BackgroundDespite the growing attention surrounding crack cocaine use in Brazil, little is understood about crack users’ histories, use patterns and the interplay of drug-use behaviors, settings, and access/barriers to care. Qualitative studies seldom cross-compare findings regarding people who use crack from different settings. This study aims to explore the insights of regular crack users in two major Brazilian cities and to examine how social and contextual factors, including stigma and marginalization, influence initial use and a range of health and social issues.MethodsIn-depth interviews and focus groups were conducted with 38 adult crack cocaine users recruited from impoverished neighborhoods in Rio de Janeiro and São Paulo. Interviews and focus groups were audio recorded and transcribed verbatim. Qualitative analysis was carried out, and content was organized and analyzed by recurrent themes relevant to study interests.ResultsFor study participants from both cities, frequent crack cocaine use plays a central role in daily life and leads to a range of physical, psychological, and social consequences. Common concerns among users include excessive crack use, engagement in risky habits, infrequent health service utilization, marginalization, and difficulty reducing use.ConclusionsDisadvantaged conditions in which many crack cocaine users grow up and live may perpetuate risk behaviors and stigma may further marginalize users from necessary health and recovery services. Reducing stigma and moralizing discourse related to drug use, especially among health professionals and law enforcement personnel, may help encourage users to seek necessary care. New harm-reduction-based care and treatment alternatives for marginalized drug users are being developed in parts of Brazil and elsewhere and should be adapted and expanded for other populations in need.
Background and ObjectivesThe use of “operational criteria” is a solution for low reliability, contrasting with a prototypical classification that is used in clinics. We aim to measure the reliability of prototypical and ICD-10 diagnoses.MethodsThis is a retrospective study, with a convenience sample of subjects treated in a university clinic. Residents reviewed their diagnosis using ICD-10 criteria, and Cohen's kappa statistic was performed on operational and prototype diagnoses.ResultsThree out of 30 residents participated, reviewing 146 subjects under their care. Diagnoses were grouped in eight classes: organic (diagnoses from F00 to F09), substance disorders (F10–F19), schizophrenia spectrum disorders (F20–F29), bipolar affective disorder (F30, F31, F34.0, F38.1), depression (F32, F33), anxiety-related disorders (F40–F49), personality disorders (F60–F69), and neurodevelopmental disorders (F70–F99). Overall, agreement was high [K = 0.77, 95% confidence interval (CI) = 0.69–0.85], with a lower agreement related to personality disorders (K = 0.58, 95% CI = 0.38–0.76) and higher with schizophrenia spectrum disorders (K = 0.91, 95% CI = 0.82–0.99).DiscussionUse of ICD-10 criteria did not significantly increase the number of diagnoses. It changed few diagnoses, implying that operational criteria were irrelevant to clinical opinion. This suggests that reliability among interviewers is more related to information gathering than diagnostic definitions. Also, it suggests an incorporation of diagnostic criteria according to training, which then became part of the clinician's prototypes. Residents should be trained in the use of diagnostic categories, but presence/absence checking is not needed to achieve operational compatible diagnoses.
ResumoIntrodução: A investigação sistemática e detalhada dos comportamentos sexuais de risco constitui um dos principais alicerces para o desenvolvimento de pesquisas que visam à criação de intervenções eficazes para a prevenção do HIV. Objetivo: Descrever e discutir as etapas do processo de adaptação lingüístico-cultural das versões masculina e feminina da Escala de Avaliação de Comportamento Sexual de Risco para pacientes psiquiátricos para o português brasileiro pelo Projeto Interdisciplinar em Sexualidade, Saúde Mental e AIDS. Método: Treinamento dos investigadores brasileiros no instrumento original, comparação da tradução e da retrotradução, seguida de adaptação lingüístico-cultural à luz da fase formativa do projeto, resultando em uma versão utilizada no treinamento dos entrevistadores brasileiros em entrevistas com pacientes psiquiátricos. Verificação lingüística, confiabilidade qualitativa do instrumento e confiabilidade entre entrevistadores constituíram as etapas complementares para a versão final do questionário. Resultados: Exclusão e adição de seções e itens da escala, tanto nos aspectos conceituais quanto estruturais, foram realizadas, bem como a incorporação de achados resultantes da fase formativa do piloto da pesquisa e mudanças lingüísticas relativas ao registro empregado. Descritores: Questionários, comportamento de risco, comparação transcultural, prevenção de doenças transmissíveis, estudos de intervenção. AbstractIntroduction: A systematic and detailed investigation of sexual risk behaviors is one of the main foundations in the development of research projects aimed at designing effective interventions for HIV prevention. Objective: This paper presents and discusses the stages of the translation and cross-cultural adaptation of male and female versions of the Sexual Risk Behavior Assessment Schedule for psychiatric patients into Brazilian Portuguese, carried out by the Interdisciplinary Project in Sexuality, Mental Health and AIDS. Methods: Training of Brazilian investigators in the original questionnaire, comparison between translation and back-translation, followed by linguistic and cultural adaptation in the light of the project formative phase were performed, resulting in a version used to train Brazilian interviewers in interviewing psychiatric patients. Language verification, qualitative reliability and interrater reliability were used to complement the final version of the instrument. Results: Elimination and addition of instrument sections and items covering both conceptual and structural aspects were carried out. Incorporation of formative findings from the pilot study and linguistic changes in terms of register were also performed.
população masculina da cidade do Rio de Janeiro, e 7,2 vezes as da população geral da referida cidade. Ao se fazer um cotejo com as taxas do Brasil, são 7,17 vezes as da população masculina e 13,34 vezes as da população geral. O risco de morte entre policiais militares é também maior que entre os agentes dos outros órgãos de segurança: chega a ser 6,44 vezes o da Guarda Municipal e 1,72 em relação à Polícia Civil. Nesse sentido, a obra produz informações estratégicas visando a subsidiar ações dos profissionais da corporação e de seus gestores para adequar a corporação às necessidades atuais da segurança pública. Sobretudo porque sendo essa a polícia que mais mata também é a que mais morre como demonstraram as autoras, fatos esses que por si só evidenciam uma política de segurança equivocada. Ainda faz-nos refletir que a estratégia de combate à criminalidade que aposta no confronto, fracassou, pois os princípios da política de segurança pública pautados por este não se encontram com os princípios da segurança humana, convertem-se em mortes anunciadas: da população civil e desses servidores públicos.
In the last decades, the initiatives implemented under the conceptual umbrella of Harm Reduction have gained momentum, with a vigor and scope (both from a geographic and social perspective) never seen before. A more balanced reevaluation could and should rather say such initiatives have resumed, to a large extent, ideas and actions launched much earlier, in the first decades of the 20th century. Notwithstanding, the dissemination of HIV/AIDS in recent years conferred an exceptional visibility and legitimacy to proposals formerly viewed as subsidiary or openly neglected. Nowadays, initiatives inspired by the Harm Reduction philosophy have faced an "identity crisis", not secondary (according to our perspective) to challenges faced by its concepts and operations, but rather as consequence of a world in a turmoil. Such fast-changing dynamics have reconfigured both drug scenes and the patterns and prospects of HIV/AIDS worldwide. This article briefly summarizes some of such recent, ongoing, changes, which have been deeply affecting both concepts and practices to the point of asking for a deep reformulation of most of the initiatives implemented so far.
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