemployment, homelessness, family problems, disillusionment and divorce, death of parents, desire for freedom, mental disorders, use of psychoactive substances, among others.

Besides the factors that lead people to live on the street, the articles point out that the link with the street has different forms and rhythms, occurring in a movement that goes from transitory to permanent in the occupation of public spaces: arriving, living and being from the street (Flores et al., 2015). Regarding the process of linking with the streets, Alcântara, Abreu and Farias (2015) explain that this is a gradual and acute process of social untying and that PLS is at the center of the threshold between poverty and misery, that is, they are people who do not have the minimum existential requirements, such as food, clothing, access to water, rest, protection from rain, cold, and environmental conditions, among other basic conditions that ensure their survival. Because of this situation, sometimes they use strategies of manguear⁶ and asking for alms, in addition to engaging in illegal activities, which corroborates the construction of the social identity of acharcador⁷. In this sense, Silva (2013) points out that social representations about the PLS oscillate between pity and indifference, between fear and elimination, which has an impact on policies directed at such social segment.

Despite the historical social invisibility and the little data about PLS, the articles studied point to the conduction of censuses and surveys at the municipal, state and national levels, carried out mainly in the last decade, regarding this population segment. In Brazil, a national survey on PLS was published in 2008 by the Ministry of Social Development and Fight Against Hunger [MDS]. At the time, 31,922 homeless adults were identified in the 71 municipalities in which the survey was applied (capitals and cities with more than 300 thousand inhabitants) and a number of approximately 50,000 people in this situation was estimated nationwide. The characteristics pointed out by the survey of MDS (2008) was used to create the definition of PLS used by the federal government:

Heterogeneous population group that has in common extreme poverty, broken or weakened family ties and the lack of regular conventional housing, and that uses public places and degraded areas as temporary and permanent space for housing and livelihoods, as well as Institutional shelter for temporary overnight stays or as temporary housing (Decreto nº 7.053, 2009, p. 1).

In 2016, the Institute of Applied Economic Research [IPEA] published an estimate of PLS in Brazil, based on data made available by 1,924 municipalities via the Unified Social Assistance System Census (Censo Suas). In that publication, it was estimated that, in 2015, there were 101,854 homeless people in Brazil.

Regarding the PLS in Chile, Flores et al. (2015) point out that the Ministerio de Desarrollo Social carried out a national survey in 2012 and registered 12,255 homeless people, estimating a population of 15,000 inhabitants living in such a situation in the country. The authors used the definition of PLS constructed by Red Calle and Hogar de Cristo, Third Sector institutions linked to the Catholic Church that historically serve this population in the country:

[…] every individual who finds him/herself in a situation of social exclusion and extreme indigence, specifically with regard to the lack of housing and residence, in turn, the presence of a break in the bonds with significant people (families, friends) and networks of support (Flores et al., 2015, p. 3).

Finally, it is worth highlighting in this section a question about the characterization of PLS addressed in some articles: the street experience as a violation of rights suffered by PLS, but also as a process of breaking with the standards of capitalism and the search for freedom. In this sense, Raupp and Adorno (2015) emphasize that being on the street is a different way of experiencing capitalist society, as the recognition of the subjects is not in their productive capacity, but in the development of adequate strategies for survival, with street cultures, shared codes and behaviors.

On the periphery of downtown or at the center of the periphery?

The second category constructed from reading the articles selected for this literature review brings together issues related to the use of urban spaces by the PLS and the processes of social hygiene directed at this population segment. Among this information, we highlight the observation that many groups of people living on the streets are concentrated in the city downtown. Thirteen articles dealt with this theme spread by Colombia (Cali, Bogotá), Brazil (São Paulo, Santos, Rio de Janeiro), Chile (Valparaíso and Viña del Mar) and Argentina (Rosario, Buenos Aires).

Hernandéz-Carrilo et al., (2015) point out, in their article, that the city downtown of Cali has been slowly becoming a place of habitation for people in poverty, who establish urban cultures with their own rules of coexistence and, above all, survival. These authors also point out that such spaces occupied by thePLS in downtownof cities, end up being characterized as spaces for the use of psychoactive substances, being called ollas or fumaderos.

In São Paulo, the largest Latin American city, the downtown region that is occupied by people on the street and who use psychoactive substances, is pejoratively known as Cracolândia. According to Raupp and Adorno (2015), in the two decades of crack in Brazil, cracolândias represent stages of disputes over proposals and interests. According to the authors, there are cracolândias in several Brazilian cities, places of sales and use of psychoactive substances, on the edge of the city, which are permeated in their daily lives by police repression and social stigma.

Still on these spaces that constitute scenes of crack use, Raupp and Adorno (2015) warn that, instead of denouncing the urban and social degradation of Brazilian cities, the authorities focus the problem on the subjects who use and/or on the substance in itself. Based on this focus, public policies are designed and implemented that reinforce negative stigmas about groups historically present in city downtown and approach them from the perspective of repressive and criminal practices.

The main factors that attract PLS to the city downtown, as reported by Serafino and Luz (2015) in research developed in downtown of Rio de Janeiro, are related to the conditions of survival. The authors pointed out that in such spaces, where trade is intense, there are greater possibilities for bicos⁸ and job opportunities. In addition, city downtown have abandoned buildings with no social use, which are often occupied by the PLS and by people fighting for the right to housing. Still, it is highlighted in this study that most of the social assistance services aimed at people living on the street, are also in the downtown regions.

In the Chilean cities of Valparaíso and Viña Del Mar, Berrota and Muñoz (2013) researched the uses and meanings of public space for homeless people, and found a relationship permeated by survival strategies, with negative (violence) and positive (freedom) factors. The authors mapped the places used by the PLS in the downtown of the aforementioned cities and observed during the day the circulation through commercial spaces and large circulation of people for work and food, and at night, peripheral places in the city downtown, with little circulation, aiming at less exposure to prejudice and violence. Finally, this study highlighted the creation of architectural barriers, new ways of building and organizing public spaces in order to expel the PLS, which in turn responds with new and creative occupation tactics.

On the occupation of spaces in city downtown by PLS in Argentina, two articles (Bufaranni, 2012; Thomasz, 2009) discuss the control over this population based on the interests of capital. In a survey conducted in the city of Rosário, Bufaranni (2012) observed social cleansing policies, in which the municipal guard took mattresses, objects and even documents from people on the streets. The author warns that these practices occurred during the management of a socialist government, which advanced in the implementation of social policies, but which did not sustain the extreme poverty explained by the PLS in the heart of the city, acting, therefore, based on control policies to hide traces of poverty in prime areas. The author also points out that from the discourse of the street as a place of passage, not of housing, a series of conflicts and disputes of meaning about proper uses and legitimate users of public spaces arise, revolving around the city as merchandise, and the right to the city.

Thomasz (2009) carried out a study in a square in the center of the city of Buenos Aires, and pointed out the region as a residual urban space relegated to beings considered residual by society and public authorities. In the studied region there were hostels, institutional shelters, among other services of social assistance and health, and protests from the neighborhood were registered, which mobilized to eliminate such services from the region due to the discomfort caused by the circulation of the PLS that used such services. In this sense, the article pointed out that the city downtown is a space for commerce, history and contradictions, and generated the question ‘who has the right to centrality?’.

Still in the article by Thomasz (2009), the concept of gentrification is presented, which refers to the expulsion of low-resource sectors from central and prime areas, generating socio-spatial segregation and the process of ghettoization. The city, conceived as a commodity, needs to be attractive for new investments, and for that it should be modern, cosmopolitan and hide ‘under the carpet’ its social problems. Thus, the author argues that policies focused on PLS constitute new ways of cleaning cities in order to make misery invisible.

The urban deterioration zones of the city of Bogotá were associated by Gongorá and Suarez (2008) with the main points on the homicide maps of the Colombian capital. In this study, there was an absence of official surveys and statistics on victims of social cleansing, and it was explained how violence regulates social relations, with the PLS being a group that characterizes a type of poverty that is not acceptable by society. According to the aforementioned authors, the “[…] fear of contamination and contagion with marginality makes the disappearance of PLS to be desired”⁹ (Gongorá & Suarez, 2008, p. 136, our translation).

Still in this context, Silva (2013) points out the action to criminalize poverty in the face of mega-events and the shock actions carried out by the city of Rio de Janeiro, removing the PLS from the city and sending it to crowded municipal shelters, using violent methods. The author questions such actions, which communicate that misery must be eliminated, as if the very subhuman conditions of existence, where one survives as one might, were not produced and reproduced in capitalist society, and denounces that there is no concern in resolving social problems, but rather camouflage them.

On the razor’s edge: between guaranteeing rights and social hygiene in serving the homeless population

The service to the PLS through social policies in Latin America has historically occurred through charities and philanthropy linked to the Catholic Church. Currently, many services remain linked to Christian institutions, but in some countries, there are already laws and public facilities designed to monitor this population segment. Most of the articles found in this literature review have experiences and reflections on policies for PLS in Brazil, and the services and policies presented in this country are public and are, above all, within the scope of the Unified Health System (SUS) and Unified Social Assistance System (SUAS). It should be noted that within the Brazilian National Social Assistance Policy (PNAS), there is a provision for public financing for entities in the third sector that perform social assistance services.

Articles with works developed in Cuba and Argentina also reveal the care provided to people on the streets by social policies implemented by the State. In Colombia and Chile, most articles describe the reception and monitoring of PLS by Non-Governmental Organizations (NGOs) and third sector institutions. Regarding the Colombian reality, Rativa, Rojas, Reina and Felizzola (2007) presented an article on the institutions that serve PLS in the country and pointed out that 72% of these institutions are private and 52% religious, with Christian bases that “[…] support their intervention almost exclusively in the word of God” (p. 100, our translation) ¹⁰.

Otolvargo and Arango (2009), in a study carried out in the city of Medellín, highlighted mixed policies of attention to PLS, as in the case of health, in which, when presenting a certificate of indigence, the municipality pays the health expenses of this public in private establishments. Despite the availability of this service, the authors emphasize the prejudice and barriers of access of the population to these services, which made 76% PLS participating in the research to recognize their right to health, but most believed that access to health it is not free/guaranteed.

In the research on the social assistance assistance to the PLS in Argentina, Seidmann, Di lorio, Azzollini and Rigueiral (2015) found services and entities of different natures: governmental and non-governmental, religious, community, among others, and observed that they organize themselves from two distinct logics: tutelary and restorative. The first is based on a conception of PLS as an object of charity and on a moralistic ethics, while the second comprises people living on the street as subjects who must have their rights restored based on an ideal of relational ethics. Such logics coexist and tension the different conceptions of socio-assistance focused on people who live on the streets of the country.

Another essential point highlighted in the articles selected for this review is the legislation, which is generally recent, that guides the service to the PLS and the guarantee of social rights to this segment. In Brazil, only in 2009, the National Policy for the Population living on the street was enacted. In Chile, according to Alvaréz, Berrical, Miranda and Olivares (2015), it was only in 2005 that the federal government recognized PLS as a state issue. In 2014, ‘the Rua Chile Solidário Program’ was created with the objective of improving the living conditions of the PLS in the areas considered most significant in relation to this population segment.

The priority areas addressed in the reviewed articles deal with health and social assistance services and policies. Regarding the former, Paiva, Lira, Justino, Miranda and Saraiva (2016) point out the need to overcome the biomedical and medicalization model in health care. According to the aforementioned authors, a large part of the scientific production associates the PLS health-disease process with dermatitis, hematosis and psychic suffering, and relates them to the PLS’s lifestyles, which, supported by a logic of meritocracy, generates individual blame and masks the relationship of determination of health-disease processes and living and working conditions of people living on the streets, who generally have their bodies as their main means of subsistence.

Continuing the discussion on health policies for PLS under SUS, Engstrom and Teixeira (2016) reported the existence of barriers to access to health care for this segment, which ends up being invisible to the system. The authors pointed out that PLS has difficulty using primary health care (APS) and only seek emergency services in serious and life-threatening situations. To overcome these difficulties, the need for creative and singularized work processes according to the needs of the clientele is pointed out, and not only to control symptoms, but also for a professional performance aimed at the full exercise of citizenship and social support, with a clinic expanded and shared in the perspective of life preservation.

Regarding the health conditions of the PLS in the city of Salvador, State of Bahia, Aguiar and Iriart (2012) observed better health conditions among homeless people who were users of hostels and institutional shelters. For the authors, this fact is possibly due to the greater access to hygiene and food by those who access the institutions. Despite the undeniable importance of social assistance services for the provision of existential minimum, such as food, hygiene and rest, such services present serious problems.

In this sense, Kunz, Heckert and Carvalho (2014), in a study on institutional sheltersfor PLS in the city of Vitória, State of Espírito Santo, came to the conclusion that such institutions have high costs and low effectiveness. In such spaces, PLS is treated in a childlike way, with excessive rules, deindividualized, and, for this reason, many people who live on the streets know public policies, but do not always use them, preferring to build care networks with PLS groups and other city residents. In the same direction, Biscoto, Jesus, Silva, Oliveira and Merigui (2016) in a study conducted with women on the streets in the State of Minas Gerais, observed that, in relation to social public policies, in Brazil, the hostel is configured as the main strategy aimed at sheltering and meeting the needs of the PLS, however, although such social equipment is important and valued by this population, there is dissatisfaction with the rigid rules and violations of rights within these institutions.

Still on social assistance services, Souza, Silva and Caricari (2007) pointed to isolated, welfarism, centralized practices that sustain and aggravate the street situation. Nascimento and Justo (2014), on the other hand, observed assistance clientelism and reflected in their article on social assistance policy as ‘management of misery’, and the homogenization of individuals into a mass of miserable people. The authors argue that what should be questioned is not the basic socio-assistance services offered, but the State’s socio-political strategies on these lives.

Considering the PLS care flow between SUS and SUAS in Brazil, Borysow and Furtado (2014) observe that this segment is in limbo between the two systems. This hypothesis is reinforced by the argument that, on the one hand, health workers have reservations in relation to PLS, seen as having ‘social issues’, objects of care and services of SUAS, on the other, social assistance workers feel unfamiliar and overwhelmed when welcoming individuals in mental distress and who abuse psychoactive substances. The authors observed that the social assistance services are forced, in many situations, to receive them indiscriminately and in an isolated way, since they end up being the only alternative for the care to the PLS, including for people with severe mental disorders, and, still, there is greater discrimination in health services, which act as if the PLS had no needs other than those related to the use/abuse of psychoactive substances.

Concerning this focus on the consumption of psychoactive substances as the main problem of PLS, Hallais and Barros (2015) consider the direct relationship ‘street drugs’ to be the wrong basis for public actions and policies directed to PLS, since it is a complex phenomenon, permeated by several determinations that intertwine. In a survey accompanying the work of the Consultório na Rua (CnaR) teams, the authors pointed out some main issues that impact the health of this segment: diseases, climatic variations, unhealthiness, little food, police violence, etc., and defend as a political strategy the hypervisibility of care lines for situations imposed by life on the street and the construction of therapeutic bonds that deconstruct stigmatizing practice.

CnaR was created in 1999 as an extension project linked to the Federal University of Bahia (UFBA), and was named as Consultório de Rua (CR). Subsequently, it was adopted nationally as a SUS policy. Since its implementation, it has been categorized as a service linked to mental health, especially for the care of people who abuse psychoactive substances. After revisions, there was a change in nomenclature - CR to CnaR - and it became a service linked to SUS Primary Care. Among its main assumptions and proposals for action are the embracement and establishment of links for the subsequent construction of therapeutic projects, network mapping, territorialization, and monitoring of PLS flows and migrations, greater flexibility in the rules of access to health services, respect users’ time and knowledge, emphasis on interdisciplinarity and popular health education.

In addition to the CnaR experience, other articles were found with reports of extension projects developed by Higher Education Institutions (HEIs) focused on PLS. In this sense, Canônico et al. (2007) addressed the extension action A gente na rua (We on the street), developed by the School of Health of the University of São Paulo (USP) with the objective of active search for treatment of tuberculosis among recyclable material collectors and PLS. This project was developed in response to PLS claims in the act called Grito dos Excluídos, which took place on July 23, 2003 in the city of São Paulo, State of São Paulo, and included nurses and health agents, who, together with students and teachers, managed to increase the rates of adherence and completion of tuberculosis treatments.

Finally, Barros, Galvani, Almeida and Soares (2013) described university extension activities carried out at the Meeting and Culture Point (PEC) in the city of São Paulo. The PEC hosted several projects and accompanied social movements, including the National Movement of Street People (MNPR). According to the authors, it was a space of meaning, an artistic, cultural, political expression, collective agency and more unique personal productions. At the PEC, political leadership training and joint construction of projects were carried out between students and activists from the MNPR, including RevistaOcas and the project of the National Center for the Defense of Human Rights of the Homeless and Recyclable Material Collectors (CNDDH). In this work, the respect and dialogue that should occur between HEIs and popular knowledge/culture was emphasized, and the importance of extension projects in the training of professionals who will work with PLS in the field of public policies.

Final considerations

The study analyzed the scientific literature that addresses social policies and PLS in Latin American countries. The analogous profile of homeless people was found in the different countries covered, with regard to characteristics such as prejudices, stigmas and violence suffered, absence of work or precarious/informal work, in addition to the lack of housing, highlighting the notion pointed out that such a segment is the true expression of the ‘social issue’. In the same way, we can see that the PLS is made up of people with different characteristics, particular histories and different ways of being and relating to the urban space. In the cities, the central and degraded territories appear as the main survival sites and services for the care to the PLS. A space of contradiction that at the same time approaches, segregates and expels people living on the streets.

Moreover, from the recent public policies created that aim to guarantee rights, it is highlighted that the razor’s edge invariably ends up cutting to the side of welfarism, and even criminalization, historical repudiations of the treatment given by Latin American States to this population segment since the process of colonization of countries in the region by Europeans. On the other hand, it is essential to recognize the advances in the creation of laws, services and policies that work with the PLS from the perspective of guaranteeing rights, and it is essential that this path continues to be followed, or ‘to point the razor at this side’.

The main emphases found in the studies on PLS were in the areas of social assistance and health. Few studies have addressed housing, education and work/income policies for the segment. In this sense, it is necessary to question the existence of housing policies for homeless people, or how the State addresses this issue, which should be central to serving this social segment. In the same way, we could question the lack of studies and social policies that address work for this segment, and the category of work is fundamental to the structuring of people and society.

Most of the studies that address the theme of PLS and public policies were produced in Brazil. Most of the guarantees implemented for the segment in the Brazilian context are due to the organization, pressure and occupation by the MNPR in different instituted spaces and others instituting participation/social control that deliberate on public policies. Therefore, we propose the conduction of studies that analyze, understand and strengthen the MNPR as a collective space for mobilization, guaranteeing rights and social transformation for people living on the streets.

In addition, in the studies on PLS, few references and citations are found among Latin American countries, in contrast, most of the citations come from North-American and European studies. In this sense, the importance of new studies on the theme is highlighted, preferably that they share experiences between the countries of the Latin American continent.

Thus, with the advancement of the neoliberal agenda, there is an impending need to deepen the discussion about the determination that produces social inequality, aiming to overcome it and advance in the construction of fairer sociability modes and in which people can access social rights for a lifetime with dignity. It is also essential to advance the implementation of social policies that aim to enable the real access to social rights by the PLS.

It is possible to see that there is still a contradiction between the gains with the advancement of social policies aimed at the PLS, and the fact that they are still preferentially welfarism. Furthermore, these guarantees remain fragile and, in these times of instability and neoliberal advancement in the political and economic situation in Latin American countries, the impact on PLS leads to the worsening of already terrible conditions of denial of rights. In this sense, the mobilization and struggle for their conquest, as they have been happening in recent years, must be sustained, showing that what is at stake is not the appeal for the benefit from governments, but the search for historically denied rights.

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• 5
  The social issue hereisunderstood as “[...] a set of political, social and economic problems posed by the emergence of the working class in the process of constituting capitalist society. In other words, it is about the manifestation, in the daily life of social life, of the capital-labor contradiction”(Yamamoto & Oliveira, 2014, p. 23).
• 6
  The meaning of the word manguear is to use artifice to get what you want; put on weight, deceive. It is widely used by the PLS to express a way of obtaining, using conversation, subsidies to survive, be it food or money, for example.
• 7
  Acharcar refers to the act of asking for money, food or essential items by the PLS through dialogues and explanations about their living conditions.
• 8
  Slang used in Brazil to name short-term jobs.
• 9
  “[...] el temor a la contaminación y al contagio de la marginalidad y la maldad, que explica el miedo hacia los habitantes de la calle que implica que su desaparición llegue a ser deseada”.
• 10
  “Otras no lohacen por basarsu intervención, casi exclusivamente, em la palabra de Dios”.

Publication Dates

• Publication in this collection
  07 Dec 2020
• Date of issue
  2020

History

• Received
  21 Oct 2018
• Accepted
  06 Apr 2020