[Disaffiliated cocaine users: measures of prevention]

Disaffiliated cocaine users have a precarious contact with the health care system thus complicating prevention of HIV and hepatitis. The lack of confidence of cocaine users towards the health care system as well as society's way of taking charge of them, hinders both the development of a relationship based on change and for users to take action towards risk reduction. The lack of coordination between health care resources constitutes yet another obstacle. After reviewing the literature on social disaffiliation and the risks of viral infections in cocaine users, the authors make a critical analysis of preventive means concerning viral infections. Thus, the model based on harm reduction, low-access programs, information interventions, sensitization as well as motivational approaches, empowerment and health promotion are discussed.