Harm reduction pioneers and public health experts gathered on November 6 at the THR+ São Paulo 2026 conference to examine lessons from the 1989 Santos syringe distribution program and debate current care standards for people who smoke, Agência Aids reported.
The panel, titled “From experience to incidence: voices that changed history and the challenges that will define the future,” was moderated by Miguel Okumura. Speakers included epidemiologist Dr. Fábio Mesquita, dental surgeon Catalina Riera Costa, and psychologist Mónica Gorgulho.
Agência Aids reported that the 1989 initiative in Santos sought to protect people who used injectable drugs from HIV transmission while they continued using substances. Revista Fórum reported that the proposal was officially announced on November 24, 1989, during the 1st Santos Seminar on AIDS under the administration of Mayor Telma de Souza and Municipal Health Secretary David Capistrano Filho.
Dr. Mesquita recalled that he, the mayor, and the health secretary faced drug trafficking charges brought by the São Paulo Public Prosecutor’s Office following the decision. “The three of us were prosecuted for drug trafficking. And the repercussion was truly a bomb,” Mesquita told Agência Aids.
Plain English Clinical Takeaways
- Harm Reduction Definition: A public health strategy focused on minimizing the health risks associated with alcohol, tobacco, or other drug use without requiring immediate abstinence as a condition for receiving care.
- Epidemiological Context: Early interventions in Santos targeted sharing vectors for bloodborne pathogens like HIV among individuals using injectable drugs before specific antibody tests were widely available.
Reflecting on the legal fallout, Mesquita said that the São Paulo Regional Council of Medicine supported the initiative. Revista Fórum said that similar syringe exchange programs later expanded to Salvador in 1995 and Porto Alegre in 1996, followed by a 1998 São Paulo state law authorizing disposable syringe distribution.
Revista Fórum reported that city and health leaders drew inspiration from European models, particularly those in France, to address discarded syringes in public spaces and contaminated water usage.
Dr. Marcos Caseiro, an infectious disease physician and city council member who also participated in the early Santos response, described public criticism of harm reduction as rooted in a lack of understanding. “The first issue is ignorance,” Caseiro told Revista Fórum.
Clinical obstacles in the early epidemic were manifold. Costa described treating a patient with oral manifestations linked to immune system failure before diagnostic tests existed. “Everything I conducted, nothing turned out within expectations. In other words, I was having a situation where I couldn’t close the diagnosis,” Costa told Agência Aids.
Gorgulho recalled that initial clinical training at the Orientation and Assistance Program for Dependents (Proad) at the Escola Paulista de Medicina emphasized total drug cessation. You don't have to commit to something you can't commit to,” Gorgulho told Agência Aids, explaining the shift toward patient-centered dialogue.
Tobacco Care Debates and Future Challenges
Panelists at the 2026 conference turned toward contemporary policy gaps, specifically how medical professionals approach tobacco use. Mesquita pointed out that knowledge of health hazards does not automatically stop clinicians from smoking. “You knowing is not enough, it’s obviously not enough,” Mesquita told Agência Aids.
Gorgulho observed that medical practitioners continue to resist applying harm reduction principles to nicotine dependence. Costa emphasized the need to examine international alternatives for nicotine dependence management and evaluate their impact on treatment costs for smoking-related diseases.
Medical Risks and Consultation Requirements for Cessation Therapies
Abrupt cessation of certain substances can trigger severe physiological withdrawal symptoms requiring supervised medical detoxification. Individuals with underlying psychiatric conditions, cardiovascular disease, or compromised immune function should disclose their complete medical and substance use history to a physician before starting or modifying cessation therapies.
References
- World Health Organization. Guidelines on community engagement and harm reduction strategies.
- Centers for Disease Control and Prevention. HIV prevention and syringe services programs.
- The Lancet. Historical evolution of public health responses to the HIV epidemic.
