The children of mama coca: Coca, cocaine and the fate of harm reduction in South America

Bastos, Francisco I.; Caiaffa, Waleska Teixeira; Rossi, Diana; Vila, Marcelo; Malta, Mônica

doi:10.1016/j.drugpo.2006.11.017

Cited by 25 publications

(8 citation statements)

References 24 publications

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“…Regarding illicit psychoactive substances, such as cocaine, there is a social clamor and overexposure of the issue in the media concerning their correlation with urban violence. 2 Consistent empirical data are needed to guide the formulation of public policies and constitute a baseline for assessing the impact of interventions. In the context of the analysis of sexual behavior of Brazilians and HIV/AIDS prevention, it is essential to assess patterns of alcohol and drug use, since there is a direct relationship between needle sharing and HIV dissemination, 13 and a modulating effect of psychoactive drugs on sexual behaviors and practices.…”

Section: Introductionmentioning

confidence: 99%

Consumo de álcool e drogas: principais achados de pesquisa de âmbito nacional, Brasil 2005

2008

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OBJECTIVE:To assess alcohol and drug use in a representative sample of the urban Brazilian population and their correlation with sexual and reproductive health. METHODS:Data from a national population-based survey with a complex sampling, performed in 2005 was used. A total of 5,040 individuals from both genders, in the age group from 16 to 65 years old, were interviewed. Issues regarding drug and alcohol use and sexual behavior were assessed. Bivariate and multivariate analyses were used. RESULTS:Alcohol was the most frequently used substance, with reports of regular use in the lives of 18% of interviewees. Use of illegal drugs was mentioned by 9% of the interviewees especially marijuana and snorted cocaine; injected drugs use was not frequent. There was a decrease in snorted cocaine use and an increase in marijuana use (in the last 12 months), compared to results of a similar survey conducted in 1998. History of sexual abuse was a risk factor for drug use and regular alcohol use. Interviewees mentioning the role of religion in their background, being White, and female were less likely to use alcohol in a regular way, which is especially prevalent among elderly males.Leisure activities and absence of current religious practice were associated with drug use. CONCLUSIONS:The regular or irregular alcohol use is prevalent in the urban Brazilian population, whereas injected drug use is rare. Over the last decade there was a decline in cocaine use. A history of sexual abuse was central to later use of alcohol and drugs.

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Section: Introductionmentioning

confidence: 99%

Consumo de álcool e drogas: principais achados de pesquisa de âmbito nacional, Brasil 2005

2008

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“…It is in the drug policies of the Netherlands that the harm reduction approach has its roots (Inciardi and Harrison 2000), with the notion of drug use as a socialhealth problem rather than a crime (VWS 2003). In South America, Brazil is considered a leading country in adopting a harm reduction strategy in official policy (Bastos et al 2007;Bueno 2007), and an example in applying harm reduction to HIV/AIDS policies (Mesquita 2006). But historic differences in terms of policy development and organizational territories have shaped these countries' responses to harm reduction both in official policies and in street practices.…”

Section: Cultures Of Surveillance In Amsterdam and Porto Alegrementioning

confidence: 99%

Surveillance cultures, chains and holes in street level networking: dealing with drug users in Amsterdam (Netherlands) and Porto Alegre (Brazil)

Rigoni¹

2015

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If surveillance is understood as a complex multi-dimensional process, then collaboration between health, social and law enforcement sectors can be viewed as a part of the surveillance culture of particular societies and urban settings. Policies towards illicit drugs usually build on a two-track approach—public health and public order—with different objectives that have to be negotiated daily by street level workers in the light of their differing beliefs on drug use. This paper brings examples of collaboration and non-collaboration among workers from social, health and law enforcement agencies in Amsterdam, the Netherlands, and Porto Alegre, Brazil in their daily interactions with drug users, to analyze the types of surveillance arising from these negotiations. The study utilizes results from 80 in-depth interviews with street level workers and 800 hours of participant observation carried out from February 2010 until March 2011, equally divided between the two cities. Different cultures of surveillance produce diverse state-citizen approaches in terms of coercion, care, and rights. In Amsterdam, close collaboration and information exchange among workers produce a ‘chain’ surveillance culture: an intensive screening allows drug users to have more access to care, yet, at the same time this can produce excessive control over users’ lives. In Porto Alegre, by contrast, insufficient collaboration produces a surveillance culture of ‘holes’: less systematic screening and lack of information sharing allows users to slip out of care, and of workers’ surveillance sight. Historically, though coming from apparently opposite extremes in terms of drug surveillance (respectively permissive and controlling), both Amsterdam and Porto Alegre in practice show surveillance cultures which combine care and order. Combinations, however, vary according to different assemblages between actors concerned with transforming drug users’ lives.

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“…While no precise epidemiological assessments are currently available, the crack user population in Brazil has been estimated to be up to 1 million, largely concentrated in young, marginalized, urban populations [3-5]. The phenomenon of crack use has spawned extensive attention and controversial debates in Brazil about appropriate intervention strategies, also due to its extensive social impact, including extensive violence (e.g., gun violence) and concerns about community health and safety, especially in impoverished neighborhoods (‘cracolandias’) affected by this problem [6-8]. …”

Section: Introductionmentioning

confidence: 99%

Patterns, determinants and barriers of health and social service utilization among young urban crack users in Brazil

Cruz

Andrade

Bastos

et al. 2013

BMC Health Serv Res

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BackgroundCrack use is prevalent across the Americas, and specifically among marginalized urban street drug users in Brazil. Crack users commonly feature multiple physical and mental health problems, while low rates of and distinct barriers to help service use have been observed in these populations. This study examined profiles and determinants of social and health service utilization, and unmet service needs, in a two-city sample of young (18–24 years), marginalized crack users in Brazil.MethodsN = 160 study participants were recruited by community-based methods from impoverished neighborhoods in the cities of Rio de Janeiro (n = 81) and Salvador (n = 79). A mixed methods protocol was used. Participants’ drug use, health, and social and health service utilization characteristics were assessed by an anonymous interviewer-administered questionnaire completed in a community setting; descriptive statistics on variables of interest were computed. Service needs and barriers were further assessed by way of several focus groups with the study population; narrative data were qualitatively analyzed. The study protocol was approved by institutional ethics review boards; data were collected between November 2010 and June 2011.ResultsThe majority of the sample was male, without stable housing, and used other drugs (e.g., alcohol, marijuana). About half the sample reported physical and mental health problems, yet most had not received medical attention for these problems. Only small minorities had utilized locally available social or health services; utilization appeared to be influenced by sex, race and housing characteristics in both sites. Participants cited limited service resources, lack of needs-specific professional skills, bureaucratic barriers and stigma as obstacles to better service access. However, most respondents stated strong interest and need for general social, health and treatment services designed for the study population, for which various key features were emphasized as important.ConclusionsThe study contributes substantive evidence to current discussions about the development and utilization of health and treatment interventions for crack use in Brazil. Based on our data, crack users’ social, service needs are largely unmet; these gaps appear to partly root in systemic barriers of access to existing services, while improved targeted service offers for the target population seem to be needed also.

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The children of mama coca: Coca, cocaine and the fate of harm reduction in South America

Cited by 25 publications

References 24 publications

Consumo de álcool e drogas: principais achados de pesquisa de âmbito nacional, Brasil 2005

Consumo de álcool e drogas: principais achados de pesquisa de âmbito nacional, Brasil 2005

Surveillance cultures, chains and holes in street level networking: dealing with drug users in Amsterdam (Netherlands) and Porto Alegre (Brazil)

Patterns, determinants and barriers of health and social service utilization among young urban crack users in Brazil

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