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From 2002 to 2005, we evaluated five Brazilian harm reduction programs ran by active drug users who distributed pipes, condoms, educational material, and provided referral to crack users. System-wide barriers identified: funds discontinuation and legislation barriers toward fieldwork. Major achievements: increased access to health, social, and psychological support. Crack-cocaine users experience a plethora of health/social problems, attenuated by low-threshold and user-friendly interventions, particularly those developed by other drug users. However, a stronger political commitment is needed to face a fast growing crack-cocaine epidemic in Brazil, aiming to ensure availability/ continuity of funds, implementation of large-scale interventions, outreach workers training, and proper evaluation. [ABSTRACT FROM AUTHOR]

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