Implementation of Harm Reduction Toward Crack Users in Brazil: Barriers and Achievements

Abstract

From 2002 to 2005, we evaluated five Brazilian harm reduction programs ran by active drug users who distributed pipes, condoms, educational material, and provided referral to crack users. System-wide barriers identified: funds discontinuation and legislation barriers toward fieldwork. Major achievements: increased access to health, social, and psychological support. Crack-cocaine users experience a plethora of health/social problems, attenuated by low-threshold and user-friendly interventions, particularly those developed by other drug users. However, a stronger political commitment is needed to face a fast growing crack-cocaine epidemic in Brazil, aiming to ensure availability/continuity of funds, implementation of large-scale interventions, outreach workers training, and proper evaluation.

Keywords :

• crack
• cocaine
• Brazil
• program evaluation
• harm reduction
• HIV
• AIDS
• crack-cocaine

THE AUTHORS

A. Domanico, psychologist, PhD, MPH, is a Visiting Research Assistant Psychologist in the Integrated Substance Abuse Programs, Department of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at UCLA, Los Angeles, USA. She has more than 20 years of experience working in the field of drug abuse and drug policy. Dr Domanico is a human rights activist and former employee of the Brazilian Ministry of Health with large experience in harm reduction strategies, HIV/AIDS, and Hepatitis prevention and treatment and advocacy strategies. During 2009/2010 she was a Hubert H. Humphrey Fellow at the Mental Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore.

M. Malta, Ph.D., M.P.H., is an Associated Researcher at the Social Science Department, National School of Public Health (DCS/ENSP) from Oswaldo Cruz Foundation, Rio de Janeiro, Brazil. She has been working for 15 years in the field of HIV/AIDS and substance abuse and has (co-) authored several papers and/or book chapters on drug use, HIV/AIDS, and related themes. Dr Malta has also worked on multiple collaborative projects sponsored by the CDC, NIH, Ford Foundation, and WHO, among others. During 2004/2005 she was a Hubert H. Humphrey Fellow at the Mental Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore.

GLOSSARY

• Harm Reduction: Harm reduction, or harm minimization, refers to a range of pragmatic and evidence-based public health policies designed to reduce the harmful consequences associated with drug use, abuse, and dependence.

• HBV: The infectious agent of Hepatitis B. The virus causes inflammation of the liver and is spread by direct contact with infected blood and infected bodily fluids (e.g., through unprotected sex).

• HCV: The infectious agent of hepatitis C. The virus was formerly known as non-A non-B hepatitis and is spread by direct contact with infected blood.

• HIV: Human Immunodeficiency Virus, the virus that causes AIDS.

• STI: Sexually Transmitted Infection.

• TB: Tuberculosis, an infectious disease characterized by the formation of abnormal hard swellings in tissues of the body, especially in the lungs.

Notes

2 The Brazilian STD/AIDS and Viral Hepatitis Department was created in 1986 by the Surveillance Unit of Brazilian Ministry of Health