Preventing HIV/AIDS and other sexually transmitted diseases among injecting drug users in Rio de Janeiro

Abstract

The harm reduction program (HRP) in Rio de Janeiro, sponsored by the Brazilian Ministry of Health, World Bank and UNDCP, and implemented in association with NEPAD-UERJ (State University of Rio de Janeiro’s drug treatment facility), began its field activities with the injecting drug users (IDUs) at the end of 1996, following the training of the outreach workers and the presentation of the project to authorities and other health and social institutions of the City. The program is based in a fixed place, close to a drug treatment facility, and equipped with a mobile unit (a van) to help in field activities. Among the activities offered by the HRP are: needle exchange, distribution of condoms and bleach, distribution of informative folders and other preventive materials, counselling, HIV testing, focus groups meetings, and referral to other clinical or drug treatment places. All IDUs attending the HRP are invited to fill a two-page voluntary anonymous questionnaire, adapted from a questionnaire used in harm reduction programs in Australia, with basic socio-demographic and risk behavior information. An evaluation study of the program was designed relying on a one-page follow-up anonymous questionnaire (questionnaires are identified by a code), collecting information on sexual and injecting risk behaviors. This study is still in its pilot phase and it is being used on those IDUs who adhere to the program. All questionnaires are administered by the program’s staff to insure that all IDUs will understand adequately the stated questions. Since its first needle exchange, in May 1997, until May 1998, the program reached a growing number of IDUs, among them 186 filled the voluntary questionnaire, 41 were referred to drug treatment places, 23 to clinical treatment and 42 to HIV testing. The HRP distributed/exchanged 8550 informative folders, 11 998 condoms, 13 344 needles/syringes and 488 kits (above material plus bleach and distilled water in a small package). Many non-injecting drug users and more than 300 sex workers, considered as potential bridges to IDUs (some of them are IDUs themselves), were also contacted. Distribution of preventive material among sex workers was very limited due to the scarce material resources and specificity of the program. Sex workers in Rio already receive assistance from many governmental and non-governmental organizations, while the harm reduction program is the unique program for IDUs in the city. The main problems faced were: (i) the legal constraints regarding needle exchange (which hampered this activity principally at the beginning of the project); (ii) the peculiar environment of Rio de Janeiro concerning IDUs networks (small, extremely segregated and with low interconnection); (iii) the great prejudice against IDUs in the city; and (iv) insufficient/inconstant financial support received by the program. Despite these problems, the program is progressively contacting an ever growing number of IDUs, allowing them to have access to preventive strategies. As needle exchange is slowly being accepted or legalized in other parts of the country, we expect positive effects in Rio, with a consequent better tolerance to the HRP activities in the City. The problems of finding IDUs on their scattered/segregated networks were solved mainly by a series of strategies implemented, and the cooperative work with religious and social care institutions.