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

Abstract

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.

Prevalence and Incidence of HCV Infection among Prisoners in Central Brazil

“…Additionally, the difference between the prevalence of HCV exposure found in this study compared with the study conducted in the same region by Pompilio et al (2011) may be explained by the decline in the frequency of injection drug users (10.6% to 1%) [16]. In fact, in recent years, the pattern of drug use in Brazil has changed, resulting in a smaller proportion of IDU which was largely replaced by smoked or inhaled crack cocaine [18–20]. …”

Criminality and Sexual Behaviours in Substance Dependents Seeking Treatment

“…Reducing stigmatizing and moralizing discourse related to drug users, especially among health and law enforcement personnel, may help encourage users to seek care before their dependence worsens and they become involved in crime. A stronger political commitment is needed to confront the drug issue in Brazil as a public health problem, with the aim of ensuring availability, stability of funds, the implementation of large-scale interventions, the training of outreach workers, and proper evaluations (Domanico and Malta 2012;Krawczyk, Filho, and Bastos 2015;Santos Cruz et al 2013b). …”

“…Considering that sex workers may have a history of homelessness, mental health issues, face discrimination, poverty, lack of access to health care and social services, incarceration, drug use, high-risk multiple male partners, and the lack of data and understanding around sex workers creates a significant barrier to HIV-prevention efforts and other complementary services (Bobashev et al 2009; Centers for Disease Control and Prevention [CDC] 2015). These factors contribute to the barriers of the client group to receiving HIVprevention activities (Santos Cruz et al 2013b). The proper treatment of alcohol and other drug users, STIs prevention, and effective strategies against crime and violence have been fundamental in the relationship between the treatment of substance dependence and broader issues of health and safety for the general population (Bobashev et al 2009;CDC 2015).…”

The Linkage of Illicit Drug Use / Alcohol Use and HIV Infection in Young Adults

“…In South America, cocaine is the drug of choice. Studies have shown young adult crack cocaine users have health and economic marginalization, an elevated risk for HIV infection and compromised health along with poor health services utilization (62)(63)(64). In the Dominican Republic, a recent study has addressed alcohol use in young adults in the context of risk for HIV infection (65).…”