Abstract

Objective:

To discuss the possible input function of artistic and cultural practices in the context of Harm Reduction (HR).

Methods:

Ethnographic research developed at the Ponto de Cultura of the Centro de Convivência "É de Lei", located in São Paulo-SP, which took place in two moments: in the first, in October 2016, participative observation of artistic and cultural activities was carried out. In the second, in November 2016, semi-structured interviews were carried out with professionals and regulars. The study identified and described artistic and cultural practices, as well as investigated their possible relationships with HR inputs in the production of the social bond. The discussion of the data was based on concepts at the interface between public health and psychoanalysis.

Results

and Discussion: The research characterized the input in HR as a promoter of a bond between the drug addict and whoever offers it with the potential to divert the subject from the established solitary relationship with the substance towards the creation of social ties that stimulates the exercise of their condition as a singular subject in culture.

Conclusion:

The study concluded that artistic and cultural practices can play the role of inputs in HR with regard to the establishment of social bonds.

Keywords:
Substance-Related Disorders; Harm Reduction; Mental health; Collective Health; Psychoanalysis

Introduction

Harm Reduction (HR) is an important aspect of care to drug users. It is a strategy of approach to drugs use related issues individually and/or collectively waiving abstinence as a condition to implement caring initiatives. The objective of HR is to create practices that reduce risks and harms to the drugs user and social groups they live with. (Cruz, 2006CRUZ, M. S. Considerações sobre possíveis razões para a resistência às estratégias de redução de danos. In: Álcool e outras drogas: escolhas, impasses e saídas possíveis. Belo Horizonte: Autêntica, p. 13-24, 2006.). According to the Policy of Full Attention to Alcohol and other Drugs Users of the Ministry of Health (PAIUAD) (Brasil, 2003) HR initiatives are one of the care guidelines provided to this population and are ruled by Directive number 1.028/2005. It is targeted to problematic or not drug users who do not intend to stop using it (Brasil, 2005).

After the 1980s outburst of the HIV/Aids epidemics and elevated occurrence of cases due to syringe sharing among injecting drug users (IDU), the Health Secretary of the municipality of Santos, State of São Paulo under the management of David Capistrano Filho initiated HR actions in 1989 in the city.

However, the conservative society rejected the initiative upon accusations of advocating drug use and negative repercussions. In 1994, the “Centro de Estudos e Terapia de Abuso de Drogas (CETAD)” of the Medicine School of “Universidade Federal da Bahia” was awarded funds by the National Coordination of Sexually Transmitted Diseases and Aids (CN-DST/Aids) and implemented the first syringe change program in Brazil (Petuco, 2014PETUCO, D. R. S. Redução de Danos: das técnicas à ética do cuidado. In: RAMMINGER, T. et al (org.). Mais substâncias para o trabalho em saúde com usuários de drogas. Porto Alegre: Rede Unida, 2014. p. 133-148. Disponível em: http://historico.redeunida.org.br/editora/biblioteca-digital/colecao-micropolitica-do-trabalho-e-o-cuidado-em-saude/mais-substancias-para-o-trabalho-em-saude-com-usuarios-de-drogas-pdf. Acesso em: 17 jun. 2016.
http://historico.redeunida.org.br/editor... ).

At that time, several countries mobilized to fight the HIV/Aids epidemics and public national policies focused to risk groups, IDU and homosexuals who, due to their practice deemed “deviant” could spread the virus. In the beginning of the 1990s, an agreement between the Brazilian Government and the World Bank involving resources of the United Nations Office on Drugs and Crime (UNDOC), implemented projects of attention to IDU encompassing syringes exchange. Through CN-DST/Aids, actions of HR for HIV control and other parenteral transmission infections among IDU began. Between 1995 and 2003, more than two hundred Harms Reduction Programs have been created (Andrade, 2011ANDRADE, T. M. Reflexões sobre políticas de drogas no Brasil. Ciência & Saúde Coletiva, v. 16, p. 4665-4674, 2011. Disponível em: https://www.scielo.br/pdf/csc/v16n12/15.pdf . Acesso em: 18 ago. 2015.
https://www.scielo.br/pdf/csc/v16n12/15.... ). Since then, HR experiences multiplied across the country and harm reducers (field workers) organized in associations as “Associação Brasileira de Redutores de Danos (ABORDA)” created in 1997 and the “Rede Brasileira de Redutores de Danos (REDUC)” in addition to state and municipalities associations (Petuco, 2014PETUCO, D. R. S. Redução de Danos: das técnicas à ética do cuidado. In: RAMMINGER, T. et al (org.). Mais substâncias para o trabalho em saúde com usuários de drogas. Porto Alegre: Rede Unida, 2014. p. 133-148. Disponível em: http://historico.redeunida.org.br/editora/biblioteca-digital/colecao-micropolitica-do-trabalho-e-o-cuidado-em-saude/mais-substancias-para-o-trabalho-em-saude-com-usuarios-de-drogas-pdf. Acesso em: 17 jun. 2016.
http://historico.redeunida.org.br/editor... ).

Although the practices of HR are legally regulated and expressed as guidelines for care recommended by the Ministry of Health, recent changes in the National Policy of Mental Health, Drugs Policy and Drugs Law shifted from a health assistance model of harms reduction to abstinence, redesigning the care based in prohibition of use (Brasil, 2017; 2018; 2019). In the perspective of advocates of less invasive care, these changes are a setback of public health policies for individuals with drug problems and are the outcome of a political and historical moment unfavorable to progressive practices as HR.

In the history of mankind, how drugs are used and experienced differ historically and culturally (Escohotado, 1998ESCOHOTADO, A. Historia General de las drogas. Madri: Alianza Editorial, 1998.). Three determinants should be considered: "drug, set and setting”. “Drug" is the drug itself as a substance and its pharmacological action; “set" is the attitude of the individual when drug is used including its personality; “setting” is the influence of the physical and social environment when drugs are used (Zinberg, 1984ZINBERG, N. E. Drug, set, and setting: The social bases of controlled drug use. New Haven: Yale University, 1984.). Studies have demonstrated how restrictive and deteriorated environments impact the problematic pattern of drugs use (Galea ., 2005GALEA, S.; RUDENSTINE, S.; VLAHOV, D. Drug use, misuse, and the urban environment. Drug and alcohol review, v. 24, n. 2, p. 127-136, 2005. Disponível em: https://deepblue.lib.umich.edu/bitstream/handle/2027.42/40353/Galea_Drug%20Use,%20Misuse,%20and%20the%20Urban%20Environment_2005.pdf?sequence=2 . Acesso em: 17 abr. 2023.
https://deepblue.lib.umich.edu/bitstream... ).

Many are the social representations and forms of perceiving drugs use in collective health (Shimoguiri , 2019SHIMOGUIRI, A. F. D. T. et al. A. Discutindo a clínica e o tratamento da toxicomania: dos discursos à constituição subjetiva. Psicologia USP, v. 30, 2019. Disponível em: https://www.scielo.br/j/pusp/a/nTcGqb9pPWGfY9ZqMY7kGCD/abstract/?lang=pt . Acesso em: 16. ago. 2022.
https://www.scielo.br/j/pusp/a/nTcGqb9pP... ). Addiction phenomenon and use of toxic substance within the psychoanalytic perspective are two different problems: not always addiction involves a chemical substance nor toxic ingestion necessarily means addiction (Serretti, 2012SERRETTI, M. A. T. Toxicomania: um estudo psicanalítico. Mosaico: estudos em psicologia, v. 5, n. 2, 2012. Disponível em: https://periodicos.ufmg.br/index.php/mosaico/article/view/6246/3838 . Acesso em: 20 mar. 2023.
https://periodicos.ufmg.br/index.php/mos... ). Addiction is an impulsive and unstoppable action that may be targeted to a wide diversity of objects and situations, including drugs (Gurfinkel, 2011GURFINKEL, D. Adicções: paixão e vício. São Paulo: Casa do Psicólogo, 2011.). Psychoanalysis defines toxicomania as the encounter and the specific bond created between an individual and a substance leading to dependence. It is an intense and exclusive relation with the drug when the use of substances is established as psychic function, unlike occasional users. The individual ties itself to the drug, prioritizing the body satisfaction at the expense of social bonds with other individuals and other forms of having pleasure in pursue of relief of existential uneasiness. One of the consequences of toxicomania is the compromise of the participation of the individuals in social, professional and family interactions. Through their relations, the individuals grant meaning to their insertion in the society and culture but if it prefers to bind exclusively to drugs, a solitary relation with the substance is established, which prevents the entanglement and satisfaction with other partnerships (Briole, 2009BRIOLE, G. Toxicomanía ¿un lazo social entre otros? In: Pharmakon: Publicacion de Grupos e Instituiciones de Toxicomanía y Alcoholismo Del Campo Freudiano. Buenos Aires: Grama Ediciones, 2009. p. 43-50.).

Social bond in psychoanalysis is what ensures the individual its singular participation in culture, it is about the relations among human beings. It exists because there is no natural bond since we live in a language-permeated world. The modalities of social bonds are closely attached to the singularity of each individual and it functions as the articulator between the society and the individual. This articulation is neither complete nor plenty. Social bond is one form of bonding with the other, a tie that connects and separates at the same time because it leans on a hollow which will host each individual’s singularity. Currently, the individuals tend to create punctual social ties affected by the model of connection and disconnection, networks and links embedded in our culture through the Internet. It is important to count with reference marks to make this mobility less erratic (Tizio, 2007TIZIO, H. Novas modalidades do laço social. aSEPHallus: Revista eletrônica do Núcleo Sephora de pesquisa sobre o moderno e o contemporâneo, v. 2, n. 4, p. 1-6, 2007. Disponível em: http://www.isepol.com/asephallus/numero_04/pdf/artigo_03.pdf . Acesso em: 13. jan. 2017.
http://www.isepol.com/asephallus/numero_... ).

Due to the radical changes of drugs use in Brazil, with decline of the number of users of injectable cocaine and increased crack use since the 1990s, the discussions about harm reduction over the nature of the inputs intensified. Examples of inputs of HR are: disposable syringes and paraphernalia for individual use of injectable drugs; internal and external preservatives; informative leaflets; lube gel; sniff kit (an individual, clean and safe device to inhale cocaine, tray and cutter to prepare the drug); silicone holder (protect the lip against burns caused by metal pipes for smoked drugs); pipes; cocoa butter to protect the lips (prevents lip drying from smoking) among others. Prevention of lip lesions is one of the objectives of HR due to the risk of contamination.

The debates supporting the initiative of gradual decline of syringes disposal containers mobilized the 5^th National Encounter of Harm Reduction organized by ABORDA in 2004. Would it be the end of HR practices in Brazil? No, because since the beginning, harms reduction was more than change syringes, prevent and treat Aids. It configured the emerging of a new ethics of care directed to drugs users and understood inputs well beyond the utilitarian dimension of diseases prevention (Petuco, 2014PETUCO, D. R. S. Redução de Danos: das técnicas à ética do cuidado. In: RAMMINGER, T. et al (org.). Mais substâncias para o trabalho em saúde com usuários de drogas. Porto Alegre: Rede Unida, 2014. p. 133-148. Disponível em: http://historico.redeunida.org.br/editora/biblioteca-digital/colecao-micropolitica-do-trabalho-e-o-cuidado-em-saude/mais-substancias-para-o-trabalho-em-saude-com-usuarios-de-drogas-pdf. Acesso em: 17 jun. 2016.
http://historico.redeunida.org.br/editor... ). Initially focused to prevent blood communicable diseases among IDU, and identified only as syringe change practice, HD started to be recognized by the core of its principles: respect to drug users, their needs and their timing (Conte, 2004CONTE, M. Psicanálise e redução de danos: articulações possíveis. Revista da Associação Psicanalítica de Porto Alegre, 2004. v. 25, p. 23-33. Disponível em: https://pt.slideshare.net/multicentrica/psicanlise-e-reduo-de-danos. Acesso em: 9 out. 2016.
https://pt.slideshare.net/multicentrica/... ).

Within the context of contemporary practices of HR, beyond syringes, preservatives and others it is important to discuss the function “inputs” represents in constructing and creating this new caring ethics focused to drug users. Damage reducers have always seen inputs further ahead than clean and safer drugs use tools. Listen, words, bond, welcoming, art are but a few common elements listed as “inputs” by harm reducers in meetings about HR (Petuco, 2016PETUCO, D. R. S. O pomo da discórdia? A constituição de um campo de lutas em torno das políticas públicas e das técnicas de cuidado em saúde dirigidas a pessoas que usam álcool e outras drogas no Brasil. 2016. Tese. Universidade Federal de Juiz de Fora, 2016.). However, these reflections have ever been addressed in scholar researches, barely quoted in a classic article by Bastos (1998BASTOS, F. I. Por uma economia simbólica das trocas... de seringas. In: BASTOS, Francisco Inácio; MESQUITA, Fábio. Troca de seringas: drogas e Aids. Ciência, debate e saúde pública. Brasília: Ministério da Saúde, 1998. p. 91-100.), who mentions "economics of symbolic change … of syringes ", but failed to go deeper and by Machado and Simas (2017) in an article of practice in street medical offices who related HR inputs to an esthetic experience.

The possible function of input in artistic and cultural practices within the context of HR is discussed in the present study. Further than utilitarian equipment, inputs are seen as social-technical objects whose nature is determined when referenced to arrangements which constitute them as such (Vargas, 2008VARGAS, E. V. Fármacos e outros objetos sociotécnicos: notas para uma genealogia das drogas. Drogas e cultura: novas perspectivas. Salvador: EDUFBA, p. 41-64, 2008.). Artistic practices are understood as an “intimate art-life liaison” involving creative processes and esthetic experience (Preciosa, 2005PRECIOSA, R. S. Arte-vida-viagem. In: Produção estética: notas sobre roupas, sujeitos e modos de vida. São Paulo: Ed: Anhembi Morumbi; 2005.). Creative processes are related to concrete doing implying in action, transformation and configuration of a certain theme (Ostrower, 2014OSTROWER, F. Criatividade e processos de criação. Petrópolis: Ed: Vozes; 2014.). The esthetic experience allows the individual to retrieve and enable the body senses; access and integrate sensations that mark the life history; finding itself in forms and situations that reveal the meaning of oneself and construct new reinvigorated daily pathways through the sensitive experience (Mecca, 2015MECCA, R. C. Experiência estética na terapia ocupacional em saúde mental: gestos na matéria sensível e alojamento no mundo humano. Tese de Doutorado. Universidade de São Paulo. São Paulo, 2015.). Culture refers to material and subjective forms the individuals of a group live with, where they act upon and communicate with each other and whose collective experience can be transmitted through symbolic ways to create the next (Ostrower, 2014).

The activities developed by “Ponto de Cultura do Centro de Convivência É de Lei (PC/CC É de Lei)” located in São Paulo - SP with interfaces with art, culture and HR are discussed in the present investigation. The relations among artistic and cultural practices, inputs and HR are reviewed while producing social bonds. The psychoanalysis concepts of “toxicomania” and “social bond” are taken as articulators of the discussion proposed. The study is relevant to individuals dedicated to the study and HR practices interested in challenging the nature and function of inputs.

Methods

Ethnographic study developed as a dissertation by the first author of professional Master’s Degree in Health Professional Education of the Post-graduation program of “Escola Politécnica de Saúde Joaquim Venâncio (ESPSJV)”of “Fundação Oswaldo Cruz (FIOCRUZ)” defended in March 2017 with title similar to the present article, which occurred in two moments. In October 2016, five sessions of participative observation of the artistic and cultural activities of PC/CC É de Lei were held. Later, in November 2026, professionals and regulars of the institution were interviewed. The Institutional Review Board of EPSJV approved the study, report number 1,755,104. No funding was obtained.

We have been acquainted with “É de Lei” in 2012 through social media when we started to follow-up the activities, mainly the artistic and cultural interventions conducted in the streets of São Paulo-SP. The research question was prepared during the Master’s period, inspired by this reference and teamwork of the Street Office (CnaR) involving artistic and cultural practices while helping individuals living in the streets and problematic drug use and discusses the possible function of input of artistic and cultural practices within HR.

In 2016, we approached “É de Lei” during the First National Meeting of Street Offices in Rio de Janeiro when we met Mário¹1 Aliases were adopted to preserve the anonymity of the study participants., historian, out-reach worker and team member. He mediated the submission of the project to the institution and when accepted, referred us to Ariel, the Coordinator of the Nucleus of Culture. The partnership helped to organize the field activities and Ariel’s empathy and willingness were essential during this process.

The methodology of choice was ethnography because it suits the study of specific phenomena involving experience, subjectivity and life history. It consists in research in-the-territory, in direct contact with the study object for a considerable period followed by systematization of the experience as a text (Fabietti; Remotti, 1997FABIETTI, U.; REMOTTI, F. Dizionario di antropologia. Bologna: Zanichelli, 1997.). It is an experience-centered process conducted with reflexive sensitiveness in the field with the individuals with whom the investigator is working (Geertz, 1989GEERTZ, C. A interpretação das culturas. Rio de Janeiro: LTC Editora, 1989.). Experience and subjectivity are important conditions in contemporary ethnography leaving room to the subjectivity of the ethnographer, utilization of the first person in the text and self-reflexive considerations (Caprara; Landim, 2008CAPRARA, A.; LANDIM, L. P. Etnografia: uso, potencialidades e limites na pesquisa em saúde. Interface-Comunicação, Saúde, Educação, v. 12, p. 363-376, 2008.). Data collection included the participative observation of the activities and workshops developed by PC/CC É de Lei located in São Paulo (SP), log of the field diary and semi-structured interviews with three professionals and three regulars.

Ethnography and interviews were conducted by the first author. The professionals interviewed were an occupational therapist (White woman), a psychologist (Brown man) and a psychologist (Asian woman) all in the age-range of 30-40 years. The regulars interviewed were two Black men and one Brown man in the age-range of 40-50 years. The inclusion criteria were willingness and availability to collaborate with the study after the invitation made in a meeting to present the study in the first day of immersion in the field in October 2016. It was decided to enroll professionals and regulars to comprehend the perspectives of the different players involved in the artistic and cultural activities of PC/CC É de Lei, and ensure a firm base to investigate the possible relation among artistic and cultural practices, inputs and HR in the production of social bonds.

The research questions presented to the attendees in the interview were: What living well means to you? In your estimation, what Harms Reduction is and how it is present in your daily life? How do you see your participation in the artistic and cultural activities developed in the institution? The concept behind the questions was to absorb the perspective of the regulars about the possible implications of HR and participation in artistic and cultural activities in the daily life and creation of social bonds.

The research questions to the professionals were: In your estimation, is there any relation among art, culture and HR in the actions of PC/CC É de Lei? How do you understand the term “inputs” applied to HR practices? Are you able to identify the relation among the strategy of inputs delivery, a characteristic of the HR practices, and the artistic and cultural actions developed in the institution? The objective was to absorb the perspective of the professionals about the possible relations among HR, inputs, art and culture in the actions developed by the institution.

The participants were briefed about the nature of the study and signed the Informed Consent Form (ICF). The names are aliases to preserve their anonymity. The field experience, the diary with data of the participative observation and transcripts of the interviews with professionals and regulars supported the analysis and discussion of the study, grounded in concepts arising from the interface between Collective Health and Psychoanalysis.

The institution regulars are drug addicts due to their problematic drug use, compromising their participation in social, occupational and family dimensions and living vulnerable situations daily in restrictive and underserved environments which impact the patterns of substance use.

Study field

The present study field is Centro de Convivência É de Lei, located in the city of São Paulo-SP. Founded in 1998 by Cristina Brites and Andrea Domanico is the first living space managed and focused to drug users in Brazil. Its actions started as a project connected to the Núcleo de Estudos para a Prevenção da AIDS (NEPAIDS) of “Universidade de São Paulo (USP)”. In 2001, it was transformed in a Non-Governmental Organization (NGO). It is a public open space that stimulates the dialogue about drug use within a non-judgmental and respectful dialogue about drugs and the choices regulars have made. The predominance of Black individuals with low education and in social vulnerability stand out (Azevedo ., 2015AZEVEDO, B. L. et al. A prática em redução de danos no espaço da convivência. In: Cultura, juventudes e redução de danos: Centro de Convivência É de Lei. São Paulo: Córrego, 2015. p. 40-46. Disponível em: https://edelei.org/wp-content/uploads/2019/01/Cultura-Juventudes-e-Reducao-de-Danos-E-de-Lei.pdf . Acesso em: 23 maio 2016.
https://edelei.org/wp-content/uploads/20... ).

The nature of the current law in force in Brazil is prohibitionist and criminalistic. It is a selective prohibition supported by the protection of the individual’s health, but ineffective in practice in relation to the reduction of the offer and demand of drugs (Grego Filho; Rassi, 2009). The discretionary nature of the current drugs legislation which does not determine the volume in possession of the individual, and distinguishes user from dealer assigning this responsibility to the law enforcement agents who make the approach, configures a feature that allows the practice of racism and management of life and death of excluded Black young adults - the main victim of prohibitionism.

In the context of drugs criminalization, racism is palpable as fundament and shrouded objective of prohibitionist practices (Júnior, 2016JÚNIOR, A. C. R. As drogas, os inimigos e a necropolítica. Cadernos do CEAS: Revista crítica de humanidades, n. 238, p. 595-610, 2016. Disponível em: https://cadernosdoceas.ucsal.br/index.php/cadernosdoceas/article/view/251/223 . Acesso em: 06 abr. 2023.
https://cadernosdoceas.ucsal.br/index.ph... ). Racism is always structural, an element imbued into the political and economic society. It ensures logic, meaning and technology to reproduce inequalities and violence that shape the contemporary social life (Almeida, 2019ALMEIDA, S. Racismo estrutural. Rio de Janeiro: Pólen Produção Editorial, 2019.).

The predominant profile of Black people among the institution’s regulars warrants the actual articulation of this reality with the effects of prohibitionism that leads to stigma, social exclusion and hurdles to access care provided to drug users, especially Black, poor, excluded young adults, and ruptured by racism. The action of É de Lei as an antiracist space targeted to individuals with drug use issues stand out as a reference and welcoming site.

NGO funding occurs through consulting, bids and notes to implement projects and train professionals of municipal Health and Social Development Secretaries. Paid courses are ministered to whoever is interested. Since 2010, the “Centro de Convivência É de Lei” became a Cultural Point within the “Programa Cultura Viva” of the Ministry of Culture, which are cultural groups, collectivities and entities developing and articulating network activities in their communities, recognized and certified by the Ministry of Culture through the National Policy of Live Culture (Brasil, 2014).

During the conduction of this study, “É de Lei” was located in Reggae Mall, São Paulo downtown, open from Monday through Friday from 2 PM to 6 PM, structured in operational nucleus: Field, Education and Research, Culture, Communication, and Management. The team counted with 14 heterogeneous middle and high educational level professionals in psychology, pedagogy, occupational therapy, social sciences, history communication and social work. The regulars attended or lived nearby in the streets. The access to the institution was ensured after they were invited by the field team who intervened in areas of drug use close to the old railway station Luz, or by the own regulars. After this research, the NGO moved out, but the ethical nature and policy were kept although some activities have been modified.

PC/CC É de Lei weekly agend varied. On Mondays, artists-mediated workshops. On Wednesdays, the "Lily Tea", a conversation round about themes proposed by the regulars with coffee, teas and crackers. On Thursdays, the Digital Cultural Round when audiovisual equipment to implement individual and collective projects with computers and Internet, e-mail, social media and others are available. The institution’s audiovisual production since 2010 resulted in 18 short-movies and Ministry of Culture-funded documentaries upon analysis of the material submitted. The productions were exhibited in cultural venues, events and parties. On Fridays, the team and regulars met to perform cultural activities with visits to museums, cultural centers, libraries, squares, theater and movies and organized the production of events.

The Conviviality

PC/CC É de Lei is an open public space and regulars with problematic drug use are not identified as such. All of them are “regulars", professionals, customers, investigators, interns or visitors. This denomination acknowledged the differences among the places of enunciation of each one and believes the common sharing through conviviality is a form to overcome the limits of established social, economic and cultural boundaries where possible while stimulating that each individual owns its creative power, experiencing other places based in the encounters and activities proposed (Alvarez, 2020ALVAREZ, A. P. E. Convivência como atividade de produção do comum: cartografias com Centros de Convivência. 2020. Tese (Doutorado em Psicologia) - Universidade Federal Fluminense, Niterói-RJ, 2020.).

Day 1 - Discotheque Workshop

The activity coordinated by DJ Dom involved everyone with sound effects created in the mixer and reproduced in speakers. It was the last meeting of an eight-week cycle where musical presentation was prepared to be shown publicly in-the-territory. Dom asked every regular to choose the music to be arranged and rehearsed together. They were exhilarated, some of them sung and danced, others mixed the music supervised by the DJ. The singularity of each one found its place, originating from the creative and musical experience. As a collective yield, the presentation was shared with the public in the territory.

Day 2 - Lily Tea

The meaning of “drug” was discussed during the activity. The selectiveness of the definition of some substances as illicit drugs was discussed. The damages caused by alcohol, a licit drug, were raised by Pedro who believes it is more damaging than weed, the other participants stepped in and voiced their reflections. We talked about pleasure and risks related to many substances, the regulars shared HR strategies as intersperse alcohol shots with water, eat, sleep and attend the activities of É de Lei, to avoid "roaming around alone and sullen” (sic), seeing the NGO as a reference to get care.

Pedro suggested the production of a video about the theme to widen the access to the discussion in the social networks and events É de Lei sponsored. The proposal was accepted and ideas about the dynamics of the implementation popped up which supported the activities of the Cultural Digital Round the next day.

Day 3 - Digital Cultural Round

The video about the meaning of the word “drug” was initiated. The regulars decided to address the dynamics of conversations as interviews about the problematic use of drugs, especially alcohol and HR.

Márcio asked José what É de Lei meant in his life and José said he has attempted to find modalities of treatment for problematic use of alcohol, including hospitalizations, all of them unsuccessful because he was unable to keep clean. He felt É de Lei as a “family-like bond” (sic), he liked being there, which helped him to control the intake.

We were surprised by Manoel who decided to interview the research interviewer “I understood that you are here to do a study about art and culture, right? What have you seen so far living with us during these days in “É De Lei”(sic). We affirmed our interest in activities of art and culture and are excited in getting acquainted with you and this was our main goal in being there. He was happy with our response and for being cooperative when interviewed by him. At that moment, we understood we have been allowed by him and his colleagues to proceed with the field study.

All the processes were conducted by the regulars: planning, handling of audiovisual equipment, selection of the place to record, video edition. The professionals mediated these creative processes.

Day 4 - Cultural Activity

A meeting to organize the “I Festival de Artes Bárbaras” which would be held on the Culture Point of the city. The order of the artistic presentation, equipment transportation logistics, foods and drinks and work dynamics were discussed. Attendees of other collectivities, culture points and health equipment as CAPS and Conviviality Centers stepped in. The offer of alcoholic beverages was raised as some of the sponsors had alcohol-related problems. A consensus to allow alcohol beverages was reached since alcohol was a licit and socially accepted drug in festive setting in addition to non-alcoholic refreshments. Seasoned water, iced tea and juices would be offered as well to the staff. Enjoy, interact, blend in is what mattered at the most in a party, each and every one should decide whether to drink alcohol and take care of itself without impacting the tasks they engaged in performing.

The regulars stepped in and engaged in the organization of the event which would stimulate the encounter of several cultural points in the city. The function of alcohol, a licit drug in parties was brought to light, sharing strategies of HR for alcohol users in these occasions. The organization of the event and other actions promoted in Cultural Activities as visits to museums, libraries, squares, theater shows, movies allow the participants to explore other possibilities of occupying the city (Valent, 2015VALENT, I. U. Do que fazemos na convivência… In: Cultura, juventudes e redução de danos: Centro de Convivência É de Lei. São Paulo: Córrego, 2015. p. 52-57. Disponível em: https://edelei.org/wp-content/uploads/2019/01/Cultura-Juventudes-e-Reducao-de-Danos-E-de-Lei.pdf . Acesso em: 23 maio 2016.
https://edelei.org/wp-content/uploads/20... ).

Along the activities described, the conviviality, music, audiovisual and cultural production shape common interests among the individuals, fostering collective activities and creation of social bonds. The contact with different individuals and diverse life trajectories and the bond created with the team facilitate the construction process of “caring for itself” (Azevedo ., 2015AZEVEDO, B. L. et al. A prática em redução de danos no espaço da convivência. In: Cultura, juventudes e redução de danos: Centro de Convivência É de Lei. São Paulo: Córrego, 2015. p. 40-46. Disponível em: https://edelei.org/wp-content/uploads/2019/01/Cultura-Juventudes-e-Reducao-de-Danos-E-de-Lei.pdf . Acesso em: 23 maio 2016.
https://edelei.org/wp-content/uploads/20... ).

É de Lei is a low demanding institution contrary to other Conviviality Centers in the area of mental health as it is based in HR and welcoming socially vulnerable individuals who usually bump into barriers to access health services due to stigma and moral judgment. Listen, welcome, living together and art are the array of HR practices the NGO performed with the regulars.

Interviews with Regulars

We asked everyone what living well meant. Manoel said home, job, social living and well-structured daily living. Pedro, living well is being accepted by the other, not be oppressed or oppress anyone, live well with itself. João claimed that living well is to be where he likes, with persons he likes, doing what it pleases him.

Next, they were asked what HR meant to them and how it manifested in their lives. Manoel understands that HR helps to organize the daily living, reduction of drug use and job improvement. Pedro believes HR is know how to live in society, respect the differences, perform activities as skating and be a regular at É de Lei. João described HR as an entanglement among persons through what is common to them and produces life.

We addressed the perception about the participation in the institution’s artistic and cultural activities in the third question. Manoel said he was a regular at the NGO for one year and participating in the activities meant something “evolutionary (sic)”. It attends the solidary economy network and is a 5-year militant of the Anti-asylum Movement. Affirmed that "art and culture teach us how to shape ourselves […] culture and art enters the person and the person shapes itself …(sic)”. Pedro told us that the participation in the activities of É de Lei expanded its circulation in the city and its social interactions. Started to be a regular in cultural spaces until then unacquainted with as theaters and museums. João, a 4-year attendee of the NGO quoted movies as one of its passions and É de Lei favored the access and produce art and culture through audiovisual.

Similar responses were found in the interviews with regulars for different questions that showed that for them, closer relations among living well, HR and daily activities existed permeated by conviviality and social bond.

Interviews with professionals

We asked whether they saw the relation among art, culture and HR in the actions of PC/CC É de Lei. Beatriz understands that as a Culture Spot, the NGO stimulates the cultural citizenship of the regulars and of the public they access in the cultural and artistic actions performed in-the- territory. She believes the participation of the regulars in the activities is made with intent, compromise and collaboration in the creative processes, which for her is a harm reduction potential.

Renato emphasized the importance of creative processes as language. Believes interface art-health is important for care to exist. He affirmed that care does not happen without communication and that art is able to create a communication channel with regulars, based on several languages adopted in the creative processes. "From the moment the guy sees himself/herself in the process, he/she too presents himself/herself differently in the world, chooses other ways, I believe art is important to get to know himself/herself somehow.” (sic)

Ariel recalled that, somehow, the professionals of the Culture Center affirm themselves through art. “We work with health, this is not a health practice, this is art! An attempt to put a name to it in another manner so people that participate were able to be recognized otherwise (sic)”. She considers that the relation among art, culture and HR is referenced to a pathway to build up autonomy, conviviality and alterity.

Further, we asked about the understanding of the term “inputs” applied to HR and whether they detected any relation between the strategy of inputs delivery, characteristics of HR practices and artistic and cultural actions developed.

For Beatriz, what is not within the physical health in delivering inputs, is the possibility of dialogue that this creates with the user to generate care.

Renato was invited to talk about inputs at an event and understood it as an intermediate while investigating the term, a bridge to reach some place. Understands that artistic practices could be related to inputs, since they "open a window for a relation, I think input is much more than the thing... the actual prevention it offers there […] we distribute the input because when you offer one thing, the other perceives you are in […] (sic)".

Ariel believes it is possible the relation between inputs, HR and artistic and cultural practices, but it is not “we go there and give the guy a workshop to stop him snorting... It’s another thing.” (sic) She understands the practices of creation, especially the collective, "as enablers of the autonomy, of civil perception, connection, symbolic production and production common to everyone.”(sic)

These interviews revealed that the professionals comprehend the relation among art, culture, inputs and HR consistent with ethics, HR practices, intersectoral and transdisciplinary features that guide É de Lei. They believe cultural practices that include art tools and go further ahead, approach the way of doing and produce subjectivities, ensuring the transformation of the way of living.

Final considerations

Arts and culture that are part of the activities of PC/CC É de Lei call for the ethical, political and esthetic mandate of HR, displacing its utilitarian symbolic representation of the term “input”, initially designed with health prevention of the 1980s, towards culture, art, rights guarantee and citizenship representations. The production of social bonds is mediated by artistic and cultural practices and conviviality that mean and affirm the singular way of everyone living in the world well beyond the stigmas bound to persons who use drugs. The activities permeated by collaborative and creative processes stimulate the subjective redesign of the participants about their relationship with drugs, which provokes reflections about life living and can change habits.

HR inputs can be characterized as instruments of care able to connect the drug user to whoever offers it. This connection diverts the subject from the solitary relation established with the substance, which grants him an impermanent physical satisfaction towards the creation of social bonds which ensure to vest upon itself its condition of singular subject of culture. Whereas the mediating nature of inputs for HR, this study revealed the possible function of inputs in artistic and cultural practices in regard to the establishment of social bonds. The inputs attribute of socio-technical objects with its nature determined when referenced to arrangements that constitute them as such (Vargas, 2008VARGAS, E. V. Fármacos e outros objetos sociotécnicos: notas para uma genealogia das drogas. Drogas e cultura: novas perspectivas. Salvador: EDUFBA, p. 41-64, 2008.) is ratified.

Change of health concepts and practices start with assembling theoretical fields and diversified practices that allow the challenging of hegemonic paradigms. The tension between health practices and psychoanalytic elaborations supported by the notion of the unconscious is essential to establish other logics, indicating new forms of operation relying by an ethics that pull away from the imposition of norms and values. Identify, report and elaborate these practices strengthens the transformative power they carry and support a space that goes beyond the mere “prescription” of conducts (Costa Val et al., 2017).

The study limitations hinder the applicability of the results. Further studies to discuss the inputs in HR are necessary to step ahead of the utilitarian dimension of diseases prevention, including art and culture as inputs and potential harm reduction²2 K. da S. Machado: project, analysis and interpretation of the data; wording of the article; critical review of the intellectual content, approval of the final version to be published, responsible for the quality assurance, accuracy and integrity of any portion of the article. M. S. Cruz: wording, critical review, approval of the final version to be published. M. C. de A. Carvalho and D. R. da S. Petuco: study design and objectives, reflection and critical review of the intellectual content, approval of the final version to be published..

Acknowledgments

To the regulars and team of “É de Lei” for their collaboration.

References

Publication Dates

History