Domestic and urban violence faced by community health workers: a multidimensional analysis in vulnerable territories in northeastern Brazil during and after the COVID-19 pandemic.

Background: Community Health Workers (CHWs) play a critical role in frontline public health, especially in vulnerable regions. However, their exposure to violence remains an understudied issue. This study explores how CHWs gender shape the perception and experience of different types of violence in Northeastern Brazil during and after the COVID-19 pandemic. Methods: We conducted a cross-sectional analysis using data collected from 3800 CHWs in 2021 and 2023, across eight municipalities in Northeastern Brazil. Data were analyzed by gender, comparing perceptions and reported experiences of domestic (DV) and urban violence (UV). Inference used Cochran-Mantel-Haenszel (CMH) pooled odds ratios with Breslow-Day tests for homogeneity. Findings: Male CHWs consistently reported higher perception to urban violence (CMH OR 0.67 [95% CI 0.53-0.83]; Interpretation: Violence is not experienced or perceived uniformly, rather, it is shaped by gender roles and context. Female CHWs demonstrated greater sensitivity to domestic and sexual violence, while male CHWs were more attuned to urban violence and criminal dynamics. These are self-reported signals and should be interpreted with appropriate caution, yet they provide actionable intelligence for local prevention. Recognizing CHWs as strategic observers of community suffering, this study underscores the urgent need for intersectional, gender-responsive, and territorially differentiated public policies. Funding: This project was funded by FUNCAP, Fiocruz-PMA, and the Lemann Research Fund from Harvard University.