Crackland in Brazil: epidemiological monitoring method and results

Crack/cocaine consumption in Brazil is more than just a public health issue. It is a consequence of the neglect to tackle socio-economic inequalities, combined with a failure to launch prevention initiatives targeting the population that is most in need. The impact of this disastrous social problem is widespread, weighing heavily on Brazil’s astronomic rates of urban violence, overstrained justice system, public healthcare services and mortality rates. According to the Brazilian National Alcohol and Drugs Survey, it is estimated that approximately 2 million Brazilians have smoked cocaine in their lifetime (1.5%) and one in one hundred used it the past year. One third of the users reside in the south-east region of Brazil, with over 160 thousand users living in the State of Sao Paulo alone. A large number of those users meet and live in certain parts of down town Sao Paulo to openly consume crack, an area called “Crackland”. Police action is limited to the prevention of major conflicts within the community and they will not stop or intervene in the open consumption and retail of drugs by adults, adolescents and children alike. This talk will be based on the repeated crossectional survey performed in three moments, between 2016 and 2017, in this location. The survey used the time-location sampling method to estimate the total population in this area and to randomly select 102, 105 and 71 participants in each wave respectively. Representative data regarding this population’s sociodemographic characteristics, health and drug use patterns and related risks as well as social vulnerability, access to services and motivation to treat were investigated.

The total population living in Crackland was 709, 1861 and 414 individuals in the three moments of evaluation. It found a significant decrease in the female and an increase of the transgender populations. Nearly 70% of the users are homeless, and more than a third of those are in this situation for more than five years. Most participants (74%) were living at home with their family before moving to Crackland, 60% never visited their homes afterwards. Most participants are polydrug users, but 15% are alcohol users only. There is a sub-population of foreigners (2.8% - mostly from Tanzania – Africa) that are heroin users (smoked and injected). Nearly one third of the participants needed emergency services in the previous year, most (74%) have been tested for DSTs (6.2% HIV positive, 12.6% Syphilis) and 13.4% have been diagnosed with tuberculosis. Nearly 20% of women have contraceptional implants, but 14% were pregnant during the interview, 60% of them never performed a prenatal examination. The rates of abortion, pre-term and stillborn among women with history of pregnancy were: 21%, 67% and 21% respectively. Nearly one third of the participants reported having been physically and/or sexually abused as a child (44% among women. One third of the participants referred never having looked for addiction treatment in their lives, 42% used at least one of the harm reduction services in the region and 45% were willing to undergo addiction treatment.

These results should guide future strategies to deal with such complex public health issue that is Brazilian’s biggest Crackland. The understanding of the profiles of this socially vulnerable population should help to improve assistance approaches.