Cuidado em saúde ao adolescente em vulnerabilidade ao uso de drogas / Health care for adolescents who are susceptible to drug use

RESUMO Este artigo trata das adolescências, no plural, como construção histórico-social de um processo dinâmico, e do adolescente perante seus modos de vida e expressão em um contexto histórico-social e singular. Entende-se aqui que ações meramente prescritivas são insuficientes para responder às complexidades dos processos de adoecimento mental na sociedade contemporânea. Objetivou-se compreender o contexto das práticas de cuidado em saúde ao adolescente em vulnerabilidade, diante do uso de drogas, na dimensão das tensões dos campos de práticas do cuidado em saúde. Estudo descritivo exploratório de abordagem qualitativa, que realizou entrevistas com profissionais da área da saúde (Unidade Básica de Saúde e Centro de Atenção Psicossocial Infantojuvenil). Destacam-se as tensões no campo de práticas entre o modelo assistencial biomédico e de guerra às drogas versus o psicossocial/comunitário; redução de estigma; acesso; redução de danos e nos atendimentos individuais, bem como a importância de refletir e fomentar o processo de mudança da mentalidade diante do adoecimento mental, visando atualizar as formas de cuidar. Esse processo tem sido realizado conforme os princípios da Reforma Psiquiátrica Brasileira, com avanços e retrocessos que repercutem na atualização das práticas de cuidado em saúde mais alinhadas às propostas de ações psicossociais e redutoras de vulnerabilidade.

ABSTRACT This article deals with adolescences, in the plural, as a socio-historical construction of a dynamic process and with the experience of adolescents with their lifestyle and self-expression in a unique socio-historical context. It assumes that purely prescriptive measures are insufficient to address the complexity of mental illness processes in contemporary society. This study aims to understand the context of health care practices for vulnerable youth, particularly those involved in substance use, through the lens of tensions in health practice domains. This is an exploratory, descriptive study using a qualitative approach, with interviews conducted with health professionals (in Basic Health Unit and Psychosocial Care Center for Children and Adolescents). The study highlights the tensions within health practice between the biomedical model and the war on drugs and a community-based psychosocial approach; it underlines the need for reducing stigmatization, improving access, harm reduction, and individualized care. It also emphasizes the importance of considering and promoting a shift in mentality towards mental illness in order to develop care strategies. This process was carried out in line with the principles of the Brazilian Mental Health Reform, with advances and setbacks that affect the updating of health practices, which are more oriented towards proposals for psychosocial and vulnerability-reducing actions.

Regulamentação e criminalização das drogas no Brasil / Drug regulation and criminalization in Brazil

O presente estudo visa avaliar, através de uma revisão narrativa da literatura, como o controle do Estado exerceu ao longo da história do Brasil a regulamentação do uso de drogas. Método Foram consultados livros, artigos de periódicos acadêmicos indexados, trabalhos completos apresentados em congressos e documentos históricos disponíveis na internet relativos ao tema. Resultados A primeira legislação penal em relação ao uso de drogas surge apenas no Brasil império. Nesse período começam a surgir também os primeiros problemas devido ao uso de drogas. A criação de cursos superiores nas áreas de saúde e de ciências naturais veio a formar profissionais capacitados na manipulação e fiscalização de produtos químicos e farmacêuticos. Com o tempo, observando-se os efeitos, algumas substâncias passam a ser proscritas. Conclusão Por toda história do país, o uso e a regulação das drogas, permearam todas as épocas influenciando na cultura, educação e no modo de vida da população. Atualmente há um grande debate acerca das políticas sobre drogas no Brasil, principalmente sobre a maconha e seus usos terapêuticos, mostrando novamente a influência do Estado sobre a saúde e a segurança da população.

The present study aims to evaluate, through a narrative review of the literature, how State's control has exercised regulation of drug use throughout the history of Brazil. Method Books, articles from indexed academic journals, complete works presented at conferences and historical documents available on the internet relating to the topic were consulted. Results The first criminal legislation related to drug use only appeared in Imperial Brazil. During this period, the first problems due to drug use also begin to appear. The creation of higher education courses in the areas of health and natural sciences resulted in the training of professionals capable of handling and supervising chemical and pharmaceutical products. Over time, observing the effects, some substances become proscribed. Conclusion Throughout the country's history, the use and regulation of drugs has permeated all eras, influencing culture, education and the population's way of life. There is currently a great debate about drug policies in Brazil, mainly regarding marijuana and its therapeutic uses, once again showing the influence of the State on the health and safety of the population.

Recreational drug usage and HIV transmission in men who have sex with men in Jinhua / 上海预防医学

Objective:To determine the association between recreational drug usage， high risk sexual behavior， and HIV infection among men who have sex with men（MSM） in Jinhua. Methods:A cross-sectional survey was conducted to recruit MSM for anonymous questionnaire survey and serological examination. We used EpiData3.1 for data entry and SPSS 19.0 for statistical analysis. Results:A total of 368 MSM were surveyed， in which the proportion of recreational drug usage was 13.3% （ 49 / 368 ）， with the HIV infection of 10.3% （38/ 368 ） and syphilis infection of 8.9% （25/368）. Risk factors associated with recreational drug usage were determined to be part-time job or being unemployed （OR=5.26； 95%CI： 2.10-13.18； P<0.001）， average monthly income ≥CNY 5 000 （OR=6.45； 95%CI： 2.87-14.61； P<0.001）， education level of high school or above （OR=1.56； 95%CI： 1.37-3.57； P=0.037）， sexual orientation being homosexual（OR=3.52； 95%CI： 1.60-7.33； P=0.002）， number of sexual partners >1 （OR=4.37； 95%CI： 1.76-10.82； P=0.001）， engaged in group sex （OR=7.90； 95%CI： 2.11-29.55； P=0.002） and previously diagnosed sexually transmitted diseases （OR=4.76； 95%CI： 1.29-17.65；P=0.019）. Conclusion:Prevalence of recreational drug usage among MSM in Jinhua is relatively low. MSM with part-time or unemployed status， monthly income ≥CNY 5 000， higher education level， homosexual orientation， multiple sexual partners， sexually transmitted diseases and group sex behavior are the risk factors associated with recreational drug usage in Jinhua city. Targeted countermeasures should be considered for intervention.

Status and associated factors of recreational drug use among man who have sex with man in Nanjing / 中华疾病控制杂志

Objective To understand the prevalence of synthetic drug use among man who have sex with man (MSM) in Nanjing and the associated factors. Methods MSM were recruited by snow-ball sampling, peer recommendation and network recruitment. Multivariate logistic regression analysis was performed to evaluate the correlated factors of recreational drug use. Results 29.6% of the 876 MSM ever used recreational drugs. The prevalence of HIV and syphilis infections were 9.5% and 9.0% respectively. After controlling the influence of correlated factors, recreational drug use was correlated with unprotected anal intercourse in the past 6 months(OR=1.83, 95% CI: 1.35-2.47, P<0.001), multiple male sex partnership in the past 6 months(OR=2.25, 95% CI: 1.65-3.05, P<0.001), higher HIV prevalence (OR=1.95, 95% CI: 1.21-3.17, P=0.007) and higher syphilis prevalence(OR=1.71, 95% CI: 1.02-2.84, P=0.040). Multivariate Logistic analysis showed that demographic and behavioral factors associated with recreational drug use including: less than 30 years old (OR=1.50, 95% CI: 1.07-2.11, P=0.020), self-identified as homosexual orientation (OR=1.65, 95% CI: 1.16-2.34, P=0.005), seeking male partners mainly via the internet(OR=1.58, 95% CI: 1.07-2.35, P=0.022), higher monthly income(OR=1.57, 95% CI: 1.13-2.17, P=0.007), receptive sexual role(OR=1.55, 95% CI: 1.04-2.32, P=0.033). Conclusions MSM has a high prevalence of recreational drug use in Nanjing, which was positively correlated with HIV/syphilis infection and high risk behaviors. Intervention efforts should be devoted to reduce and combat drug use among MSM.