Sexual Health

From "combined prevention" to "comprehensive prevention": building the response to the syndemic with adolescents and youth in São Paulo, Brazil (2020-2023).

TL;DR

This essay argues for transitioning from 'combined prevention' to 'comprehensive prevention' as a conceptual framework better suited to addressing the syndemic nature of overlapping health and social crises affecting adolescents and youth in São Paulo, Brazil.

Key Findings

The concept of 'comprehensive prevention' was found to better address syndemics than the prior framework of 'combined prevention' by incorporating human rights, psychosocial dimensions, and territorial context.

  • The intervention research was conducted across three cities in the state of São Paulo, Brazil: São Paulo, Santos, and Sorocaba, from 2020 to 2023.
  • Comprehensive prevention addressed overlapping vulnerabilities including COVID-19, mpox, STIs/AIDS, violence, unwanted pregnancy, and psychosocial distress.
  • The framework was described as 'particularly effective in preparing for syndemic cycles within the context of environmental crises.'
  • The approach emphasized co-construction of 'transversal skills in the personal, collective and territorial responses.'

Political polarization driven by the far right was identified as a structural barrier that inhibits human rights-based approaches to sexual health and amplifies health misinformation (infodemic) among youth.

  • Far-right political polarization was described as 'aggressively inhibiting approaches based on human rights, especially in the field of sexuality.'
  • This polarization was found to enhance 'the infodemic that downplays the severity of ongoing pandemics.'
  • The framework encouraged young people to 'develop creative responses to political polarization fueled by the far right.'
  • Social crisis was identified as intensifying the syndemic nature of pandemics.

The use of 'scenes' as units of interpretation and intervention focal points was identified as a productive methodological approach for addressing vulnerability contexts among adolescents and youth.

  • Scenes were adopted as 'units of interpretation and focal points for responding to contexts of vulnerability.'
  • This approach favored 'the co-construction of transversal skills in the personal, collective and territorial responses.'
  • The methodology was applied specifically in 'marginalized territories' (periferias).
  • The scenes approach was described as enabling responses that 'dynamically anticipate and address events that synergistically overlap.'

The concept of comprehensive care ('integralidade') was found productive for developing initiatives that dynamically anticipate and address synergistically overlapping health and social adversities in peripheral territories.

  • The paper underlines 'the productivity of the concept of comprehensive care in developing initiatives related to human rights and prevention.'
  • These initiatives were designed to address adversities 'that threaten adolescents and youth both physically and mentally.'
  • The framework addressed events occurring concomitantly across physical and mental health dimensions.
  • The approach was framed as suited to contexts where multiple epidemics overlap synergistically in marginalized settings.

Comprehensive prevention was concluded to be a more adequate conceptual framework than combined prevention for guiding responses to the syndemic context of pandemic cycles intensified by social and environmental crises.

  • The transition proposed is from 'combined prevention' to 'comprehensive prevention' ('prevención integral' in Spanish).
  • The framework addressed the sexual and reproductive health of adolescents and youth specifically.
  • The essay concludes that comprehensive prevention 'provided guidance for addressing the syndemic nature of pandemics intensified by social crises.'
  • The study period covered 2020–2023, encompassing both the COVID-19 pandemic and the mpox outbreak.

What This Means

This research essay examines how public health programs in Brazil can better protect young people's sexual and reproductive health when multiple health crises hit at the same time. The researchers worked with adolescents and youth in three cities in São Paulo state between 2020 and 2023, a period that included COVID-19, mpox, and ongoing threats like HIV/AIDS, violence, unwanted pregnancy, and mental health challenges. They found that the existing framework of 'combined prevention' — which focuses on layering specific biomedical tools like condoms and testing — was insufficient for dealing with these overlapping crises, and proposed a broader concept called 'comprehensive prevention' that also addresses social inequalities, human rights, and the contexts in which young people actually live. This research suggests that when pandemics and social crises occur together (what researchers call a 'syndemic'), health programs need to go beyond individual risk behaviors and address the social and political environments that make people vulnerable in the first place. The study highlights how far-right political movements in Brazil actively blocked human-rights-based approaches to sexuality education and spread misinformation about health threats, making young people — especially those in marginalized communities — even more vulnerable. The researchers used 'scenes' from everyday life as a practical tool to help young people recognize and respond to these overlapping risks in their own communities. This research suggests that health programs for youth in contexts of political polarization and environmental crisis need frameworks that can simultaneously address physical health, mental health, violence, and social rights. By building skills at personal, community, and territorial levels, comprehensive prevention aims to prepare young people to respond creatively and collectively to adversities that do not occur in isolation from one another.

Have a question about this study?

Citation

Paiva V, Ayres J, França Junior I, Garcia M, Silva C, Simões J, et al.. (2025). From "combined prevention" to "comprehensive prevention": building the response to the syndemic with adolescents and youth in São Paulo, Brazil (2020-2023).. Cadernos de saude publica. https://doi.org/10.1590/0102-311XEN084323