Psychology Department, Faculty of Philosophy, Sciences, and Letters of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-900, Brazil.
Central Paulista University Center - UNICEP, São Carlos, SP, 13563-470, Brazil.
Harm Reduct J. 2024 Mar 4;21(1):56. doi: 10.1186/s12954-024-00962-7.
Although harm reduction is highlighted as an effective intervention for alcohol and drug use, a funding gap for harm reduction interventions has been identified, mainly in low- and middle-income countries. In these countries, tensions between abstinence and harm reduction models have impaired the shift from punitive practices to evidence-based interventions committed to guaranteeing the human rights of people who use drugs. Since 2015, the Brazilian government has adopted a more punitive and abstinence-focused drug policy that jeopardizes the care of people who use alcohol and other drugs and the comprehension of the harm reduction workers' perspective in relation to their practice. Therefore, this study aimed to comprehend the meanings constructed by Brazilian harm reduction workers regarding their practices with vulnerable populations amidst a context of political tension.
We conducted 15 in-depth semi-structured qualitative interviews with harm reduction workers employed in public health services for at least 6 months. Data were analyzed using thematic analysis.
The thematic axis "The joy and pain of being a harm reduction worker in Brazil" was constructed and divided into four major themes: (1) Invisibility of harm reduction work; (2) Black, poor, and people who use drugs: identification with the service users; (3) Between advocacy and profession: harm reduction as a political act; (4) Small achievements matter. Despite the perceived invisibility of harm reduction workers in the public health and alcohol and drug fields, valuing small achievements and advocacy were important resources to deal with political tension and punitive strategies in Brazil. The findings also highlight the important role of harm reduction workers due to their personal characteristics and understanding of drug use behavior, which bring the target audience closer to actions within the public health system.
There is an urgent need to acknowledge harm reduction based on peer support as a professional category that deserves adequate financial support and workplace benefits. Additionally, expanding evidence-based harm reduction interventions and community-based voluntary drug use treatment centers should be prioritized by public policies to address the human rights violations experienced by people who use drugs.
尽管减少伤害被强调为一种有效的干预酒精和药物使用的方法，但减少伤害干预措施的资金缺口已经被确定，主要是在中低收入国家。在这些国家，禁欲和减少伤害模式之间的紧张关系阻碍了从惩罚性做法向基于证据的干预措施的转变，这些干预措施致力于保障吸毒者的人权。自 2015 年以来，巴西政府采取了更具惩罚性和禁欲主义的毒品政策，危及到酒精和其他药物使用者的护理，以及减少伤害工作者对其实践的看法的理解。因此，本研究旨在理解巴西减少伤害工作者在政治紧张局势背景下对弱势人群的实践所构建的意义。
我们对至少在公共卫生服务部门工作了 6 个月的 15 名减少伤害工作者进行了 15 次深入的半结构化定性访谈。使用主题分析对数据进行分析。
构建了主题轴“作为巴西减少伤害工作者的快乐与痛苦”，并分为四个主要主题：（1）减少伤害工作的不被重视；（2）黑人、穷人、吸毒者：与服务使用者的认同；（3）倡导与职业之间：减少伤害作为一种政治行为；（4）小成就很重要。尽管减少伤害工作者在公共卫生和酒精和毒品领域被认为是不被重视的，但重视小成就和倡导是应对巴西政治紧张局势和惩罚性策略的重要资源。研究结果还强调了减少伤害工作者的重要作用，因为他们的个人特征和对药物使用行为的理解，使目标受众更接近公共卫生系统内的行动。
迫切需要承认基于同伴支持的减少伤害作为一个专业类别，值得获得足够的财政支持和工作场所福利。此外，应优先考虑扩大基于证据的减少伤害干预措施和社区为基础的自愿药物使用治疗中心，作为公共政策的一部分，以解决吸毒者所经历的侵犯人权问题。
