Cross-cultural approaches to harm reduction research: Some considerations on the Brazil experience

Harm reduction initiatives for drug users comprise a range of approaches, i ncluding drug-user treatment, advocacy for changes in drug policy, needle e xchange programs, bleach distribution, and broad-based interventions that f ocus on both safer drug use and less risky sexual behaviors. In many develo ping nations, harm reduction is a relatively new strategy, which focuses al most exclusively on the connections between drug use and the spread of HIV infection. In Brazil, harm reduction programs are few, and little has been documented about their scope, experience, and effectiveness. This paper rev iews the status of Brazilian harm reduction initiatives in general, with a specific focus on lessons learned from the conduct of cross-national resear ch in Rio de Janeiro. The study demonstrated the feasibility of implementin g a community-based prevention program among an at-risk population of cocai ne users in Brazil, and in other countries where there is little tradition of research with out-of-treatment drug users. Finally, the paper addresses aspects of the harm reduction movement that tend to hamper its progress in both developed and developing nations.