ABSTRACT
RESUMO Este artigo teve como objetivo apresentar a experiência da implementação dos Consultórios de Rua na cidade do Recife-PE como estratégia de prevenção ao HIV/Aids e Redução de Danos (RD) decorrentes do uso de álcool, crack e outras drogas. Ainda que o resgate da história desse processo apresente tensões, impermanências e alternâncias nos modelos de cuidado implementados pela gestão municipal, sua análise aponta a importância de reafirmar, no contexto atual, a proposição de práticas e experiências nesse campo, ancoradas na RD e na defesa da cidadania e dos direitos humanos. Observa-se que os Consultórios de Rua contribuem para fortalecer a prática de RD no Sistema Único de Saúde (SUS) como estratégia de saúde pública, assim como reduzem as vulnerabilidades às Infecções Sexualmente Transmissíveis (IST) e Aids associadas ao uso de álcool, crack e outras drogas. A experiência do CR ampliou a promoção à linha de cuidado para pessoas que usam álcool, crack, e outras drogas, reduzindo também as vulnerabilidades das IST/Aids associadas a esse consumo. No entanto, vê-se que é preciso investir e manter processos formativos que sejam permanentes, além de estudos e pesquisas epidemiológicas que demonstrem os resultados alcançados nos diferentes contextos.
ABSTRACT This article aims to present the experience of implementing 'Street Outreach Teams' in the city of Recife-PE as a strategy for HIV/AIDS prevention and Harm Reduction (HR) associated with the use of alcohol, crack, and other drugs. Although the review of the history of this process reveals tensions, volatility, and alternations in the care models implemented by the city management, the analysis points out the importance of reaffirming, in the current context, the practices and experiences in that field, anchored in HR and in the defense of civil and human rights. Street outreach teams have been found to help strengthen the practice of HR in the Unified Health System, as a public health strategy to reduce vulnerabilities to Sexually Transmitted Infections (STI) and AIDS associated with the use of alcohol, crack, and other drugs. The experience has expanded the promotion of the line of care for people who use alcohol, crack, and other drugs and reduced the vulnerabilities of STI/AIDS associated with such use. However, it seems that it is necessary to invest and maintain permanent training processes, in addition to epidemiological studies and research demonstrating the results achieved in different contexts.
ABSTRACT
RESUMEN Se analiza la dinámica espacial de las cadenas de reclutamiento de consumidores de drogas en un estudio respondent-driven sampling (RDS) en la ciudad de Recife, Brasil. El propósito es comprender los cuellos de botella geográficos, influenciados por la geografía social, que han sido un gran desafío para los estudios basados en RDS. Se utilizó el análisis espacio-temporal. La dinámica del proceso de reclutamiento se presenta en mapas, teniendo en cuenta el barrio de residencia y/o los sitios de consumo de drogas. La regresión de Poisson se ajustó para modelar la tasa de reclutamiento por barrio de residencia y/o sitios de consumo de drogas y las características demográficas de los barrios. La distancia entre el barrio de residencia y/o los sitios de consumo de drogas y el centro de evaluación se asoció negativamente con el reclutamiento. Hubo una asociación positiva entre la proporción de la población que vive en entornos informales y la tasa de reclutamiento por barrio de residencia y/o sitios de consumo de drogas. Las cadenas de reclutamiento dependen de la geografía social y demográfica de la población. Los estudios deben incorporar semillas de reclutamiento de tantos barrios como sea posible, así como más de un centro de evaluación.
ABSTRACT This study analyzes the spatial dynamics of drug users' recruitment chains in the context of a respondent-driven sampling (RDS) study in the city of Recife, Brazil. The purpose is to understand the geographic bottlenecks, influenced by social geography, which have been a major challenge for RDS-based studies. Temporo-spatial analysis was used. Sequential maps depicted the dynamics of the recruiting process, considering neighborhood of residence and/or places of drug use. Poisson regression was fitted to model the recruiting rate by neighborhood or residence and/or pace of drug use, and the different neighborhoods' demographics. The distance between neighborhood of residence and/or place of drug use and the assessment center was negatively associated with recruitment. There was a positive association between the proportion of the population living in informal settings and the recruiting rate per neighborhood of residence and/or place of drug use. Recruitment chains depend on the social geography and demographics of the population. Studies should incorporate seeds from as many neighborhoods as possible, and more than one assessment center should be utilized.