Using and dealing on Calle 19: a high risk street community in central Bogotá

Abstract

Rapid assessment methods were applied to a user–dealer population in a central street of Bogotá, Colombia, to explore patterns of drug use and behaviours associated with overdose, crime, violence, and other risks, particularly those associated with the spread of sexually transmitted infections and HIV. A participant-intervention technique was used with the researcher developing health promotion and harm reduction activities during initial research fieldwork and in subsequent continuing responses to risks encountered. Peer leaders progressively took on participatory intervention activities. Complex interrelations were found among different subgroups within the population, and between the deviant user–dealer community and the ‘straight’ world. Common behaviour patterns were found to involve poly-drug use associated with multiple risks. Sharing of syringes and other paraphernalia was frequently encountered, but dealing-related and police violence was perceived by the research subjects as more dangerous, and violence was found to be a dominant theme of the street dealing life-style. Further health harms came from malnutrition and sexual risk-taking, including commercial sex work. Lack of identity papers and health insurance, compounded by self-perception as deviant and socially excluded, limits access to health care and drug dependence treatment. Health promotion and harm reduction strategies were developed from needs expressed and risks encountered, and were aimed at empowerment to make changes self-sustaining. Client advocacy was carried out to gain official approval for safe injection kits and improved access to health care facilities. The low costs and speed of these methods suggest small scale action-research projects can make a significant contribution to reducing dangerous behaviour contributing to the spread of HIV and other life threatening harms in high risk urban street communities.