Maria Andréa Loyola

Sexualidade e medicina: a revolução do século XX

O artigo discute a contribuicao da medicina, segundo o controle normativo e tecnologico da sexualidade feminina e do processo reprodutivo (parto, aleitamento, contracepcao e tratamento das infertilidades) para a construcao, durante o seculo XX, de um novo modelo de reproducao (biologica e social), calcado em uma mudanca radical das identidades e das relacoes e formas de uniao entre os sexos (desagregacao de lacos matrimoniais tradicionais, crescimento das unioes consensuais, monogamia serial, etc.). Este modelo se sustenta em uma separacao radical entre sexualidade e reproducao correlata de um modelo unico e horizontal de sexualidade (contrariamente ao modelo hierarquico dos dois sexos do seculo XIX), dirigida primordialmente para o prazer e progressivamente desvinculada dos lacos sociais e afetos que lhes sao correspondentes. Discute, alem da contribuicao da medicina (notadamente a partir dos efeitos da reproducao assistida) e da sexologia (universalizacao do imperativo do orgasmo), a contribuicao da epidemiologia (por meio das pesquisas relacionadas a AIDS) para a transformacao de uma normal moral sobre a sexualidade em uma norma abstrata e meramente estatistica.This paper discusses the role of medicine, ranging from the normative and technological control of womens sexuality ad reproductive process (childbirth, breastfeeding, contraception, and treatment of infertility) through the construction of a new (biological and social) reproductive model, based on a radical change of identities, relations, and forms of union between the sexes (a break with the traditional concept of marriage, growth of open unions, serial monogamy, etc.). This model is sustained by a radical distinction between sexuality and reproduction, related to a unique and horizontal model of sexuality (in opposition to the hierarchical 19th-century two-sexes model); the new model focuses mainly on pleasure and moves progressively away from social ties and affection. In addition to the contribution of medicine (notably through assisted reproduction) and sexology (universalization of the orgasm imperative), the paper also discusses the contribution of epidemiology (through AIDS-related research) to the transformation of a moral sexual norm into an abstract and merely statistical standard

Sexualidade e reprodução

Ao contrario do que se supoe ainda hoje, as sociedades organizam e intervem nos diferentes momentos da sequenciado processo reprodutivo, desde a organizacao social do coito, da gravidez, do parto e da amamentacao, ao numero e a socializacao das criancas, sendo todo momento da sequencia reprodutiva um terreno possivel de decisao, de gestao e de conflito. Os aspectos que comandam a organizacao desses diferentes momentos estao relacionados com as formas de organizacao social, a divisao sexual do trabalho, os sistemas de representacao e, em particular, as concepcoes acercadas formas das relacoes entre os sexos. Dependendo da configuracao desses aspectos num dado momento, e possivel falar em diferentes sistemas ou diferentes modelos de reproducao. Discutem-se aqui algumas hipoteses sobre a construcao, enquanto tipo ideais, desses modelos.

A Saga das Ciências Sociais na área da Saúde Coletiva: elementos para reflexão

O aporte das ciencias sociais, a partir dos anos 1970, atraves de suas teorias e metodologias ja consolidadas, foi indispensavel para o desenvolvimento e consolidacao da area que, no campo da saude, se tornou conhecida como Saude Coletiva. Em contraste com sua participacao, as ciencias sociais sempre ocuparam um lugar subalterno neste campo, dominado, em seus primordios, isto e, durante as decadas de 1970 e 1980, pelo planejamento em saude e, a partir da decada de 1990, pela epidemiologia. O dominio da epidemiologia acontece justamente quando, reconhecida pela Capes como uma area autonoma, esperava-se maior equilibrio entre as diferentes disciplinas que compoem a area da Saude Coletiva. Este estudo levanta questoes sobre a situacao das ciencias sociais na area, em relacao com a execucao da politica de fomento das agencias nacionais - Capes e CNPq. A imposicao de uma logica custo-beneficio de carater predominantemente economicista e quantitativista, aplicada pelas agencias na concessao de recursos, interfere tanto na producao quanto na circulacao do conhecimento, com prejuizos para as ciencias sociais. Contornar essa situacao constitui um dos desafios que se colocam hoje para as ciencias sociais e, em particular, para a area da Saude Coletiva.

Drugs, health policy and AIDS: changes in a dependent policy

Since the 1970s the Brazilian government has made efforts to implement a pharmaceutical policy that, in spite of a market predominantly oligopolized and dominated by multinational pharmaceutical industries, guarantees access to essential drugs for the population. In this context, in 1999, a law regarding generics was approved. This article aims at analyzing the elements that interfered in the implementation process of this law. Based on specialized bibliography, on the debate in the Brazilian press (1992-2002) and on interviews with industry members, physicians, politicians, activists and civil servants we try to show that the implementation of generics in Brazil is strongly related to the AIDS epidemic. More precisely, it is related to the successful health policy against this disease involving different actors and a variety of elements to be analyzed here, among them the policy of copycat versions of drugs, the law of universal access to anti-AIDS drugs, the struggle of organized social movements, the governmental bureaucracy implemented for fighting this epidemic and the strong mobilization of the media.

Novas tecnologias reprodutivas: novas estratégias de reprodução?

A partir de entrevistas realizadas com um grupo de mulheres que tem, ou tiveram, dificuldade de engravidar, este estudo discute imagens da familia, da crianca e da paternidade / maternidade, apos o surgimento das novas tecnologias reprodutivas. A possibilidade de realizacao de bebes de proveta e ainda marcada por aspectos contraditorios, que colocam dificuldades para as pessoas e casais desejosos de reproducao, e que as utilizam ou pretendem utiliza-las. Quase totalmente instaladas no setor privado da medicina, a introducao e a difusao dessas tecnologias reproduzem a mesma logica excludente que vige no quadro da saude brasileira.

Sexualidade e medicina: a revolução do século XX: the 20th-century sexual revolution

O artigo discute a contribuicao da medicina, segundo o controle normativo e tecnologico da sexualidade feminina e do processo reprodutivo (parto, aleitamento, contracepcao e tratamento das infertilidades) para a construcao, durante o seculo XX, de um novo modelo de reproducao (biologica e social), calcado em uma mudanca radical das identidades e das relacoes e formas de uniao entre os sexos (desagregacao de lacos matrimoniais tradicionais, crescimento das unioes consensuais, monogamia serial, etc.). Este modelo se sustenta em uma separacao radical entre sexualidade e reproducao correlata de um modelo unico e horizontal de sexualidade (contrariamente ao modelo hierarquico dos dois sexos do seculo XIX), dirigida primordialmente para o prazer e progressivamente desvinculada dos lacos sociais e afetos que lhes sao correspondentes. Discute, alem da contribuicao da medicina (notadamente a partir dos efeitos da reproducao assistida) e da sexologia (universalizacao do imperativo do orgasmo), a contribuicao da epidemiologia (por meio das pesquisas relacionadas a AIDS) para a transformacao de uma normal moral sobre a sexualidade em uma norma abstrata e meramente estatistica.This paper discusses the role of medicine, ranging from the normative and technological control of womens sexuality ad reproductive process (childbirth, breastfeeding, contraception, and treatment of infertility) through the construction of a new (biological and social) reproductive model, based on a radical change of identities, relations, and forms of union between the sexes (a break with the traditional concept of marriage, growth of open unions, serial monogamy, etc.). This model is sustained by a radical distinction between sexuality and reproduction, related to a unique and horizontal model of sexuality (in opposition to the hierarchical 19th-century two-sexes model); the new model focuses mainly on pleasure and moves progressively away from social ties and affection. In addition to the contribution of medicine (notably through assisted reproduction) and sexology (universalization of the orgasm imperative), the paper also discusses the contribution of epidemiology (through AIDS-related research) to the transformation of a moral sexual norm into an abstract and merely statistical standard

Tecnologias de reprodução assistida no Brasil: opções para ampliar o acesso

This article revisits the pattern of assimilation and dissemination of assisted reproductive technologies (ART) in Brazil, characterized by extreme concentration of this technology in the private medical sector and very low setting in the application of these techniques. This pattern has generated enormous difficulties and barriers to access to these techniques, basically for economic reasons. From the presentation of the overview of the history of ART, the article focuses on two cases that may propose solutions for excessive exclusion access, although it does not modify the same privatization logic that marks RT in the country, since the problem of infertility was not prioritized, so far, by the Unified Health System. The first, brought by the pharmaceutical industry, consists of a subsidized purchasing program of drug users by the so-called Programa Acesso. The second proposal, known as shared ovules donation, implies the exchange between two women, of biologically scarce reproductive materials (oocytes). This exchange occurs, in general, from a woman who has ovules and cannot afford treatment and another who has no ovules to reproduce, and pays for the treatment of the donor. Both proposals diffuse a legal framework rather poorly regulated in terms of the application of ART, but prohibit practices not authorized in the Constitution and criminalized in penal law such as the sale of human organs and tissues in general, as well as volunteers to payment tests for research. In terms of methodology, the article assumes monographic character and literary debate, but is also based on the collection of recent secondary data, as well as numerous empirical studies conducted over the last 25 years by the authors.

Regulating the Copy Drug Market in Brazil: Testing Generics and Similar Medicines (1999–2015)

The chapter, written by Marilena Correa, Maurice Cassier and Maria Andrea Loyola, shows the formation, expansion and regulation of the similar and generic medicines’ markets since the 1990s. In particular, it explores the diffusion of bio-equivalence tests for the copy of both similar and generic medicines. The bio-equivalence tests carried out in centres authorized by ANVISA measure the quality of copies to guarantee their interchangeability with first medicines. The growth of the bio-equivalence test market and the extension of the network of bio-equivalence centres approved by the Health Surveillance Agency is a keystone in the construction of the pharmaceutical innovation system. In 2000, the national bio-equivalence centres performed only 27 percent of all bio-equivalence tests, whereas in 2010 they performed 87 percent of them. The process of standardizing Brazilian copies has until now been oriented primarily towards the needs of the domestic and regional markets. Obtaining the WHO prequalification standard could represent a new frontier of this standardization, aimed at international donor markets such as those of the Global Fund. To date, no Brazilian firm has acquired WHO prequalification, in contrast to Indian firms which make substantial use of them to conquer global generics markets.

Sexuality and medicine

O artigo discute a contribuicao da medicina, segundo o controle normativo e tecnologico da sexualidade feminina e do processo reprodutivo (parto, aleitamento, contracepcao e tratamento das infertilidades) para a construcao, durante o seculo XX, de um novo modelo de reproducao (biologica e social), calcado em uma mudanca radical das identidades e das relacoes e formas de uniao entre os sexos (desagregacao de lacos matrimoniais tradicionais, crescimento das unioes consensuais, monogamia serial, etc.). Este modelo se sustenta em uma separacao radical entre sexualidade e reproducao correlata de um modelo unico e horizontal de sexualidade (contrariamente ao modelo hierarquico dos dois sexos do seculo XIX), dirigida primordialmente para o prazer e progressivamente desvinculada dos lacos sociais e afetos que lhes sao correspondentes. Discute, alem da contribuicao da medicina (notadamente a partir dos efeitos da reproducao assistida) e da sexologia (universalizacao do imperativo do orgasmo), a contribuicao da epidemiologia (por meio das pesquisas relacionadas a AIDS) para a transformacao de uma normal moral sobre a sexualidade em uma norma abstrata e meramente estatistica.This paper discusses the role of medicine, ranging from the normative and technological control of womens sexuality ad reproductive process (childbirth, breastfeeding, contraception, and treatment of infertility) through the construction of a new (biological and social) reproductive model, based on a radical change of identities, relations, and forms of union between the sexes (a break with the traditional concept of marriage, growth of open unions, serial monogamy, etc.). This model is sustained by a radical distinction between sexuality and reproduction, related to a unique and horizontal model of sexuality (in opposition to the hierarchical 19th-century two-sexes model); the new model focuses mainly on pleasure and moves progressively away from social ties and affection. In addition to the contribution of medicine (notably through assisted reproduction) and sexology (universalization of the orgasm imperative), the paper also discusses the contribution of epidemiology (through AIDS-related research) to the transformation of a moral sexual norm into an abstract and merely statistical standard

Sexuality and medicine: the 20th-century sexual revolution

O artigo discute a contribuicao da medicina, segundo o controle normativo e tecnologico da sexualidade feminina e do processo reprodutivo (parto, aleitamento, contracepcao e tratamento das infertilidades) para a construcao, durante o seculo XX, de um novo modelo de reproducao (biologica e social), calcado em uma mudanca radical das identidades e das relacoes e formas de uniao entre os sexos (desagregacao de lacos matrimoniais tradicionais, crescimento das unioes consensuais, monogamia serial, etc.). Este modelo se sustenta em uma separacao radical entre sexualidade e reproducao correlata de um modelo unico e horizontal de sexualidade (contrariamente ao modelo hierarquico dos dois sexos do seculo XIX), dirigida primordialmente para o prazer e progressivamente desvinculada dos lacos sociais e afetos que lhes sao correspondentes. Discute, alem da contribuicao da medicina (notadamente a partir dos efeitos da reproducao assistida) e da sexologia (universalizacao do imperativo do orgasmo), a contribuicao da epidemiologia (por meio das pesquisas relacionadas a AIDS) para a transformacao de uma normal moral sobre a sexualidade em uma norma abstrata e meramente estatistica.This paper discusses the role of medicine, ranging from the normative and technological control of womens sexuality ad reproductive process (childbirth, breastfeeding, contraception, and treatment of infertility) through the construction of a new (biological and social) reproductive model, based on a radical change of identities, relations, and forms of union between the sexes (a break with the traditional concept of marriage, growth of open unions, serial monogamy, etc.). This model is sustained by a radical distinction between sexuality and reproduction, related to a unique and horizontal model of sexuality (in opposition to the hierarchical 19th-century two-sexes model); the new model focuses mainly on pleasure and moves progressively away from social ties and affection. In addition to the contribution of medicine (notably through assisted reproduction) and sexology (universalization of the orgasm imperative), the paper also discusses the contribution of epidemiology (through AIDS-related research) to the transformation of a moral sexual norm into an abstract and merely statistical standard