Although young people in their everyday lives consume a bewildering array of pharmaceutical, dietary and cosmetic products to self-manage their bodies, moods and sexuality, these practices are generally overlooked by sexual and reproductive health programmes. Nevertheless, this self-management can involve significant (sexual) health risks. This article draws from the initial findings of the University of Amsterdam's ChemicalYouth project. Based on interviews with 142 youths, focus group discussions and participant observation in South Sulawesi, Indonesia, we found that young people - in the domain of sexual health - turn to pharmaceuticals and cosmetics to: (1) feel clean and attractive; (2) increase (sexual) stamina; (3) feel good and sexually confident; (4) counter sexual risks; and (5) for a group of transgender youths, to feminize their male bodies. How youth achieve these desires varies depending on their income and the demands of their working lives. Interestingly, the use of pharmaceuticals and cosmetics was less gendered than expected. Sexual health programmes need to widen their definitions of risk, cooperate with harm reduction programmes to provide youth with accurate information, and tailor themselves to the diverse sexual health concerns of their target groups.
This paper addresses the working practices of a mobile mental health outreach team in a large French city, one that ‘targets’ homeless people with severe psychiatric disorders who are considered ‘hard to reach’ by the public health authorities and medical services. Analysis of the team's work – where acts of curing and caring are closely tied – reveals the importance of moving beyond a polarized vision of cure and care. The paper departs from much of the literature on the medicalization of social problems by arguing that medicalization is not only a means of social control, but has ethical value as well. In examining the practices of frontline health workers, it aims to show that integrating the methods and theoretical approaches of social work in medical practice is necessary to address the specific problems of homeless people, to enable health professionals to pursue medical cures, and to challenge the shortcomings of public policy.
BackgroundMembers of Indonesia's diverse male-to-female transgender community often describe themselves as waria. Waria do not equate being feminine with being female. They do not want to be women; they aspire to be like women. It entails cultivating mannerisms and wearing make-up and women's clothes, shaving one's legs and styling one's hair. But some go further in their practices of self-administered, chemically assisted bodily transformation.MethodsField research took place in Makassar, the capital city of South Sulawesi; in a smaller town in the regency of Bulukumba on the south coast of Sulawesi; and in the special region of Yogyakarta in Java. Data were collected through repeated in-depth interviews with ten waria youths aged between 18 and 26 in each site; interviews with pharmacists, drug and cosmetics store clerks; three focus group discussions at each site; and participant observation.ResultsOur respondents saw their bodies as ‘projects’ they can manipulate with pharmaceutical products and cosmetics. To lighten their skin, they experimented with different brands of exfoliating liquid, whitening cream, powder, foundation, face soap and skin scrub. To grow breasts and reduce muscle mass, they experimented with different brands and dosages of contraceptive pills and injections in order to get faster, better and longer-lasting results.ConclusionHarm reduction programs often neglect chemicals that are not narcotics, not related to sexually transmitted infections, and which are legally and freely available. Safety issues arise when otherwise safe products are used off-label in large quantities. Drug policy-makers are paying insufficient attention to the safety of cosmetics.
Introduction: From Criminalization to Informed Use Harm reduction programs emerged out of the need for pragmatic strategies to minimize the risk of HIV transmission among people who inject drugs and evidence of successful needle exchange programs in the Netherlands, the United Kingdom, and Australia in the 1980s (Erickson, Riley, Cheueng, & O'Hare, 1997; although see Seddon, 2010, pp. 86-88, for a discussion of harm reduction in earlier periods). Both as theory and practice, harm reduction evolved as a critique and alternative to controlling drug use and drug users through legal sanctions. Its proponents claim that prohibitionist approaches aggravate both harms to health and society by stigmatizing and marginalizing drug users, in effect turning them into criminals. A wide range of harm reduction programs have evolved since the 1980s, targeting the use of substances ranging from heroin and amphetamines to cannabis, tobacco, and alcohol. Some programs provide users with safer means to administer substances such as clean needles to inject heroin or patches to deliver nicotine. Others promote safer alternatives such as buprenorphine or methadone to replace illegal heroin. Yet other projects create spaces that facilitate safer substance use and disseminate information designed to minimize harm rather than promote abstinence. The success or otherwise of such programs has been reported in regular conferences and a wide range of journals, including a journal dedicated to harm reduction, launched in 2004. Early harm reduction efforts that focused on ''high-risk'' groups such as injecting drug users and sex workers often assumed drug users to be relatively powerless in the face of potent substances, the victims of environments that mediate unsafe and illegal drug use (e.g., Duff, 2008; Rhodes, 2009). More recently, harm reduction efforts aimed at broader publics have called on smokers and drinkers to take responsibility for their own health. Such efforts have been analyzed extensively through the Foucaldian lenses of biopower and governmentality (Campbell & Shaw, 2008).
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