Harm Reduction: a strategy to reduce social inequalities. Brazilian programs that have worked.

Background: 20% of the Brazilian population is socially vulnerable. The Unified Health System (SUS) offers universal and free care. However, people who use drugs experiencing multiple vulnerabilities are the most disadvantaged because they see denied the access to health, social assistance, and justice. Harm Reduction plays here an essential role to enable access and this is the main reason to have it part of public policy.

Description of model of care: Brazil has its own style of Harm Reduction, based on Collective Health, since the health of one person influences its surroundings. Protagonism and emancipation are encouraged. Here we present three practical HR actions that have changed the lives of drug users who lived in social vulnerability:
1) Porto Alegre’s Test & Treatment programme completely eliminated the incidence of hepatitis C in detention centers by implementing free testing and follow-up to treatment using HR’s working guidelines, with low demands and shared responsibility for care.
2) Participation in Rights Councils: The Drug Policy Council has a constitutional basis for the participation of users in the formulation, implementation and evaluation/supervision of public policies, bringing State and Civil Society closer together.
3) Boca de Rua (Street Speaking) newspaper has been produced by homeless people for the past 20 years. There are 35 members who work directly on the newspaper and sell it on the streets. It generates income, autonomy and citizenship, with monthly meetings with a journalist and rules of coexistence including harm reduction.
Effectiveness: HR increases access and adherence to services and social rights, and stimulates the self-organisation of users in the effective formulation of drug policies.

Conclusion: HR is a political force for citizenship, care and the exercise of democracy, by empowering drug users who now have common agendas for struggle, reducing social inequalities.