A presente pesquisa problematiza a polarização presente no debate acerca da política sobre drogas no Brasil, a fim de contribuir com a construção de uma Clínica do Possível no cuidado de pessoas que usam drogas propondo a aproximação entre os princípios e diretrizes da Redução de Danos e da Política Nacional de Humanização. A fim de superar os embates que contrapõem, de um lado o paradigma proibicionista - centrado na abstinência - e, de outro, o antiproibicionismo – pautado pela singularidade - a aposta é em uma clínica-política que coloca o sujeito como protagonista no processo de produção de sua saúde. A tentativa é a de dar visibilidade às novas práticas de cuidado, focadas na produção de saúde como potência de vida, a partir de referências conceituais da filosofia nietzscheana. Na perspectiva teórica adotada pelo presente estudo, utilizamos como fundamento metodológico a pesquisa-intervenção, propondo cartografar os caminhos tecidos pelos usuários de drogas em seu território, a fim de detectar e analisar quais os “nós” (rituais, estratégias, serviços, afetos...) da rede produzem saúde e apontam uma Clínica do Possível pautada no cuidado, vínculo e afeto. A pesquisa foi realizada em um território da rede de saúde do município de Caxias do Sul, na serra gaúcha, sendo construída por várias mãos, pois contou com o apoio de técnicos da equipe da Unidade Básica de Saúde da Região e alunos da Faculdade da Serra Gaúcha. A intervenção desenvolveu-se ao longo de três etapas, organizadas em torno de diferentes instrumentos de intervenção (pin-hole, oficinas de fotografias, hip-hop) contando, ao todo, com 18 participantes, sendo que 09 usuários permaneceram em todas as etapas. As atividades foram realizadas ao longo de oito meses, 26 encontros ocorridos entre o ano de 2011 e início de 2012. No percurso da pesquisa o Hip Hop emergiu como dispositivo expressivo do cotidiano dos usuários que demarcava seus espaços de produção de saúde, potencializando a vida através da arte. Entre os resultados, foi possível identificar a criação de um espaço coletivo que emergiu dessa experimentação proposta pela pesquisa-intervenção, aproximando os usuários tidos como “não aderentes” aos tratamentos ofertados na rede, de um modo diverso àquele com que eles usualmente referiam (e resistiam) (a) os atendimentos que recebem dos serviços de saúde. Ao final da pesquisa, a produção coletiva e espontânea de um rap ritmando as vivências e posições dos usuários que podem pautar a construção de uma política sobre drogas na perspectiva da Redução de Danos apontou a possibilidade de criação de novos territórios existenciais, para além do ressentimento, que sejam produtores de saúde compreendida como expansão de vida. / This project is based on discusses about drug´s politics polarization in Brazil in order to contribute for the construction of a Possible Clinical care for people who use drugs proposing closer relations between the principles and guidelines of the Harm Reduction and the National Humanization´s Politics. In order to overcome the conflicts that opposed, on one hand the prohibitionist paradigm - centered on abstinence - and on the other side, the anti prohibitionist - guided by the singularity - the focus is in a clinical politic that to put the subject as the protagonist in the production process of your health. The attempt is to bring out new care practices, focused on the production of health as a power of life, from conceptual references of nietzschean philosophy. According with the theoretical approach adopted by this study, we used as a methodological research-based intervention, proposing to record the informations about the paths woven by drug users in their territory in order to detect and analyze which "knots" (rituals, strategies, services, affections. ..) from the network produce health and show a Possible Clinical based on the care, link and affection. The search was conducted in a territory of the health network at Caxias do Sul, Rio Grande do Sul, a city in the mountains, being built by many hands, it had the support of the technical staff of the Basic Health Unit in the Region and the students from Serra Gaúcha College. The intervention was developed over three stages, organized around different kinds (pin-hole, photo workshops, hip-hop) overall, with 18 participants, within 09 users remain at all stages. The activities were held over eight months, 26 meetings that occurred between 2011 and early 2012. During the Hip Hop research emerged as an expressive device of daily users that demarcated spaces of health production, enhancing life through art. Among the results, it was possible to identify the creation of a collective atmosphere that emerged from this trial proposed by the research intervention, bringing users considered "non adherent" to treatment offered on the network, in a different way to that with which they usually referred (and resisted) the care that they receive from health services. Concluding, it´s possible to refer that at the end of the study, the collective´s production and spontaneous rap were responsible to put rhythm at the experiences and views of users that can guide the construction about drug´s politic in the perspective of harm reduction, pointed out the possibility of creating new existential territories, beyond the resentment, which are producers of health understood as an expansion of life.

Este trabalho traz algumas considerações e problematizações das políticas sobre drogas, transcorrendo pela história da Redução de Danos em seu percurso clínicopolítico desde o campo da AIDS e sua transição como diretriz de trabalho para o cuidado a pessoas que usam álcool e outras drogas no campo da saúde mental. Para isso, utilizamo-nos do Método da Roda, que serviu também para pensar o papel do apoiador institucional e a cogestão de coletivos, para nos aproximamos de um município em que foi possível acompanhar os modos de andar a redução de danos também no campo micropolítico e, assim, pensar nessa transição e nas perspectivas de trabalho para a atenção básica. Com isso, apresentamos a Redução de Danos como tecnologia leve de cuidado, que circula pelo território e acompanha os diferentes modos de andar a vida, que está atravessada pelos impasses da Reforma Psiquiátrica e pela precarização do trabalho, que acompanha o trabalho da redução de danos desde o seu início e que se atualiza neste campo de pesquisa. / This essay brings some consideration and render problematily of the politics about drugs, elapsing between harm reduction in its political clinical course since Aids field and its transition as guideline of working to care to people that use alcohol and other drugs in the mental health field. For this, we use the wheel method, that fit also to think about the institucional supportes role and the co-management of collective to approach to a county that was possible to follow the way of the harm damage goes and also in the micropolitical field and, so, think about this transition and in the work perspectives to the basic attention. Therewith, we show the harm reduction as light care technology, that moves within the territory and follows the different ways of livong life, that is crossed by impasses of the psychiatric reform and by Precariously of the work, that follows the harm reduction work since its updates in this research field.

O Bairro da Luz surge como uma região nobre no centro da cidade de São Paulo no final do século XIX. Com a queda da economia do café e a expansão da cidade para outras regiões mais valorizadas, o bairro passou a viver mudanças significativas em suas dinâmicas econômicas e sociais. Após a desativação do Terminal Rodoviário em 1982, intensificou-se o processo de degradação urbana e social que já acompanhava a história do bairro. A chegada do crack - mistura de pasta base de cocaína, água e bicarbonato de sódio (e outras substâncias desconhecidas) - no início dos anos 1990, configurou nova dinâmica local e contribuiu para diversas ações do poder público, que trouxeram mudanças ambientais significativas para moradores e frequentadores. Neste contexto, o crack é uma substância que passou a ter um uso social e cotidiano para a população da região. A relação de consumo e comércio desta substância se territorializou e agravou uma considerada desqualificação social e urbana no bairro, que associada à política proibicionista em relação às drogas, teve efeitos perversos. Tal condição potencializa o forte estigma da sociedade associado a este espaço, o que leva a uma consequente exclusão dos que lá estão. Para a Saúde Ambiental, a deterioração física e social deste ambiente pode propiciar condições de baixa qualidade de vida e facilitar a ocorrências de agravos à saúde para além da condição de uso de uma determinada substância. Nesse sentido, este projeto se propõe a investigar a relação entre saúde e ambiente (contexto) no cotidiano das pessoas que fazem uso do crack na cracolândia, região central da cidade de São Paulo. A partir desta aproximação este estudo tem o objetivo de trazer informações capazes de subsidiar políticas públicas mais eficientes. / R. Luso-Brasileira, 4 - Jardim Estoril IV, Bauru - SP, 17016-230 The Luz district emerges as a prime area in the center of São Paulo in the late nineteenth century. With the fall of the coffee economy and the city\'s expansion to more valued regions, the neighborhood lived significant changes in its economic and social dynamics. The deactivation of the Bus Terminal in 1982 intensified the process of urban and social degradation that has accompanied the history of the neighborhood. The \'arrival of crack\' - mixture of cocaine base paste, water and baking soda (and other unknown substances) - in the early 1990s, set up new local dynamics and contributed to several government actions that brought significant environmental changes for locals and other people that regularly attend the place. In this context, the crack is a substance which has a social use in a daily life for the population of the region. The relationship of consumption and trade of this substance have aggravated a territorialized considered social and urban disqualification in the neighborhood, which associated with the prohibitionist policy on drugs, had perverse effects. This condition enhances the strong stigma in society associated with this space, which leads to a consequent exclusion of those who are there. For Environmental Health, physical and social deterioration of this environment can provide conditions of low quality of life and facilitate the health problems of occurrence beyond a condition of use of a substance. In this sense, this project aims to investigate the relationship between health and environment (context) in the daily life of people who use crack in cracolândia, central region of São Paulo. From this approach, this study aims to bring information that can support more efficient public policies.

Sveriges narkotikapolitik har en tydlig noll vision; Sverige skall bli ett drogfritt samhälle. För att uppnå det målet följer Sverige en så kallad nolltoleransmodell, vilket innebär en strikt policy som säger att all hantering och bruk oavsett volym och syfte är olagligt. Jag argumenterar att det är en skadlig och ineffektiv policy att applicera på drogproblematiken i Sverige och argumenterar därför istället för att införa en så kallad skadereducerande policy. Detta är istället en policy som accepterar att droger är en del av samhället. En sådan policy jobbar främst med förebyggande och behandlande åtgärder, jag argumenterar för en avkriminalisering av personligt bruk av drog. Jag kommer använda mig av empirisk källor och moralfilosofiska argument för att påvisa att en skadereducerade policy gynnar samhället både ur ett socialt och ekonomiskt perspektiv.

INTRODUCTION: Drug consumption rooms (DCR) are places for the hygienic consumption of preobtained drugs in a non-judgemental environment and under the supervision of trained staff. Since 1986, the DCR have been established in 10 countries around the world. Despite the fact that Czech Republic offers wide range of services aimed to minimize the risks connected to problematic drug users, intravenous aplication still prevails. While, effectivity of DCR has already been proven, there are none in the Czech Republic. AIMS: The work aims to provide systematic and comprehensive summary of current state of knowledge regarding establishment and runing of DCR from international experiences. Additionally, the target of this work is to describe what conditions, necessary for legal establishment of DCR, were set in these countries and whether these conditions can be set in Czech Republic. Finally, the thesis analyzes whether the DCR are visited and used by clients and describes what the profile of a typical client is. METHODS: For the first part which deals with establishment of DCR, method of written text analysis based on international scientific databases was used. Second part considering the running of DCR was prepared by analyzing the webpages of individual institutions in order to find out organizational...

The current opioid crisis has, among other things, resulted in soaring rates of fatal overdose across Canada, prompting officials to turn to harm reduction in hopes of combatting the epidemic. The Coroners Service of British Columbia issued a statement in March 2017 reporting an 80% increase in the number of deaths resulting from illicit drug use in 2016 from 2015 (Coroners Service of British Columbia, 2017). Despite the abundance of evidence demonstrating the effectiveness of supervised injection services (SIS) in Canada and worldwide, the implementation of this intervention has remained highly controversial, particularly in Ottawa. Guided by Michel Foucault’s theory of governmentality, this thesis explores the obstacles hindering the implementation of supervised injection services in Ottawa, Ontario. Through eight qualitative semi-structured interviews with front-line workers of harm reduction programs, this thesis identifies and explores several obstacles to the implementation of SIS, primarily bureaucratic obstacles stemming from the enactment of the Respect for Communities Act (2015).

Objectives are (1) Describe HIV/HCV prevalence in TN and Central Appalachia; (2) Understand syringe access in pharmacy settings. Identify and refer clients to local syringe service programs.

Opioid overdose deaths have impacted the lives of countless Canadians at unprecedented rates and have taken the lives of over 19,000 people since 2016, over 4,000 of those deaths occurred in 2017. The overdose crisis has been repeatedly represented in the media and how the issues are represented by key stakeholders is an area left primarily unresearched. Online news media articles stemming from International Overdose Awareness Day in 2017 were collected and methodologically reviewed via Critical discourse analysis to answer the following: What messages, and from which key stakeholders, how key stakeholders challenged or accepted constructions of substances and PWUD, and how messages converged and/or diverged amongst key stakeholders. Loved Ones most the most cited, then Frontline Providers, followed by Experiential People, Government Officials, and Indigenous People the least. Themes that emerged included the Stigma Experience, Sharing Experience of Grief, Loss, and Substance Use, and Problems and Solutions. Competing and divergent views also presented themselves through the stakeholder voices and often revolved around similar goals but different approaches. The voices in the media for International Overdose Awareness Day advocated and disrupted pre-conceived notions yet also contributed to constructions directly connected to the stigma and oppression PWUD face. / Graduate

BACKGROUND: Although the total number of new documented HIV diagnoses annually decreased from 2008-2018, the rate of decrease started to slow in 2013, and substantial variation exists across at-risk groups. People who inject drugs (PWID) account for 9% of new diagnoses annually, with increasing incidence in this population starting in 2015. Among PWID, 34% of new HIV diagnoses occurred in individuals who were also classified as men who have sex with men (MSM), indicating that MSM-PWID have elevated HIV risk. Data on MSM-PWID are scarce, and programmatic and advocacy efforts in HIV prevention do not specifically target MSM-PWID, with no CDC-recommended interventions existing for this population. OBJECTIVE: We sought to characterize the complex, intersecting and unique HIV risks faced by MSM-PWID, including perceptions of HIV risk and attitudes toward antiretroviral pre-exposure prophylaxis (PrEP) among MSM-PWID in urban and non-urban areas of Massachusetts and Rhode Island. METHODS: We recruited PWID through community-based organizations (CBOs; e.g. syringe service programs) in 18 urban centers and smaller cities and towns across Massachusetts and Rhode Island. Participants completed semi-structured interviews exploring substance use behaviors and HIV prevention needs. This in-depth analysis focused on describing the experiences and HIV prevention needs and attitudes of nine participants in the sample who reported a sexual orientation other than “heterosexual.” RESULTS: Most participants identified as cisgender, bisexual men. However, the context of their sexual behaviors varied, with some participants only engaging in same-sex behavior during sex work. The relationship between identity and behavior is explored in the context of reported risk behavior. All participants engaged in at least one behavior that increased risk of HIV acquisition, including syringe sharing, inconsistent condom use, and sex work. Participants also described heightened risk when these behaviors overlapped, particularly within contexts of “sex parties” that some individuals described. At the same time, experiences of isolation and exclusion were common in the sample, indicating a potential vulnerability in this population. HIV risk perception varied among participants, but was not consistently aligned with the behaviors described. Many participants did not perceive needing HIV prevention services “yet,” indicating that they did not view their risk to be high enough to warrant prevention services. Alternatively, some described needing to prioritize daily survival and mental health over HIV prevention efforts. Although knowledge of PrEP was low, acceptability of PrEP was high in this sample, and several participants provided specific suggestions for improving the feasibility of PrEP. CONCLUSION: Data from this study illustrate the HIV risks and prevention needs of this at-risk population and highlight mechanisms to engage them in preventative care. Our main findings are (1) participants had low knowledge of PrEP, but were largely enthusiastic after learning about it from interviewers, (2) varying identity related to same-sex behavior among men who have sex with men and inject drugs may play a role in shaping HIV risk and prevention needs, (3) specific healthcare and prevention service needs of this population emerged, including reducing risk at sex parties and improving access to non-stigmatizing mental health services. An in-depth understanding of the ways in which sexual orientation and gender identity shape HIV risk and prevention needs remains crucial in providing treatment and prevention services to MSM-PWID.

The aim of the thesis is to understand how professionals within different needle exchange programs in Sweden describe the surroundings impact of the contact with patients. Further the aim is to understand how the professionals work with their treatment towards the patients within the clinic due to the impact of the surroundings. The method used is a qualitative method, specifically semi-structured interviews with a various group of six informants. The selections are professionals with different professions who have worked within the needle exchange program, chosen by a targeted selection method. With a semi- structured method, the intention is to capture a secondhand view of patients experiences within the healthcare system in general but also within the needle exchange program.  The results are analyzed with previous research and social science theories based on stigma, labeling and systems. Findings show that patients' experiences are influenced by the surroundings such as social and structural perceptions and attitudes. The society's resistance against the needle exchange program affects the trust against authorities such as social services, police and health care systems. Previous wrong experience with different authorities, more specific healthcare does affect the target group to search for help. Other parts that the results show is internalized stigma within the group of people who inject drugs, either by the individual themselves or by others who consume drugs. The results create an insight on how injecting drugs while being a parent or a woman may involve an additional vulnerability. The thesis shows that professionals that work at the needle exchange program consider the structural impact of their patients while encountering them. Finally, the discussion indicates that the workers accepting, and welcoming approach does help the patients to seek help and to evolve trust. By considering a holistic perspective of the patients and working with harm reduction the professionals do create a neutral environment without the risk of getting stigmatized.