[Consumption of psychoactive substances: from punishment to care]. / Consumos de sustancias psicoactivas: del castigo al cuidado.

Although the consumption of psychoactive substances is a practice that dates back to the earliest days of humanity, in the last century it has become an issue that has gained attention from the scientific community, State agencies of control, professionals in a number of diverse settings, and society at large. Despite being a complex issue with multiple manifestations, there has been a tendency to reduce it to a question of disease or of crime; nonetheless, not all forms of consumption constitute problematic substance use, nor do they produce substance use disorders. Bearing this in mind, the call for papers on "the consumption of psychoactive substances: from punishment to care" brings together research that contributes both knowledge and actions that are contrary to punitive responses, which unfortunately remain prevalent in society.

Si bien los consumos de sustancias psicoactivas son una práctica que se remonta a los albores de la humanidad, en el último siglo se han constituido en un problema que interpela a la comunidad científica, a las agencias estatales de control, a los profesionales que actúan en los más diversos ámbitos, a la comunidad toda. Siendo una cuestión compleja que se expresa en múltiples manifestaciones, se ha tendido a circunscribirla como enfermedad y/o como delito; sin embargo, no todas las formas de consumo representan un uso problemático, ni producen trastornos por el uso de sustancias. En este sentido, la convocatoria abierta "Consumos de sustancias psicoactivas: del castigo al cuidado" reunió investigaciones que aportan conocimientos y acciones contrarias al punitivismo, que desgraciadamente insiste en permanecer en la sociedad.

Changes in time-use and drug use by young adults in poor neighbourhoods of Greater Buenos Aires, Argentina, after the political transitions of 2001-2002: Results of a survey.

BACKGROUND: In some countries, "Big Events" like crises and transitions have been followed by large increases in drug use, drug injection and HIV/AIDS. Argentina experienced an economic crisis and political transition in 2001/2002 that affected how people use their time. This paper studies how time use changes between years 2001 and 2004, subsequent to these events, were associated with drug consumption in poor neighbourhoods of Greater Buenos Aires. METHODS: In 2003-2004, 68 current injecting drug users (IDUs) and 235 young non-IDUs, aged 21-35, who lived in impoverished drug-impacted neighbourhoods in Greater Buenos Aires, were asked about time use then and in 2001. Data on weekly hours spent working or looking for work, doing housework/childcare, consuming drugs, being with friends, and hanging out in the neighbourhood, were studied in relation to time spent using drugs. Field observations and focus groups were also conducted. RESULTS: After 2001, among both IDUs and non-IDUs, mean weekly time spent working declined significantly (especially among IDUs); time spent looking for work increased, and time spent with friends and hanging out in the neighbourhood decreased.We found no increase in injecting or non-injecting drug consumption after 2001. Subjects most affected by the way the crises led to decreased work time and/or to increased time looking for work--and by the associated increase in time spent in one's neighbourhood--were most likely to increase their time using drugs. CONCLUSIONS: Time use methods are useful to study changes in drug use and their relationships to every day life activities. In these previously-drug-impacted neighbourhoods, the Argentinean crisis did not lead to an increase in drug use, which somewhat contradicts our initial expectations. Nevertheless, those for whom the crises led to decreased work time, increased time looking for work, and increased time spent in indoor or outdoor neighbourhood environments, were likely to spend more time using drugs. These data suggest that young adults in traditionally less-impoverished neighbourhoods may be more vulnerable to Big Events than those in previously drug-impacted impoverished neighbourhoods. Since Big Events will continue to occur, research on the pathways that determine their sequelae is needed.

Harm reduction theory: users' culture, micro-social indigenous harm reduction, and the self-organization and outside-organizing of users' groups.

This paper discusses the user side of harm reduction, focusing to some extent on the early responses to the HIV/AIDS epidemic in each of four sets of localities-New York City, Rotterdam, Buenos Aires, and sites in Central Asia. Using available qualitative and quantitative information, we present a series of vignettes about user activities in four different localities in behalf of reducing drug-related harm. Some of these activities have been micro-social (small group) activities; others have been conducted by formal organizations of users that the users organized at their own initiative. In spite of the limitations of the methodology, the data suggest that users' activities have helped limit HIV spread. These activities are shaped by broader social contexts, such as the extent to which drug scenes are integrated with broader social networks and the way the political and economic systems impinge on drug users' lives. Drug users are active agents in their own individual and collective behalf, and in helping to protect wider communities. Harm reduction activities and research should take note of and draw upon both the micro-social and formal organizations of users. Finally, both researchers and policy makers should help develop ways to enable and support both micro-social and formally organized action by users.

Some data-driven reflections on priorities in AIDS network research.

Risk networks can transmit HIV or other infections; social networks can transmit social influence and thus help shape norms and behaviors. This primarily-theoretical paper starts with a review of network concepts, and then presents data from a New York network study to study patterns of sexual and injection linkages among IDUs and other drug users and nonusers, men who have sex with men, women who have sex with women, other men and other women in a high-risk community and the distribution of HIV, sex at group sex events, and health intravention behaviors in this network. It then discusses how risk network microstructures might influence HIV epidemics and urban vulnerability to epidemics; what social and other forces (such as "Big Events" like wars or ecological disasters) might shape networks and their associated norms, intraventions, practices and behaviors; and how network theory and research have and may continue to contribute to developing interventions against HIV epidemics.

The HIV/AIDS epidemic and changes in injecting drug use in Buenos Aires, Argentina.

This article discusses the changes in injecting drug use from 1998 to 2003 in Buenos Aires, Argentina. The Rapid Situation Assessment and Response methodology was used to obtain the information. Quantitative and qualitative techniques were triangulated: 140 current IDUs and 35 sex partners of injection drug users (IDUs) were surveyed; 17 in-depth interviews with the surveyed IDUs and 2 focus groups were held, as well as ethnographic observations. The way in which risk and care practices among injecting drug users changed and the influence of the HIV/ AIDS epidemic on this process are described. In recent years, the frequency of injection practices and sharing of injecting equipment has decreased, while injecting drug use is a more hidden practice in a context of increasing impact of the disease in the injecting drug use social networks and changes in the price and quality of drugs. Knowledge about these changes helps build harm reduction activities oriented to IDUs in their particular social context.

The HIV/AIDS epidemic and changes in injecting drug use in Buenos Aires, Argentina

Este artículo refleja los cambios en el uso inyectable de drogas producidos entre 1998 y 2003 en Buenos Aires, Argentina. Para obtener la información se empleó la metodología de Evaluación y Respuesta Rápida, triangulando técnicas cuantitativas y cualitativas. Durante 2003-2004 se realizaron encuestas a 140 usuarios de drogas inyectables (UDIs) actuales y a 35 parejas sexuales de UDIs. De este universo, 17 UDIs fueron entrevistados en profundidad; se formaron dos grupos de discusión y observaciones etnográficas. Se describe el modo en que cambiaron las prácticas de cuidado y riesgo en el uso inyectable y la influencia de la epidemia de VIH/SIDA en este proceso. En los últimos años disminuyó la frecuencia de uso y del uso compartido de material de inyección, se incrementó el ocultamiento del uso inyectable; en un contexto de fuerte impacto de la enfermedad en el entorno cercano a los UDIs y de un cambio en la relación precio-calidad de las drogas. Conocer estos cambios permite intervenir más adecuadamente en la reducción de los daños asociados al uso inyectable de drogas en el contexto particular en que estas prácticas se desarrollan.

Human immunodeficiency virus/acquired immunodeficiency syndrome prevention in injection drug users and their partners and children: lessons learned in Latin America--the Argentinean case.

Thirty-nine percent of Argentineans living with acquired immunodeficiency syndrome were infected with human immunodeficiency virus through the injection of drugs. However, it was not until the 1990s that harm reduction programs were created. Research and outreach projects have been developed to identify and interact with the hidden injection drug user (IDU) population. Implementation of rapid assessment and response methodology contributed to the founding of Argentina's first syringe exchange program. Community-based outreach is the appropriate method for working with the impoverished population of Buenos Aires. Seroprevalence studies and focused prevention campaigns targeting IDUs and their sex partners and children have been developed. Collaborations between government and nongovernmental organizations in various cities supported the distribution of prevention and harm reduction messages to 900 IDUs within a 3-month period. Ongoing research, community-based interventions, and collaborative work among different organizations allow for more frequent and more consistent contact with the IDU population of Argentina.

Obstacles to the development of prevention and public health policies in Argentina.

The spread of the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) epidemic and its impact in the injection drug user population occurred while the social assistance of the State diminished and poverty increased within the Argentinean population. Five main obstacles have been identified for the development of HIV infection/AIDS prevention policies for injection drug users: the scarce development of research and its poor impact in the definition of governmental policies, the characteristics of the legal framework regarding illegal drug use, the orientation of the health and social care services directed to drug users, deficiencies in the training of technicians and professionals related to these issues, and problems in assigning existing resources. International agencies play a very important role in this context. The project "Prevention of HIV Infection in Injection Drug Users in the Southern Cone," financially supported by the Joint United Nations Programme on HIV/AIDS and the United Nations Office on Drugs and Crime, is presented as an example.

HIV and injection drug use in Latin America.

OBJECTIVE: This paper presents HIV/AIDS-related data on injection drug use (IDU) and drug use trends in Latin America, and policy issues and strategies developed to face the HIV epidemic. METHODS: Serosurveillance data on HIV/AIDS and IDU in Latin America were compiled. Key experts were consulted in Argentina, Brazil, Colombia and Mexico. Published and grey literature was reviewed. An overview and information on selected countries is discussed in order to analyse different responses. RESULTS: IDU AIDS cases are driving the epidemiological trend in the Southern Cone at 34.3%, followed by Brazil at 20.2%, Latin Caribbean 2.8%, Central America 0.9%, Mexico 0.6%, and the Andean area 0.2%. Available prevalence data are absent or scarce with the exception of Argentina and Brazil. Even with evidence of HIV transmission occurring in IDU, there is a notorious lack of studies in most other countries. In 1984-2000 only four out of 21 Latin American countries had reported prevalence studies. CONCLUSION: For countries that have already initiated harm-reduction programmes (HRP) the great challenge is to ensure that these activities are sustained. In other countries, IDU as a high-risk factor is currently of less importance. However, an increase in the frequency of IDU has been detected, and HIV prevalence is expected to increase. It is therefore necessary to implement HRP to encourage and help drug users to adopt safer methods, such as access to equipment and sterile materials, cleaning materials and information about safe sex, as well as counselling, support groups and medical assistance.

Experiencias de reducción de daños asociados a las drogas en la ciudad de Buenos Aires / Experiences of reduction of damages associated to drugs in the city of Buenos Aires

La práctica inyectable de uso de drogas y su asociación con la transmisión del VIH hacen necesario el diseño y la implementación de políticas dirigidas a las necesidades de los usuarios de drogas. Se describen diferentes iniciativas de la Asociación Civil Intercambios, dirigidas a desarrollar intervenciones para reducir los daños asociados al uso de drogas, desde la perspectiva de salud pública

Experiencias de reducción de daños asociados a las drogas en la ciudad de Buenos Aires / Experiences of reduction of damages associated to drugs in the city of Buenos Aires

La práctica inyectable de uso de drogas y su asociación con la transmisión del VIH hacen necesario el diseño y la implementación de políticas dirigidas a las necesidades de los usuarios de drogas. Se describen diferentes iniciativas de la Asociación Civil Intercambios, dirigidas a desarrollar intervenciones para reducir los daños asociados al uso de drogas, desde la perspectiva de salud pública

La prevención primaria de la farmacodependencia / The primary prevention in the pharmacodependence

El presente trabajo muestra los fundamentos del Modelo Etico Social elaborado por el Fondo de Ayuda Toxicológica (F.A.T.) y su aplicación en el período correspondiente a 1984. Dicho modelo revierte los esquemas tradicionales, basados en el temor o en el protagonismo de la droga como "peligro" enunciado desde el lugar del supuesto saber. El sistema preventivo puesto en práctica, rubrica el sentido ético del mensaje, centrándolo en sus reales protagonistas: familia, adolescente, comunidad, para el replanteo de sus roles específicos y la valorización de sus propuestas. Metodológicamente, se plantea la circularidad del mensaje con plena participación de los interesados, para la comprensión del fenómeno adictivo, el cambio actitudinal ligado a lo afectivo y los proyectos individuales y grupales. Se impulsa a la comunidad a asumir este compromiso, brindando los adecuados canales de participación