Peer‑Led Harm Reduction in Brazil: Gender‑Based Violence, Intersectionality, and Decolonial Perspectives of Community-based care

This article examines how gender‑based violence (GBV) and substance use intersect in the lives of trans women and travestis in Brazil, and how community harm reduction practices emerge in response. It also analyzes harm reduction as a technology of care and life‑sustaining practice. Two ethnographic studies were conducted in Brazil between 2019 and 2023, combining life histories, interviews, and participant observation with trans women, sex workers, activists, health professionals, and NGOs. Data from both studies were intersected and analyzed to identify common themes, resulting in four categories: (1) gender‑based violence and trajectories of marginalisation; (2) substance use as coping and as risk; (3) harm reduction from the margins through community practices of care; and (4) agency, resistance, and re‑signification of marginality. Findings indicate that the suffering experienced by trans women can be conceptualized as a form of “crossroads suffering,” produced at the intersection of trajectories of vulnerabilisation and encruzilhamento that challenge binary logics. The study also demonstrates that self‑care and community care practices within solidarity networks play a crucial role in everyday survival, emphasizing the importance of situated knowledges in contexts of care. Central to these practices was the role of lived experience: trans women and travestis drew on their own histories of violence, exclusion, and survival to generate harm reduction strategies that were credible, culturally resonant, and effective in reaching peers. Their experiential expertise functioned as a counter‑hegemonic form of health knowledge, challenging biomedical authority and reshaping harm reduction from the margins. Experiences of violence and exclusion generated both vulnerability and innovative strategies of resistance and harm reduction, contributing to the construction of alternative pathways and possibilities. By centering these practices, the article expands the conceptual and practical horizons of harm reduction through an intersectional and decolonial perspective. It argues for broadening the notion of harm reduction from Global South contexts, such as Brazil, where the harms to be reduced are not limited to drug‑related risks but include those produced by colonialism, racism, patriarchy, and neoliberal capitalism. Harm reduction is thus understood as a technology of care that extends beyond health, sustaining more dignified and less precarious lives.