Indigence, marginalization and HIV infection among Brazilian cocaine users

In recent years the HIV/AIDS epidemic in Brazil has increasingly affected younger and more impoverished segments of the population. The rate of infection among drug users has also risen dramatically over the past decade. Despite these alarming trends, epidemiologic studies of indigent drug users in Brazil are virtually nonexistent. In order to fill this void, a research demonstration program was initiated in Rio de Janeiro which targeted drug users from the poorest strata of society, assessed their HIV risk behaviors and serostatus, and provided HIV prevention counseling, hygiene materials, and follow-up. Because participation in the intervention program appeared to impact on drug use and sexual risk behaviors, the implementation of successful prevention programs with this population appears feasible. In that HIV prevalence among this sample of poor injectors was markedly lower than that reported in previous studies of higher socioeconomic status injectors, the timely and widespread implementation of risk reduction strategies assumes great importance for the prevention of HIV infection in the most marginalized segments of Brazilian society.