How do we do our job in pandemic times?
By Ana Luiza Voltolini Uwai
Translation by Lucia Sestokas
The É de Lei Coexistence Center has been doing harm reduction work for over 20 years. The teams’ proposal, when carrying out field work, has always been to work on the notion of self-care, mainly through the establishment of bonds, so that the strategies of care in face of the risks and damages related to the use of substances are a joint construction.
The supplies are part of this process, as they are a starting point for a conversation, a way of maintaining the bond and prevention tools, always built together with the people who will use them.
Such supplies need to adapt to the contexts in which they are operated and adapt to changes. When É de Lei began operating in downtown São Paulo, in the early 1990s, the use of injectable cocaine was very common and one of the main factors for the increase in HIV infection. Thus, an important supply at the time were the disposable syringes, which harm reduction workers exchanged for the used ones.
Over time, smoked cocaine – crack – became the substance most associated with people living in vulnerable situations in the city of São Paulo, not surprisingly the territory in which É de Lei is most present in recent years is the region known as Cracolândia*.
Today, the damage reduction supplies used by people who work in harm reduction in the É de Lei team are: silicone cigarette holders, which have the purpose of encouraging individual use, avoiding the sharing of pipes; lip balms, which protect and help in the healing of lip fissures and burns caused by the constant use of the aluminum pipe; internal and external condoms and lubricating gel, supplies provided by the government to reduce the risks of sexually transmitted infections (STIs) and viral hepatitis, as well as a folders with information on each of the most common substances in the lives of the people we work with: crack/cocaine, alcohol and marijuana.
Most recently, É de Lei started a group of harm reduction practices aimed at women (cis, trans and travestis), which led the teams to act based on a view that seeks to discuss gender issues in the territory. From this dialogue, supplies such as panties and tampons started to incorporate the organization’s harm reduction kits.
Harm Reduction and Coronavirus
With the new coronavirus pandemic, a lot has changed. The territory’s demands have changed, and the teams’ way of acting also needed to adapt to this reality. If before the field trips were made twice a week, at least, after the government determination of social isolation, it was necessary to rethink ways to be present.
Harm Reduction kits are now delivered along with hygiene kits, with alcohol gel, soap, tissues and disposable masks. Material with specific information for prevention in contexts of vulnerability was also designed, with indications of where to access water to wash hands and food, as public health and assistance services were closed.
In addition to the supplies, the way of carrying out the actions needed to adjust to the necessary security measures to prevent the spread of the coronavirus. In this way, the team received training on how to use Personal Protective Equipment correctly.
During the actions and the making of the kits:
-Hand hygiene with water and liquid soap (when access to the sink is possible) and hand hygiene with 70% alcoholic preparation;
-Use of goggles or face shield;
-Use of mask;
-Use of apron;
-Use of surgical gloves;
In cases of need for referral to health facilities:
-All mentioned care above;
-Previous notification from the health servisse to where the suspected or confirmed case will be forwarded.
*Cracolândia is the name given to an area in the center of São Paulo known for concentrating a number of people who use drugs and are in vulnerable situations.