Harm Reduction Unit of the City of Santo André, São Paulo State, Brazil: An Evaluation

Abstract

The Harm Reduction Unit (HRU) in Santo André (São Paulo State) was created to improve the health of people who either live or work on the streets: drug users, commercial sex workers (male and female), men who have sex with men, sexually exploited adolescents, transsexuals, transvestites, lesbians, and women working in brothels. This project was undertaken to evaluate the HRU from the perspective of its users. A semi-structured interview was administered to nineteen users from different segments of the populations served by the unit. The major weaknesses of the HRU were felt to be its inconsistent presence in some areas and the absence of psychologists to provide follow-up care. The unit was seen as promoting better health, increased use of condoms, reduction in drug usage, increased access and use of health care services, and less sharing of equipment used in drug consumption. Users see the HRU as a sympathetic presence whose ongoing work provides them with a sense of security and protection. The impact of the HRU went beyond harm reduction; users reported transformative changes such as increased awareness of their social rights and knowledge about how those rights can be demanded. Users had been given new tools to face their problems and seek access to education, work, and housing. Key words: harm reduction, illegal drugs, health service evaluation, social problems