RESUMO
BACKGROUND: In 2009, Mexico reformed its health law to partially decriminalize drug possession considered for personal use and to increase mandatory referrals to certified drug rehabilitation centers in lieu of incarceration. Concurrently, news media reported violent attacks perpetrated by drug cartels against Mexican drug rehabilitation centers and instances of human rights violations by staff against people who inject drugs (PWID) in treatment. In many cases, these violent situations took place at "Peer Support" (Ayuda Mutua) drug rehabilitation centers that house a large number of drug-dependent PWID. In an effort to understand barriers to treatment uptake, we examined prevalence and correlates of perceived risk of violence at drug rehabilitation centers among PWID in Tijuana, Mexico. METHODS: Secondary analysis of baseline data collected between March 2011 and May 2013 of PWID recruited into a prospective cohort study in Tijuana. Interviewer-administered surveys measured perceived risk of violence at drug rehabilitation centers by asking participants to indicate their level of agreement with the statement "going to rehabilitation puts me at risk of violence". Logistic regression was used to examine factors associated with perceived risk of violence. RESULTS: Of 733 PWID, 34.5 % perceived risk of violence at drug rehabilitation centers. In multivariate analysis, reporting ever having used crystal methamphetamine and cocaine (separately), having a great or urgent need to get help for drug use, and ever receiving professional help for drug/alcohol use were negatively associated with perceived risk of violence at drug rehabilitation centers, while having been told by law enforcement that drug rehabilitation attendance is mandatory was positively associated with perceived risk of violence. All associations were significant at a 0.05 alpha level. CONCLUSION: The perception of violence at drug rehabilitation centers among PWID does not represent the lived experience of those PWID who attended professionalized services, reported a great or urgent need to get help for their drug use and had a history of using crystal and cocaine. Professionalizing service delivery and engaging law enforcement in their new role of decriminalization and service referral for PWID could address the perceptions of violence at drug rehabilitation centers. Similarly, health authorities should expand periodic inspections at drug rehabilitation centers to guarantee quality service provision and minimize PWIDs' concerns about violence.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/psicologia , Abuso de Substâncias por Via Intravenosa/reabilitação , Violência/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Estudos Prospectivos , Centros de Tratamento de Abuso de Substâncias/legislação & jurisprudênciaRESUMO
OBJECTIVE: To understand the social context of female sex workers who use crack and its impact on HIV/AIDS risk behaviors. METHODODOLOGICAL PROCEDURES: Qualitative study carried out in Foz do Iguaçu, Southern Brazil, in 2003. Twenty-six in-depth interviews and two focus groups were carried out with female commercial sex workers who frequently use crack. In-depth interviews with health providers, community leaders and public policy managers, as well as field observations were also conducted. Transcript data was entered into Atlas.ti software and grounded theory methodology was used to analyze the data and develop a conceptual model as a result of this study. ANALYSIS OF RESULTS: Female sex workers who use crack had low self-perceived HIV risk in spite of being engaged in risky behaviors (e.g. unprotected sex with multiple partners). Physical and sexual violence among clients, occasional and stable partners was widespread jeopardizing negotiation and consistent condom use. According to health providers, community leaders and public policy managers, several female sex workers who use crack are homeless or live in slums, and rarely have access to health services, voluntary counseling and testing, social support, pre-natal and reproductive care. CONCLUSIONS: Female sex workers who use crack experience a plethora of health and social problems, which apparently affect their risks for HIV infection. Low-threshold, user-friendly and gender-tailored interventions should be implemented, in order to increase the access to health and social-support services among this population. Those initiatives might also increase their access to reproductive health in general, and to preventive strategies focusing on HIV/AIDS and other sexually transmitted infections.
Assuntos
Transtornos Relacionados ao Uso de Cocaína , Cocaína Crack , Infecções por HIV/transmissão , Conhecimentos, Atitudes e Prática em Saúde , Trabalho Sexual , Síndrome da Imunodeficiência Adquirida/epidemiologia , Síndrome da Imunodeficiência Adquirida/prevenção & controle , Adolescente , Adulto , Brasil/epidemiologia , Transtornos Relacionados ao Uso de Cocaína/complicações , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Preservativos/estatística & dados numéricos , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Pesquisa Qualitativa , Medição de Risco , Assunção de Riscos , Autoimagem , Delitos Sexuais , Trabalho Sexual/estatística & dados numéricos , Comportamento Sexual , Fatores Socioeconômicos , Populações Vulneráveis , Adulto JovemRESUMO
OBJECTIVE: To understand the social context of female sex workers who use crack and its impact on HIV/AIDS risk behaviors. METHODODOLOGICAL PROCEDURES: Qualitative study carried out in Foz do Iguaçu, Southern Brazil, in 2003. Twenty-six in-depth interviews and two focus groups were carried out with female commercial sex workers who frequently use crack. In-depth interviews with health providers, community leaders and public policy managers, as well as field observations were also conducted. Transcript data was entered into Atlas.ti software and grounded theory methodology was used to analyze the data and develop a conceptual model as a result of this study. ANALYSIS OF RESULTS: Female sex workers who use crack had low self-perceived HIV risk in spite of being engaged in risky behaviors (e.g. unprotected sex with multiple partners). Physical and sexual violence among clients, occasional and stable partners was widespread jeopardizing negotiation and consistent condom use. According to health providers, community leaders and public policy managers, several female sex workers who use crack are homeless or live in slums, and rarely have access to health services, voluntary counseling and testing, social support, pre-natal and reproductive care. CONCLUSIONS: Female sex workers who use crack experience a plethora of health and social problems, which apparently affect their risks for HIV infection. Low-threshold, user-friendly and gender-tailored interventions should be implemented, in order to increase the access to health and social-support services among this population. Those initiatives might also increase their access to reproductive health in general, and to preventive strategies focusing on HIV/AIDS and other sexually transmitted infections.
OBJETIVO: Compreender o contexto social no qual estão inseridas trabalhadoras do sexo que usam crack e seu impacto na adoção de comportamentos de risco frente ao HIV/Aids. PROCEDIMENTOS METODOLÓGICOS: Estudo qualitativo realizado em Foz do Iguaçu (PR), em 2003. Foram realizadas 26 entrevistas em profundidade e dois grupos focais com trabalhadoras do sexo que utilizam crack freqüentemente. Também foram realizadas entrevistas em profundidade com profissionais de saúde, líderes comunitários e gerentes de políticas públicas, além de observações de campo. Os dados transcritos foram codificados com auxílio do software Atlas.ti e a metodologia grounded theory (teoria fundamentada em dados) foi utilizada para analisar os dados e desenvolver um modelo conceitual como resultado do estudo. ANÁLISE DOS RESULTADOS: As trabalhadoras do sexo que utilizam crack apresentaram baixa autopercepção de risco frente ao HIV, apesar de estarem envolvidas em comportamentos de risco, como sexo desprotegido com múltiplos parceiros. Experiências de violência física e sexual com clientes, parceiros ocasionais e estáveis foram bastante freqüentes entre estas mulheres, prejudicando a negociação e o uso consistente de preservativos. Segundo profissionais de saúde, líderes comunitários e gerentes de políticas públicas, diversas trabalhadoras do sexo usuárias de crack, são moradoras de rua ou favelas, raramente acessam serviços de saúde, de aconselhamento e testagem anônimos, de apoio social e de saúde reprodutiva e pré-natal. CONCLUSÕES: As profissionais do sexo que utilizam crack vivenciam vários problemas sociais e de saúde que parecem influenciar o risco à infecção pelo HIV. Intervenções de limiar baixo, amigáveis e voltadas para questões de gênero devem ser implementadas objetivando facilitar o acesso a serviços de saúde e de apoio social nessa população. Tais iniciativas poderão também facilitar o acesso deste grupo a serviços voltados para saúde reprodutiva em geral ...
OBJETIVO: Comprender el contexto social en el cual están insertadas trabajadoras del sexo que usan crack y su impacto en la adopción de comportamientos de riesgo frente al HIV/Sida. MÉTODOS: Se realizó estudio cualitativo en Foz de Iguacu (Sur de Brasil), en 2003. Se realizaron 26 encuestas con profundidad y dos grupos focales con trabajadoras del sexo que utilizan crack frecuentemente. También se realizaron encuestas con profundidad con profesionales de la salud, líderes comunitarios y gerentes de políticas públicas, además de observaciones de campo. Los datos transcritos fueron codificados con ayuda del software Atlas.ti y el método grounded theory (teoría fundamentada en datos) fue utilizada para analizar los datos y desarrollar un modelo conceptual como resultado de estudio. ANÁLISIS DE LOS RESULTADOS: Las trabajadoras del sexo que utilizan crack presentaron baja autopercepción del riesgo frente al HIV, a pesar de estar relacionadas con comportamientos de riesgo, como sexo desprotegido con múltiples parejas. Experiencias de violencia física y sexual con clientes, parejas ocasionales y estables fueron bastante frecuentes entre estas mujeres, perjudicando la negociación y el uso consistente de preservativos. Según los profesionales de la salud, los líderes comunitarios y los gerentes de políticas públicas, diversas trabajadoras del sexo usuarias de crack, viven en las calles o en barrios, raramente tienen acceso a los servicios de salud, de consejos y exámenes anónimos, de apoyo social y de salud reproductiva y pre-natal. CONCLUSIONES: Las profesionales del sexo que utilizan crack experimentaron varios problemas sociales y de salud que parecen influenciar sobre el riesgo a la infección por el HIV. Intervenciones de bajo umbral, amigables y dirigidas para cuestiones de género deben ser implementadas buscando facilitar el acceso a servicios de salud y de apoyo social en esa población. Tales iniciativas podrán también facilitar el acceso ...