Paper short abstract:

Brazil, Portugal, and the United States each interpret the term "harm reduction" differently. Given such little consensus, there is much to be learned from a comparative analysis of national harm reduction policies and practices, as well as their impact on people who use drugs and society at large.

Paper long abstract:

It is a well-documented phenomena that vulnerable populations face inequalities in healthcare access and quality. No matter the nation, people who use drugs (PWUD) have faced scrutiny and stigma from medical professionals, politicians, and their communities at-large. That said, initiatives for harm reduction in Brazil and Portugal, countries which take a human rights approach to healthcare, vastly differ in and of themselves, as well as differ from those living in the United States. A comparative approach of the three countries using historical analyses of drug use, as well as analyses of interviews with PWUD, activists, healthcare workers, and policymakers, helps to reveal the differing meanings of harm reduction across health systems and countries. Given the priorities of each system, Portugal's approach at decriminalization seems to have elicited satisfaction from PWUD and policymaking respondents alike, with social support seen and accepted as a responsibility of the state and a means of harm reduction. Brazil's largest city, São Paulo, attempted a similar social welfare policy to respond to crack cocaine use, yet the program was received immediate criticism and has since been severely defunded. The United States has yet to implement a national harm reduction strategy, thereby deferring to states and municipalities. The variations within and across countries as to whether harm reduction is the responsibility of the state reveal how deeply stigma is rooted in national policy, as well as the potential for success when such policies take a human rights approach.