Assuntos
Ansiedade/terapia , Transtornos do Comportamento Infantil/terapia , Relações Interpessoais , Relações Médico-Paciente , Psicoterapia/métodos , Adolescente , Comportamento do Adolescente , Brasil , Humanos , Deficiências da Aprendizagem , Masculino , Áreas de Pobreza , Psicologia do Adolescente , Professores Escolares , ViolênciaRESUMO
This article, based on ethnographic fieldwork including twelve months of participant observation and 428 interviews with 84 converts and leaders in Pentecostal ministries founded and run by former addicts in Puerto Rico, describes redefined masculinity as a treatment for addiction. Industrial disinvestment and resulting unemployment and drug trade in urban North and Latin America have led to narcotic addiction among Latino and African American men and attendant homicide, infection, and incarceration. Pentecostal-evangelical street ministries are prevalent in these regions. Their alternative vision of masculine honor and power addresses a cultural crisis of men's social space. They replace the unachievable ideal of the male breadwinner with an image of male spiritual power. In place of the violence of the drug trade, they cultivate male domesticity and responsibility for the home. In place of a deleterious drug economy, they offer the social and cultural capital of ministry networks and biblical knowledge. Yet the trajectories of ministry converts reveal the limits, as well as the promise, of evangelist masculinity as a treatment for addiction. In the course of building leadership among their converts, the ministries create their own, internal hierarchies, fall short of the spiritual democracy they espouse, and lead to relapse among those left at the bottom.
Assuntos
Comportamento Aditivo/terapia , Cristianismo , Usuários de Drogas/psicologia , Masculinidade , Autoimagem , Humanos , Entrevistas como Assunto , Masculino , Porto Rico , DesempregoRESUMO
This article describes the debates leading to Puerto Rico's Mental Health Law of 2000, which defined addiction as a spiritual and social problem rather than a mental disorder, in order to trace three competing approaches to addiction in Puerto Rico: evangelist, biomedical, and harm-reductionist. Highlighting the ways in which the evangelist approach of Puerto Rican street ministries challenges the individualism underlying US faith-based initiatives and the punitive approach of the US War on Drugs, this article concludes that the virtues of the evangelist approach to addiction would be best supported by public funding for biomedical and harm-reduction approaches within a pluralistic system of treatment for addiction.
Assuntos
Cristianismo , Cura pela Fé/métodos , Serviços de Saúde Mental/estatística & dados numéricos , Religião e Psicologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Redução do Dano , Humanos , Porto RicoRESUMO
BACKGROUND: Substance abuse is an escalating problem among poor urban Latina women; little is known about their access to drug treatment and to needed social and health services. OBJECTIVE: Our objectives were to (1) examine the need and use of substance abuse treatment, health services, government entitlement programs, and social service programs among cocaine and heroin using Puerto Rican women and (2) identify whether service use predicts their prospective entry into drug treatment. RESEARCH DESIGN: This was a 3-wave longitudinal study of community substance abusing women evaluated on substance abuse and dependence using diagnostic measures, and hair and urine toxicological screens. Information was collected on self-reported need and receipt of substance abuse treatment, social services, general health services, and government entitlement programs. SUBJECTS: A community sample of cocaine-, crack-, and/or heroin-using women from copping areas in low-income urban centers of Puerto Rico were interviewed in 1997-1998 with 2 follow-up periods. RESULTS: Drug treatment, health, and social service utilization were low relative to need for services throughout all data waves. Social service utilization predicted prospective entry into drug treatment but not contacts with general health services or government entitlement programs. CONCLUSION: Drug-abusing women in low-income urban areas in Puerto Rico have substantial unmet substance abuse treatment, health, and social service needs. Mandated treatment by social service agencies may explain their clients' higher likelihood of entering drug treatment. Building linkages between service sectors to augment entry into drug treatment is essential for meeting the complex needs of this underserved population.
Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Serviço Social/estatística & dados numéricos , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/terapia , Saúde da Mulher , Adulto , Feminino , Seguimentos , Pesquisas sobre Atenção à Saúde , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Estudos Longitudinais , Pobreza/estatística & dados numéricos , Porto Rico/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/etnologia , Saúde da População Urbana , Saúde da Mulher/etnologiaRESUMO
Three-hundred-eleven female drug-using sex workers in urban Puerto Rico were asked to describe their last negotiation with a client. They described efforts to protect themselves from many hazards of sex work, including violence, illness, and drug withdrawal. They also described efforts to minimize the stigma and marginalization of sex work by cultivating relationships with clients, distinguishing between types of clients, and prioritizing their role as mothers. Sex workers adopted alternating gender roles to leverage autonomy and respect from clients. Their narratives suggest that sex workers negotiate a world in which HIV is relative to other risks, and in which sexual practices which are incomprehensible from an HIV-prevention perspective are actually rooted in a local cultural logic. Future HIV prevention efforts should frame condom use and other self-protective acts in terms that build upon sex workers own strategies for understanding their options and modifying their risks.