Abstract

Introduction

Data on the use of crack cocaine (henceforth referred to as ‘crack’) in Brazil reveals a discreet and stable consumption within the Brazilian population during 2001-2005. However, there is strong evidence that from 2009 onwards the use of this substance, and its association with several health problems, has become more frequent¹1. Brasil. Presidência da República; Secretaria Nacional de Políticas sobre Drogas. Relatório brasileiro sobre drogas [periódico na Internet]. Brasília: SENAD, IME/USP; 2009 [acessado 2009 jul 12] Disponível em: http://www.obid.senad.gov.br/portais/OBID/biblioteca/documentos/Relatorios/328379.pdf
http://www.obid.senad.gov.br/portais/OBI... .

Crack users often engage in risky behavior in order to maintain their consumption patterns and they are in a position of great social vulnerability. In general, they do not have access to education or formal work and most of them live on the streets²2. United Nations Office on Drugs and Crime (US). World Drug Report 2012. New York: United Nations Publication; 2012.^–44. Malta M, Monteiro S, Lima RMJ, Bauken S, Marco A, Zuim GC, Bastos FI, Singer M, Strathdee SA. HIV/AIDS risk among female sex workers who use crack in Southern Brazil. Rev Saude Publica 2008; 42(5):830-837..

In a survey of young people and adults aged 12 – 65, living in 108 cities with more than 200,000 inhabitants in Brazil, males had a higher prevalence of crack use, both in 2001 and in 2005¹1. Brasil. Presidência da República; Secretaria Nacional de Políticas sobre Drogas. Relatório brasileiro sobre drogas [periódico na Internet]. Brasília: SENAD, IME/USP; 2009 [acessado 2009 jul 12] Disponível em: http://www.obid.senad.gov.br/portais/OBID/biblioteca/documentos/Relatorios/328379.pdf
http://www.obid.senad.gov.br/portais/OBI... . Another study, which was conducted with students of primary and secondary education in the public and private school systems in 27 capital cities, pointed to differences in substance use among young users: a higher proportion of young males reported illicit drug use, including crack, while young people women reported a higher consumption of drugs without prescription³3. Carlini EA. VI Levantamento Nacional sobre o Consumo de Drogas Psicotrópicas entre Estudantes do Ensino Fundamental e Médio das Redes Pública e Privada de Ensino nas 27 Capitais Brasileiras – 2010 [periódico na internet]. São Paulo: CEBRID, UNIFESP; 2010 [acessado 2011 mar 02] Disponível em: http://www.obid.senad.gov.br/portais/OBID/biblioteca/documentos/Publicacoes/328890.pdf
http://www.obid.senad.gov.br/portais/OBI... . However, even if the prevalence of male crack consumption is higher, women have a more significant risk of contracting sexually transmitted diseases, such as hepatitis and HIV, due to a greater use of the female body as a form of exchange for drugs. Women have a large number of sexual partners and condoms are seldom used during sex⁴4. Malta M, Monteiro S, Lima RMJ, Bauken S, Marco A, Zuim GC, Bastos FI, Singer M, Strathdee SA. HIV/AIDS risk among female sex workers who use crack in Southern Brazil. Rev Saude Publica 2008; 42(5):830-837.^–77. Corsi KF, Rinehart DJ, Kwiatkowski CF, Booth RE. Case Management Outcomes for Women Who Use Crack. J Evid Based Soc Work 2010; 7(1):30-40.. There are frequent reports of physical and sexual violence among this group of women (especially related to negotiations about the use of condoms)⁸8. Rodrigues DS, Backes DS, Freitas HMB, Zamberlan C, Gelhen MH, Colomé JS. Conhecimentos produzidos acerca do crack: uma incursão nas dissertações e teses brasileiras. Cien Saude Colet 2012; 17(5):1247-1258..

Brazilian studies about the use of crack have primarily focused on students in elementary and secondary education, health professionals, university students, and children and adolescents living on the streets. Within the aforementioned studies the following issues have been most common: risky sexual behavior; the profiles of crack users; and the areas where crack circulates⁵5. Duailibi LB, Ribeiro M, Laranjeira R. Perfil dos usuários de cocaína e crack no Brasil. Cad Saude Publica 2008; 24(Supl. 4):S545-S557.^,99. Oliveira JF. (In)visibilidade do consumo de drogas como problema de saúde num contexto assistencial: uma abordagem de gênero [tese]. Salvador: Universidade Federal da Bahia; 2008.^–1313. Shannon K, Rusch M, Shoveller J, Alexson D, Gibson K, Tyndall NW. Mapping violence and policing as an environmental-structural barrier to health service and syringe availability among substance-using women in street-level sex work. Int J Drug Policy 2008; 19(2):140-147..

The relationship between women, prostitution and drug addiction has been addressed in international studies that have dealt with issues such as public policy, violence, barriers to access to health services, and social vulnerability¹⁴14. Mehrabadi A, Craib KJ, Patterson K, Adam W, Moniruzzaman A, Ward-Burkitt B, Schechter MT, Spittal PM. The Cedar Project: a comparison of HIV-related vulnerabilities amongst young Aboriginal women surviving drug use and sex work in two Canadian cities. Int J Drug Policy 2008; 19(2):159-168.^–1616. Nappo, SA, Sanchez Z, Oliveira LG. Women, crack and AIDS in São Paulo. Subst Use Misuse 2011; 46(4):476-485.. However, there is an under-representation of Brazilian studies on this subject, more specifically regarding the abuse of substances by the female population. There are particularly few studies that focus on the prevalence of the use of crack in terms of gender and the practice of prostitution, as well as other related aspects¹⁷17. Malta M, Monteiro S, Lima RMJ, Bauken S, Marco A, Zuim GC, Bastos FI, Singer M, Strathdee SA. HIV/AIDS risk among female sex workers who use crack in Southern Brazil. Rev Saude Publica 2008; 42(5):830-837.^,1818. Arruda MSB; Soares CB; Adorno RCF. Revisão bibliográfica: o consumo de crack nos últimos 20 anos. Sau. & Transf. Soc. [periódico na Internet]. 2013 [acessado 2013 jul 07];4(2):[cerca de 09 p.] Disponível em: http://www.incubadora.ufsc.br/index.php/saudee transformacao/article/view/2251
http://www.incubadora.ufsc.br/index.php/... . For example, issues such as the class or gender of those who exchange sex for money or drugs have been little discussed¹⁸18. Arruda MSB; Soares CB; Adorno RCF. Revisão bibliográfica: o consumo de crack nos últimos 20 anos. Sau. & Transf. Soc. [periódico na Internet]. 2013 [acessado 2013 jul 07];4(2):[cerca de 09 p.] Disponível em: http://www.incubadora.ufsc.br/index.php/saudee transformacao/article/view/2251
http://www.incubadora.ufsc.br/index.php/... .

The term ‘gender’ establishes a biological demarcation between what is culturally constructed and attributed to the female and male sexes. This term can be used to refer to a system of signs and symbols that mark relations of power, hierarchy and constant negotiations between the sexes¹⁹19. Schienbinger L. O femininismo mudou a ciência? [Internet] 2001 [acessado 2011 jul 10] Bauru: EDUSC: [cerca de 384 p.] Disponível em: http://brasil.indymedia.org/media/2007/06/386937.pdf.
http://brasil.indymedia.org/media/2007/0... ^,2020. Laqueur T. Inventando o sexo: corpo e gênero dos gregos a Freud. Rio de Janeiro: Relume-Dumará; 2001.. Analyses that address gender issues need to include aspects related to sex, sexuality, sexual orientation, race/ethnicity and social class²¹21. Porto JRR. Violência contra a mulher: expectativas de um acolhimento humanizado [dissertação]. Porto Alegre: UFRS; 2004..

The roles that are socially assigned to women and men are gradually constructed within social, cultural and economic relationships. These roles are mainly allocated so as to favor certain more hierarchical power relations, and sometimes in relation to violence against women²¹21. Porto JRR. Violência contra a mulher: expectativas de um acolhimento humanizado [dissertação]. Porto Alegre: UFRS; 2004.^,2222. Abdala C, Silveira K, Minayo MCS. Aplicação da lei Maria da Penha nas delegacias de mulheres: O caso do Rio de Janeiro. DILEMAS: Revista de Estudos de Conflitos e Controle Social 2011; 4(4):571-600.. Gender violence is a concept that should be understood through the dynamics of social relations and not only by legal proceedings. It should also include the identity of minorities that are discriminated against because it will have different impacts on children, adolescents, women, men and the elderly²³23. Debert GG, Gregori MF. Violência e gênero: novas propostas, velhos dilemas. Rev Bras Ci Soci. 2008; 23(66):165-185..

This perspective helps us to understand the dynamics of conjugal relations without incurring the error of simply victimizing women or blaming men, given that this phenomenon is much more complex than simply searching for victims and perpetrators²²22. Abdala C, Silveira K, Minayo MCS. Aplicação da lei Maria da Penha nas delegacias de mulheres: O caso do Rio de Janeiro. DILEMAS: Revista de Estudos de Conflitos e Controle Social 2011; 4(4):571-600.^,2424. Bordieu P. A Dominação Masculina. 2ª ed. Rio de Janeiro: Bertrand Brasil; 2002..

This study highlights the relationships constructed between women and men who are crack users. Consequently, the following objectives stand as benchmarks for this analysis: to identify the nature of the gender relations in the daily lives of crack users living on the streets, and to analyze the dynamics that permeate the construction of these relationships involving exchange and power.

This study considers people who live on the streets to be a heterogeneous population group that has in common factors such as extreme poverty, interrupted or weakened family ties, the absence of regular conventional housing, and that uses public places, either temporarily or permanently²⁵25. Brasil. Decreto nº 7.053, de 23 de Dezembro de 2009. Institui a Política Nacional para a População em Situação de Rua e seu Comitê Intersetorial de Acompanhamento e Monitoramento, e dá outras providências. Diário Oficial da União 2009; 24 dez..

Method

This is a qualitative, descriptive, exploratory study of phenomenological²⁶26. Giacomini M. Theory Matters in Qualitative Health Research. In: Bourgeault I, Dingwall R, Vries R, organizadores. The Sage Handbook of Qualitative Methods in Health Research. London: SAGE Publications Ltda; 2010. p. 125-156. orientation, which is based on the narratives of male and female crack users living on the streets of the city of Rio de Janeiro; the data was collected between June and August 2011.

This study examines the qualitative dimension of “an exploratory study about the profile of crack users in three Brazilian cities”²⁷27. Santos Cruz M, Andrade T, Bastos FI, Leal E, Bertoni N, Villar LM, Tiesmaki M, Fischer B. Key drug use, health and socio-economic characteristics of young crack users in two Brazilian cities. Int J Drug Policy 2013; 24(5):432-438.^,2828. Bertoni N, Burnett C, Cruz MS, Andrade T, Bastos FI, Fischer B. Exploring sex differences in drug use, health and service use characteristics among young urban crack users in Brazil. Int J Equity Health 2014; 13(1):70..

The data was collected in the community of Manguinhos/Jacarezinho in the city of Rio de Janeiro, Brazil, which is a neighborhood known for the presence of drug trafficking and the use of crack by people on the streets in outdoor public spaces, which are known as “cracolândias“ (cracklands).

This study included the participation of men and women aged over 18, who were regular users of crack (for at least three days each week in the previous three months), with behavior that would allow participation in groups; they were recruited on the streets through the help of the main participant in this study. The group meetings were conducted in the Family Clinic, a primary health care unit located within the community.

Before being included in this study, all the participants read and signed an informed consent form (ICF). The study was submitted to the Ethics Committee of the Institute of Psychiatry at the Federal University of Rio de Janeiro (UFRJ) and to the National Commission for Research Ethics, CONEP, and was approved.

Using a previously established script, and also an identification sheet, eight focus groups (n = 31) were conducted. The script was intended to focus on the following issues: the subjective and bodily experiences that motivate crack use, both during and after use; the relationships between men and women that are mediated by crack; affective relationships; the use of the body; the management of conflicting relationships between couples; and the autonomy to make decisions. By these means we tried to access certain phenomena of consciousness, i.e. ideal objects that exist in the minds of individuals that are provided with “significance”²⁹29. Carol L. Phenomenology. In: Bourgeault I, Dingwall R, Vries R, organizadores. The Sage Handbook of Qualitative Methods in Health Research. London: SAGE Publications Ltda; 2010. p. 229-248..

Furthermore, in order to meet the objectives of the study there were two individual interviews with a man and a woman who had participated in the focus group stage, to amplify some relevant points.

Two groups were formed that consisted only of women; this was intended to allow discussion of matters that had proved difficult to discuss in the presence of men. The interviews were recorded and lasted an average of 40 minutes; they were later transcribed. The original names were replaced by fictitious names.

After a first reading, the results were pre-categorized into an explanatory scheme: gender hierarchy, conjugalities and sexual practice. Constant re-readings were made comparing them with the original scheme. A second group was organized because of themes that were perceived in the statements. These themes were: narratives of silence; resistance and permanence in everyday affections; and the use of the body.

Results

The socio-demographic profile of the 31 individuals (13 men and 18 women) revealed that 23 of them were from the city of Rio de Janeiro, 20 were mixed race, and only one was white. In addition, 22 were single, 25 had incomplete primary education, 24 had no religion, 22 were involved in informal work (of which 9 were unemployed) and 28 did not receive any government benefits.

Narratives of silence: resistance and permanence in everyday affections

The everyday affections of crack users emerge through different relationships that are marked by positions of “resistance” and “permanence”, and which can be examined from a gender perspective.

We define “resistance” here as that which breaks with more traditional attitudes within a hierarchical reading of gender – the organization between men and women based on criteria of power and subordination. Such postures of resistance point to the possibility of more equal agreements among those who participated in this survey.

The term “permanence” denotes behaviours and attitudes in the environment that was studied that corroborate with more traditional and hierarchical gender relations.

The daily routine of crack use is marked by different modes of agreement. It was possible to observe the need on the part of those who participated in this study to constitute bonds that are similar to those of a family. Certain groups were organized so that their interactions were marked by relationships between women and men that were more in keeping with solidarity, and these relationships were actually referred to as “family.” It was noted in the interviews that there were agreements that were less hierarchical; those that involved the sharing of food, crack, support and protection.

These agreements were arranged in such a way as to benefit one or another, depending on the pressing interests of the moment. Thus, when referring to a previous relationship, Renata pointed to a more equal form of coexistence:

There was a dialogue; there was an arrangement between us (Renata).

It is also possible to see that crack operates as a method of exchange between couples and that it acts as a mediator in tense situations. When questioned about the experiences that she had the last time she used crack, Rebecca stated:

[…] I wasn't thinking about using it, but it was just that his father [the father of Rebeca's son] uses my addiction to keep me in the house […] he hates me, he sees that I'm angry, that I'm about to leave, he says: here, buy your drugs! According to Rebeca, her partner was also a crack user.

Violence is present in daily life. Situations of aggression and threats are present among couples, in most cases aimed at women. In the mixed groups, it was the men who mentioned these situations. The women tended to “naturalize” the pain attributed to the use of crack.

This was clear in the speeches of this group when Rosa started talking about the pain that she frequently feels. She was then interrupted by one of the males in the group, who stated that the aggression that Rosa had suffered from her husband was responsible for her pain. He added, pointing to the other women in the group:

[…] These women here are the victims of beatings! (Reginaldo).

The silence of the women, which was repeated at various times in the focus groups, was illustrated when Rita refused to talk. When she was asked about what it was like to be a provider of sexual services for crack users, despite the insistence and provocation of Robson, she clammed up, supported by Ruth, who was another member of the group.

With regard to maternity and paternity, it was strongly observed that a more traditional, hierarchical organization held sway, with clearly defined roles for men and women. In these cases, the women still occupy a prioritized place regarding responsibility for childcare and multiple other tasks; the men mostly relate to paternity in an irresponsible manner.

For these women, despite all the weakness that crack consumption can bring them, there is no dispute about their responsibility for childcare:

[…] My day is complicated because of the responsibility for him [adopted son of the participant], he studies in the morning, leaves here at seven in the morning […] finishes there at four in the afternoon […] I go to work […] he gives me a lot of headaches […] he doesn't want to leave me […] but he is my son because he calls me mother […] (Rebeca).

As for the men, a large number of them had children but most of them did not assume any responsibility for them, often having little or no contact with them:

[…] Well I'm single now! I have eight children but I couldn't tell you their ages. (Ronaldo)

With regard to pregnancy, the women who were prostitutes were keen to assert that their children were the result of choices that occurred within specific relationships, and that drugs were not responsible for their pregnancies.

Ronda made it clear that her three children were the result of her choices.

[…] My kids were born because I allowed it to happen. I became involved with somebody specifically so that I would become pregnant. My oldest son is ten years old, the middle one is four and the youngest is three. Look at the gaps I put between their ages […] (Ronda).

[…] Drugs do not cause pregnancy! Do you understand? (Raqueli).

Even when they decided to leave their children for adoption, these women related it to an act of responsibility in relation to the baby's life.

[…] My daughter was born on the street […] afterwards I went by ambulance to the hospital […] only I preferred to leave the girl there […] how I was going to stay with a child in the street? My daughter could have died from an infection. (Ronda).

The interviews contained concerns about HIV infection. Most of the women who worked as prostitutes made it a point to say that they didn't use condoms, claiming to have “a prejudice against their clients” (Raqueli). When they were asked about how they obtained condoms some of them said that got them by exchanging them for crack.

The fact of being a mother was reported as containing a certain measure of status.

The jealousy of the women without children in relation to those who did have children was evident.

[…] Every time I get pregnant she becomes pregnant as well. (Renata).

Silence: prostitution and the use of the body – resistance and permanence

The different ways in which the use of the body occurred emerged in the narratives of the interviewees, who highlighted the use of the body as a means of subsistence. Prostitution is routine in the life of those who were interviewed, but with different nuances. It is clear that they make a distinct effort to separate what they consider to be affection - loving choices – from what they consider to be “work.”

The use of the body, either for money or for crack, is commonplace for both men and women. In one of the groups male prostitution was openly acknowledged, for example in a humorous way when males were asked if they had been offered money or crack to prostitute themselves.

Renan, Robson and Reinaldo were very relaxed about discussing the issue:

[…] Various gays […] they turn up without any shame! And I go, and when it comes to the moment I don't go through with it [laughs]. (Reinaldo)

However, female prostitution seemed to be surrounded with caution and some strategies of silencing. In the groups it was observed that the women always needed to stress that it was “other” women who were involved in prostitution rather than themselves, which suggests how prostitution can be problematic for their male partners.

[…] If he knew, he would kill me! He would prefer it if I went into a shopping mall and stole everything, if I were arrested, than if I did ‘that’ for anyone. (Raquel).

These women's boyfriends or partners often know about the activities of their women, and even share the gains, but this activity cannot become public, and in no way should it be visible to the other males in the group. Some of the women are blackmailed by other men and they have to “pay” for their silence, either with money or with crack.

[…] If you say that you will not give a piece of crack to that person who knows, they will be all over my boyfriend and will tell him that I have been turning tricks. Certainly, blackmail exists. (Rosinda).

However, other forms of agreements were also evident. The “control” of the female body oscillates and sometimes tends to favour the female side with respect to the power of seduction:

[…] It's easier for women, just with a look … a woman just needs to look at a guy and he's going to give her money […]. (Reinaldo).

At other times this form of control works in favour of men, for example, when what is at stake is related to physical force:

[…] For work … to get some money together, like work. Only give work to a man because men can handle it. (Reinaldo).

Women seem to be more protected in relation to certain forms of violence precisely because they are women. When a man commits a mistake within the community it can bring more serious consequences than for a woman:

[…] Men are more able to take a beating … if you can get by the guys find out, men get beaten much more […]. (Reinaldo).

Discussion

For those who participated in this study, crack plays an important mediating role between the different possible affective agreements in their daily lives. These findings, in a similar way to other studies, indicate a predominance of men and women with a profle of low levels of education and informal working practices⁸8. Rodrigues DS, Backes DS, Freitas HMB, Zamberlan C, Gelhen MH, Colomé JS. Conhecimentos produzidos acerca do crack: uma incursão nas dissertações e teses brasileiras. Cien Saude Colet 2012; 17(5):1247-1258.^,1010. Seleghim MR, Inoue KC, Santos JAT, Oliveira MLF. Aspectos da estrutura familiar de jovens usuários de crack: um estudo do genograma. Cienc Cuid Saude 2012; 10(4):795-802.^,3030. Malta M, Monteiro S, Lima RMJ, Bauken S, Marco A, Zuim GC, Bastos FI, Singer M, Strathdee SA. HIV/AIDS risk among female sex workers who use crack in Southern Brazil. Rev Saude Publica 2008; 42(5):830-837..

Our findings revealed that agreements to share (from food to crack) form part of everyday life. This fact is both interesting and revealing because, contrary to what common sense might suggest (i.e. despite the heavy use of crack), these people are able to establish links, partnerships and affective choices, even if the latter are mediated by crack. Consequently, in the context of crack use, a relational space prevails where different agreements and exchanges are constructed¹²12. Raupp L, Adorno RCF. Circuitos de uso de crack na região central da cidade de São Paulo (SP, Brasil). Cien Saude Colet 2011; 16(5):2613-2622..

This research revealed strong evidence of what we would refer to as “narratives of silence”. This silence takes on different meanings and it can be representative of permanence in agreements that are based on a traditional gender hierarchy. However, it can also be evidence of resistance in relation to pre-established and agreed discourses between men and women. This was especially observed when topics such as violence and the use of the body for prostitution were discussed.

Therefore, particularly in terms of relationships that are influenced by the presence of violence, it would be incorrect to assume the victimization of women or the guilt of men, thereby simplifying roles that can be assigned to victims and perpetrators²²22. Abdala C, Silveira K, Minayo MCS. Aplicação da lei Maria da Penha nas delegacias de mulheres: O caso do Rio de Janeiro. DILEMAS: Revista de Estudos de Conflitos e Controle Social 2011; 4(4):571-600..

These “narratives of silence” in the mixed groups indicated the possibility of a certain “resistance” by the women – in the sense that they would talk when they wanted to, and not when asked to by other people. When the option was silence, it seemed that they were giving support to each other not to talk, as a specific choice. This is the type of resistance that makes it possible to “challenge” gender relations that are more hegemonic, traditional and hierarchical, as has been indicated by other writers³¹31. Grimberg M. Sexualidad, experiencias corporales y género: un estudio etnográfico entre personas viviendo con VIH en el Área Metropolitana de Buenos Aires, Argentina. Cad Saude Publica 2009; 25(1):133-141.^–3333. Munévar-Munévar DI, Mena-Ortiz LZ. Violencia estructural de género. Rev Fac Med 2009; 57(4):356-365..

Power relations can arise in everyday life either explicitly or implicitly³¹31. Grimberg M. Sexualidad, experiencias corporales y género: un estudio etnográfico entre personas viviendo con VIH en el Área Metropolitana de Buenos Aires, Argentina. Cad Saude Publica 2009; 25(1):133-141. and those which are analyzed in the present study are challenged by women who participated in this study through a strategy of opting to remain silent.

Bearing in mind that the mixed groups were also composed of couples, we understand that talking openly might have threatened relationships of trust between peers that were related to drug use, as has been pointed out by other authors³⁴34. Iversen J, Wandb H, Gonnermannc A, Mahera L. Gender differences in hepatitis C antibody prevalence and risk behaviours amongst people who inject drugs in Australia 1998–2008. Int J Drug Policy 2010; 21(6):471-476..

There are some cultural determinants that are still very deeply rooted, and which are present in the construction of male and female roles, regardless of what has been discussed by feminist movements³⁵35. Lamoglia CVA, Minayo MCS. Violência conjugal, um problema social e de saúde pública: estudo em uma delegacia do interior do Estado do Rio de Janeiro. Cien Saude Colet 2009; 14(2):595-604..

The narratives contained in this study sometimes contain support for a more traditional hierarchical organization in which women are considered to be responsible for the care of the young and men are seen as providers who support the use of drugs (crack), often assuming a position of superiority.

On the other hand, in the groups that only comprised women there was evidence of what can be recognized as a form of “resistance” and positions that contain the likelihood of making choices. In these groups, statements in support of motherhood, and the separation of that from the use of the body for work (prostitution), were very clear.

Being a mother appears to allow the possibility of rising to a privileged place in the group, thereby giving these women very important status, i.e. that of possessing something produced or designed in a particular way, and which sometimes originates from their own choices. Motherhood has a function that reaffirms them as women and that allows them to be more respected by the other males and female with whom they live. This goes against what many other authors have indicated as being the reason for women becoming pregnant, which under different analyses, still constitutes a value that defines being female³⁶36. Cote NG, Deutsch FM. Flowers for Mom, a Tie for Dad: How Gender is Created on Mother's and Father's Day. Gend. Issues 2008; 25(4):215-228..

However, the characterization of motherhood as an act of love or responsibility needs to be explored in greater detail by further studies.

The direct and simplistic assertion that women are “victims” of their partners is not sufficient to express the complexity of relational arrangements that arise in extreme adversity, as is the case of the everyday situation of people living on the streets³⁷37. Barcinski M. Agency and victimization in the trajectory of women involved in drug trafficking in Rio de Janeiro. Cien Saude Colet 2009; 14(2):577-586..

There were reports of agreements between partners that suggest situations characterized by greater violence. However, when such situations are analyzed within the setting of “cracolândia” they point to much more complex codes and reveal agreements within certain relationships where “control” fluctuates, sometimes favoring women and sometimes men²²22. Abdala C, Silveira K, Minayo MCS. Aplicação da lei Maria da Penha nas delegacias de mulheres: O caso do Rio de Janeiro. DILEMAS: Revista de Estudos de Conflitos e Controle Social 2011; 4(4):571-600..

In the narratives about prostitution in the present study, crack appears as either contributing to the maintenance of hierarchical roles or as “breaking” the power of those roles for some of the women who were interviewed.

It was particularly noteworthy that prostitution was a prevailing informal activity among the group of women, which corroborates the analysis of other authors on this issue¹⁶16. Nappo, SA, Sanchez Z, Oliveira LG. Women, crack and AIDS in São Paulo. Subst Use Misuse 2011; 46(4):476-485.^,1717. Malta M, Monteiro S, Lima RMJ, Bauken S, Marco A, Zuim GC, Bastos FI, Singer M, Strathdee SA. HIV/AIDS risk among female sex workers who use crack in Southern Brazil. Rev Saude Publica 2008; 42(5):830-837.^,3434. Iversen J, Wandb H, Gonnermannc A, Mahera L. Gender differences in hepatitis C antibody prevalence and risk behaviours amongst people who inject drugs in Australia 1998–2008. Int J Drug Policy 2010; 21(6):471-476.^,3636. Cote NG, Deutsch FM. Flowers for Mom, a Tie for Dad: How Gender is Created on Mother's and Father's Day. Gend. Issues 2008; 25(4):215-228..

In the statements about the use of body and female prostitution it was noticed that there was a “pact of silence”, based on what might be called a “question of honor”. Sometimes it is necessary to “pay” in order to ensure silence about something that is commonplace, but revealing. In this way, crack is the main method of currency in relations, and it can either ensure silence or not. However, some authors suggest that power relations contribute to women being forced to share equipment for drug use, at the risk of violence, particularly arising from men³⁸38. Bauman Z. O estranho revisitado e revisitando. In: Bauman Z. Vida em Fragmentos: sobre ética pós-moderna. Rio de Janeiro: Zahar; 2011. p. 173-190.^,3939. Bungay V, Johnson JL, Varcoe C, Boyd S. Women's health and use of crack cocaine in context: Structural and ‘everyday’ violence. Int J Drug Policy 2010; 21(4):321-329..

Some writers³⁹39. Bungay V, Johnson JL, Varcoe C, Boyd S. Women's health and use of crack cocaine in context: Structural and ‘everyday’ violence. Int J Drug Policy 2010; 21(4):321-329.^,4040. Riehman KS, Wechsberg WM, Zule W, Lam WK, Levine B. Gender Differences in the Impact of Social Support on Crack Use Among African Americans. Subst Use Misuse 2008; 43(1):85-104. have suggested that, in general, drug users tend to seek partners who bring them benefits. The narratives in our study point to crack being a major factor in mediating relationships between women and men who use this drug.

Conclusions

Our immersion in the universe of crack users, through focus groups and interviews, revealed that despite the extreme violence that exists in Manguinhos it is a particularly rich and dynamic context.

Through the narratives, it was observed that despite the relevance of crack in the lives of the individuals who were interviewed, in certain situations they are able to make choices and agreements. The demarcation of groups referred to as “families” clearly demonstrates the possibility of establishing choices, i.e. strong, well defined ties. Such choices are manifested in the narratives, which speak of everyday life, of affections, about the means to “make a living” by resorting to prostitution for cash or crack, for example, but also by preserving life through agreements and alliances

Analyzing the issues relating to gender and power that emerged in the statements it was possible to observe the coexistence of permanence and resistance, as well as agreements that were more and less hierarchical. Although at a first sight it may seem that relationships rooted in a traditional hierarchy of gender are predominant, such as the responsibilities of motherhood and childcare, a closer look at the material shows the presence of lines of flight, of movements towards taking positions on the part of crack users, such as attempts to reaffirm positions of choices about having children or whether or not to use condoms. However, these issues need to be further developed in future studies.

Although the influence of certain socio-cultural determinants was observed in the narratives, for example in the demarcation of scripts regarding what should be male and the female, the way that they are played out on a daily basis for those who were interviewed was polysemic in nature.

Understanding how the relationships between male and female crack users are established enables the development of prevention and intervention strategies that can valorize gender issues. It also makes it possible to think about ways in which to approach these people in order to facilitate their access to available treatment sites.

In this research, the study of established relationships revealed that it was not possible to point to perpetrators or victims. What emerged was a plural and fluid universe in a permanent stage of construction, with shifts that sometimes work in favor of women and sometimes in favor of men.

Among the limitations of this study was the need to expand the number of individuals who participated. All the verbal contributions were self-authorized, which may have been influenced by the presence of men and women in the same group, as well as police raids in that community. Although we arranged focus groups that were composed only of women, we did not arrange focus groups solely comprised of men, which would have allowed us to better hear the opinions of male crack users. The data regarding the socio-demographic profile of those interviewed needs to be expanded; issues such as family composition and the economic power of the individuals were not sufficiently detailed. In addition, the details of how individuals started using crack, and the factors that led to that choice, should be included in future research.

Thus, it is suggested that further exploratory studies should be performed to expand upon the universe that was researched and also to value the voices of both men and women. The material that was investigated points to the need for greater investment in research that can assist in building forms of care that are consistent with the real needs of crack users.

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