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.
Highlights
Crack use is prevalent across the Americas, and among marginalized urban street drug users in Brazil
Since the early 1990s, crack use has widely spread in cities across Brazil, and has become prevalent among street drug users [1,2]
The phenomenon of crack use has spawned extensive attention and controversial debates in Brazil about appropriate intervention strategies, due to its extensive social impact, including extensive violence and concerns about community health and safety, especially in impoverished neighborhoods (‘cracolandias’) affected by this problem [6,7,8]. Drawing on both data from Brazil and other settings in the Americas (e.g., North American cities) where crack use is common, it is evident that crack users typically feature extensive health and social problems, even when compared to other illicit drug users [9,10,11]
Summary
Crack use is prevalent across the Americas, and among marginalized urban street drug users in Brazil. The phenomenon of crack use has spawned extensive attention and controversial debates in Brazil about appropriate intervention strategies, 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 [6,7,8] Drawing on both data from Brazil and other settings in the Americas (e.g., North American cities) where crack use is common, it is evident that crack users typically feature extensive health and social problems, even when compared to other illicit drug users [9,10,11]. Both Blood-Borne Viruses (BBVs) (e.g., HIV and/or Hepatitis B/C Viruses) are disproportionately common among crack users – influenced by both extensive sexual (e.g., sex trade involvement or sex-for drug exchanges) and/or drug use related risk behaviors (e.g., drug use paraphernalia sharing) [27,28,29,30,31,32]
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