Implementation of an mHealth intervention to increase adherence to triage among HPV positive women with HPV-self-collection (ATICA study): post-implementation evaluation from the women's perspective.

BACKGROUND: Low adherence to triage after positive screening is a widespread problem for cervical cancer screening programs in Low- and Middle-income Countries. Adherence to cytology-based triage can be challenging, especially among women with self-collected tests. SMS-based interventions are accepted by women and can increase screening uptake. The ATICA study was an effectiveness-implementation hybrid type I trial, combining a cluster randomized controlled trial (RCT) with a mixed-methods implementation evaluation involving quantitative and qualitative methods. Although the RCT provided evidence regarding the effectiveness of the SMS-based intervention, less is known about its acceptability, relevance, and usefulness from the women´s perspective. METHODS: We carried out a cross-sectional study based on a structured questionnaire among HPV-positive women who were enrolled in ATICA's intervention group. We measured acceptability, appropriateness, and message content comprehension. Also, we evaluated if the SMS message was considered a cue to encourage women to pick up their HPV test results and promote the triage. RESULTS: We interviewed 370 HPV-positive women. Acceptability of SMS messages among women who had received at least one message was high (97%). We found high levels of agreement in all appropriateness dimensions. More than 77% of women showed high comprehension of the content. Among women who received at least one SMS message, 76% went to the health center to pick up their results. Among those who got their results, 90% reported that the SMS message had influenced them to go. We found no significant differences in acceptability, appropriateness or message comprehension between women who adhered to triage and those who did not adhere after receiving the SMS messages. CONCLUSION: The intervention was highly acceptable, and women reported SMS was an appropriate channel to be informed about HPV test results availability. SMS was also a useful cue to go to the health center to pick up results. The implementation did not encounter barriers associated with the SMS message itself, suggesting the existence of other obstacles to triage adherence. Our results support the RCT findings that scaling up SMS is a highly acceptable intervention to promote cervical screening triage adherence.

Assessing the implementation fidelity of HPV self-collection offered by community health workers during home visits (the EMA strategy): a case study in a low-middle-resource setting in Argentina.

BACKGROUND: In Argentina, HPV self-collection offered by community health workers was demonstrated to be effective to improve cervical cancer screening uptake. Based on these findings, the EMA strategy was scaled up in nine Argentinian provinces. However, there is no evidence about the degree of fidelity-in relation to the core components proposed by the National Program on Cervical Cancer Prevention-with which this strategy was implemented in the new jurisdictions. We carried out a fidelity evaluation of the EMA strategy scaling-up aimed at evaluating the level of adherence to the core components of the EMA strategy, and how different moderating factors affected the implementation fidelity. METHODS: This descriptive study used a multi-method approach involving quantitative and qualitative evaluations of the implementation fidelity using the Conceptual Framework for Implementation Fidelity. Evaluation of the degree of adherence to the core components of the EMA strategy was carried out through the analysis of a self-administered survey of health promoters, observations, and secondary data from the National Screening Information System. The analysis of moderating factors was carried out through analysis of field notes, and semi-structured interviews with key stakeholders. RESULTS: Our results showed that the core components with highest fidelity were training, sample handling, and transportation. Regarding the offer of HPV self-collection, we found some adaptations such as locations in which health promoters offered HPV self-collection, and fewer pieces of information provided to women during the offer. In the follow-up and treatment core component, we found a reduced adherence to triage and colposcopy. Some contextual factors had a negative impact on implementation fidelity, such as urban insecurity and the reduction in the number of health promoters that offered HPV self-collection. Moderating factors that contributed to achieve high level of fidelity included a well-defined strategy with clear steps to follow, permanent feedback and high level of engagement among implementers. CONCLUSIONS: Our study shows how the analysis of fidelity and adaptations of HPV self-collection in real-world contexts are key to measure and maximize its effectiveness in low-middle-income settings.

Implementation and scaling-up of an effective mHealth intervention to increase adherence to triage of HPV-positive women (ATICA study): perceptions of health decision-makers and health-care providers.

BACKGROUND: The ATICA study was a Hybrid I type randomized effectiveness-implementation trial that demonstrated effectiveness of a multicomponent mHealth intervention (Up to four SMS messages sent to HPV-positive women, and one SMS message to CHWs to prompt a visit of women with no triage Pap 60 days after a positive-test), to increase adherence to triage of HPV positive women (ATICA Study). We report data on perceptions of health decision-makers and health-care providers regarding the intervention implementation and scaling-up. METHODS: A qualitative study was carried out based on individual, semi-structured interviews with health decision-makers (n = 10) and health-care providers (n = 10). The themes explored were selected and analyzed using domains and constructs of the Consolidated Framework for Implementation Research (CFIR) and the maintenance dimension of the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. RESULTS: Both health-care providers and decision-makers had a positive assessment of the intervention through most included constructs: knowledge of the intervention, intervention source, design quality, adaptability, compatibility, access to knowledge and information, relative advantage, women's needs, and relative priority. However, some potential barriers were also identified including: complexity, leadership engagement, external policies, economic cost, women needs and maintenance. Stakeholders conditioned the strategy's sustainability to the political commitment of national and provincial health authorities to prioritize cervical cancer prevention, and to the establishment of the ATICA strategy as a programmatic line of work by health authorities. They also highlighted the need to ensure, above all, that there was staff to take Pap tests and carry out the HPV-lab work, and to guarantee a constant provision of HPV-tests. CONCLUSION: Health decision-makers and health-care providers had a positive perception regarding implementation of the multicomponent mHealth intervention designed to increase adherence to triage among women with HPV self-collected tests. This increases the potential for a successful scaling-up of the intervention, with great implications not only for Argentina but also for middle and low-income countries considering using mHealth interventions to enhance the cervical screening/follow-up/treatment process.

Ten Steps to Design a Counseling App to Reduce the Psychosocial Impact of Human Papillomavirus Testing on the Basis of a User-Centered Design Approach in a Low- and Middle-Income Setting.

PURPOSE: This study describes the 10 steps followed to produce the information architecture of a user-centered design (UCD) counseling mobile application, the first phase to develop an app. The app aims to reduce the psychosocial impact of the human papillomavirus test result and improve women's knowledge of human papilloma virus and cervical cancer. METHODS: We used a UCD approach to produce the information architecture of the app (ie, how to organize contents into features). We analyzed field notes, meeting agendas, and documentation produced during each stage of the design process. We described the goals, methods, and outcomes of each step. We also discussed the critical challenges and the strategies to address them. RESULTS: The steps are (1) knowledge, attitudes, and beliefs mapping: reanalysis of team's research findings from prior studies; (2) environmental scanning of apps available on the market; (3) stakeholders' point of view: The International Advisory Committee; (4) potential user's profile: building archetypes through the Persona method; (5) women's interviews: user's preferences and experiences; (6) effective features: scoping review to select app's features that address psychosocial impact; (7) the user journey: ideal interaction with the gynecological service and the counseling app; (8) women's focus groups: using Personas and Scenarios to discuss app's mock-up; (9) women's design sessions: prototype test and card-sorting techniques; and (10) team's design session: translating results into visual objects and features. CONCLUSION: We provide here detailed descriptions of the UCD process of an app for human papillomavirus-tested women for those venturing into the area of mHealth strategies work. Our experience can be used as a guide for future mHealth app development for a low- and middle-income setting.

A Counseling Mobile App to Reduce the Psychosocial Impact of Human Papillomavirus Testing: Formative Research Using a User-Centered Design Approach in a Low-Middle-Income Setting in Argentina.

BACKGROUND: Human papillomavirus (HPV) testing detects sexually transmitted infections with oncogenic types of HPV. For many HPV-positive women, this result has negative connotations. It produces anxiety, fear of cancer or death, and disease denial. Face-to-face counseling could present many difficulties in its implementation, but a counseling mobile app could be practical and may help HPV-positive women reduce the psychosocial impact of the result, improve their knowledge of HPV and cervical cancer, and increase adherence to follow-up. OBJECTIVE: This study aims to understand HPV-tested women's perceptions about an app as a tool to receive information and support to reduce the emotional impact of HPV-positive results. We investigated their preferences regarding app design, content, and framing. METHODS: We conducted formative research based on a user-centered design approach. We carried out 29 individual online interviews with HPV-positive women aged 30 years and over and 4 focus groups (FGs) with women through a virtual platform (n=19). We shared a draft of the app's potential screens with a provisional label of the possible content, options menus, draft illustrations, and wording. This allowed us to give women understandable triggers to debate the concepts involved on each screen. The draft content and labels were developed drawing from the health belief model (HBM) and integrative behavioral model (IBM) variables and findings of mobile health literature. We used an FG guide to generate data for the information architecture (ie, how to organize contents into features). We carried out thematic analysis using constructs from the HBM and IBM to identify content preferences and turn them into app features. We used the RQDA package of R software for data processing. RESULTS: We found that participants required more information regarding the procedures they had received, what HPV-positive means, what the causes of HPV are, and its consequences on their sexuality. The women mentioned fear of the disease and stated they had concerns and misconceptions, such as believing that an HPV-positive result is a synonym for cancer. They accepted the app as a tool to obtain information and to reduce fears related to HPV-positive results. They would use a mobile app under doctor or health authority recommendation. The women did not agree with the draft organization of screens and contents. They believed the app should first offer information about HPV and then provide customized content according to the users' needs. The app should provide information via videos with experts and testimonies of other HPV-positive women, and they suggested a medical appointment reminder feature. The app should also offer information through illustrations, or infographics, but not pictures or solely text. CONCLUSIONS: Providing information that meets women's needs and counseling could be a method to reduce fears. A mobile app seems to be an acceptable and suitable tool to help HPV-positive women.

["I felt myself getting sick:" women's perceptions and understandings of a positive human papillomavirus test in Jujuy, Argentina]. / "Me sentí enfermar": percepciones y comprensión de las mujeres del resultado positivo de un test de virus del papiloma humano en Jujuy, Argentina.

With the purpose of analyzing women's perceptions and classifying their modes of understanding a positive human papillomavirus (HPV+) test, we conducted 38 in-depth interviews with women who had received an HPV diagnosis (normal and abnormal Pap smear), screened in Jujuy's public health system in 2016. A typology based on women's understandings of the result was developed: 1) understanding; 2) lack of understanding; a) underestimation; b) overestimation; c) confusion. The interviewees who experienced confusion over the results reported contradictory perceptions in relation to a positive HPV test and its severity; those who underestimated it tended to mention the absence of symptoms and expressed little concern over the result; while those who overestimated it considered themselves sick and described concern, narrating a biographical disruption and physical pain. These findings confirm the need to improve the delivery of results and the provision of information in order to decrease psychosocial impact and increase follow-up adherence in HPV-positive women.

Con el objetivo de analizar las percepciones y clasificar las modalidades de comprensión sobre un resultado positivo del test de virus del papiloma humano (VPH+), en 2016 realizamos 38 entrevistas en profundidad a mujeres con diagnóstico de VPH+ (prueba de Papanicolaou normal y anormal), realizado en el sistema público de salud de Jujuy. Se elaboró una tipología que delimita perfiles de mujeres en función del tipo de comprensión del resultado: 1) comprensión; 2) no-comprensión, a) subestimación, b) sobreestimación, y c) confusión. Entre aquellas que no comprendían, las entrevistadas que confundían el resultado relataron percepciones contradictorias con relación al VPH y su gravedad; quienes lo subestimaban tendían a mencionar ausencia de síntomas y a expresar escasa preocupación; mientras que aquellas que lo sobreestimaban se consideraban enfermas y expresaban preocupación, relato de una ruptura biográfica y dolores físicos. Los hallazgos confirman la necesidad de mejorar los mecanismos de entrega e información sobre los resultados para disminuir el impacto psicosocial en las mujeres y aumentar la adherencia al seguimiento sugerido.

"I'm neither here, which would be bad, nor there, which would be good": the information needs of HPV+ women. A qualitative study based on in-depth interviews and counselling sessions in Jujuy, Argentina.

The objective of this qualitative study was to explore the information needs of HPV+ women. We conducted 38 in-depth interviews with HPV+ women in the province of Jujuy, Argentina. The interviews included a counselling session to respond to women's concerns and questions. Women perceived the information provided as good, despite having several doubts and misconceptions after receiving results of an HPV+ test. They expressed difficulties in formulating questions during the consultation due to shame, excess of information provided or lack of familiarity with technical language. They valued emotional support and being treated kindly by professionals. The perceived information needs that emerged as most important were: (1) the meaning of an HPV+ result and its relationship with cervical cancer evolution and severity; (2) continuity and timing of the care process; (3) information on the sexual transmission of the virus; (4) explanation of the presence or absence of symptoms. Women's primary unperceived information needs were: (1) detailed information about colposcopy, biopsy and treatments and their effects (including fertility consequences); and (2) deconstructing the association of sexual transmission with infidelity. Sources of information included: (1) the health care system; (2) the internet; and (3) social encounters (close friends and relatives). It is crucial to strengthen the processes for delivering results, with more thorough information, improved emotional support and active listening focused on the patient, as well as to conceive new formats to provide information in stages and/or gradually, in order to facilitate women's access to the health care system and the information they need.

[Argentinian women and the uses of drugs: A sociohistorical analysis of female drug use in Argentina (1860-1930)]. / Mujeres argentinas y usos de drogas: análisis sociohistórico del uso femenino de sustancias psicoactivas en Argentina (1860-1930).

This article describes cases presented by experts from the legislative and medical-legal fields regarding the use of psychoactive substances among Argentinian women from 1878 to 1930. Background information is presented regarding the relationship between women and the use different drugs, medical interventions on the female body where psychoactive substances were used are analyzed, and experts' descriptions of cases of female drug users are detailed. Experts' discourses during this period did not attempt to comprehend the specificities of female consumption, but were rather used to position the issue of drug use as a social problem. This was done using three prototypes: the victim of a sick husband; the prostitute who encourages drug use among the weak in spirit (natural-born criminals); and the virtuous young woman who succumbs to drug addiction in spite of her father's rule. Each figure reinforces the need for state intervention and increased social control.

Este trabajo describe casos expuestos por expertos de los ámbitos legislativo y médico-legal periodístico, en los que se reporta el consumo de sustancias psicoactivas por parte de mujeres de Argentina, entre 1878 y 1930. Se presentan antecedentes sobre mujeres y usos de distintos fármacos, se analizan las intervenciones médicas que utilizan sustancias psicoactivas sobre el cuerpo femenino, y se detallan los casos de mujeres consumidoras desde las miradas expertas. En este periodo, los discursos expertos no buscaron comprender la especificidad femenina del consumo, sino promover el tema drogas como un problema. Esto se produce utilizando tres prototipos: la víctima de un marido enfermo, la prostituta que envicia a los débiles de espíritu (criminal nata), y la joven virtuosa que contraviene la ley del padre y sucumbe en la toxicomanía. Cada figura refuerza la necesidad de intervención estatal y control social.

Psycho-social impact of positive human papillomavirus testing in Jujuy, Argentina results from the Psycho-Estampa study.

Human papillomavirus (HPV) testing can have a negative impact on women's lives which might also result in abandoning the follow-up and treatment process. This study measured the psycho-social impact of HPV-positivity among HPV-tested women from Jujuy, Argentina, a middle-low income setting. In this cross-sectional study (2015-2016), the psycho-social impact of HPV-positivity was measured using the Psycho-Estampa Scale, specifically designed and validated to be used in screening contexts. We measured mean scores for each of the five scale domains, and the Overall Impact score (Values from 1: No impact to 4: Heavy impact). We compared scores according to cytology triage diagnosis using ordinal logistic regression. A total of 163 HPV-positive women were recruited at the Centro Carlos Alvarado hospital and included in the study sample; of these, 124 (76.1%) had normal triage cytologies. The overall Impact score was between low and moderate (mean:2.56, SD:0.65). The highest psycho-social impact was measured in the Worries about cancer and treatment domain (mean score:3.60, SD:0.60), followed by Sexuality domain (mean:2.50; SD:1.00). The Uncertainty about information provided by health providers domain had the lowest mean score (mean:2.14, SD:0.73). Compared to women with normal cytologies (n = 124), women with abnormal cytologies (n = 39) had a higher likelihood of greater overall Psycho-social Impact (OR: 2.91; p = 0.0036). No statistically significant differences were found in scores of specific domains according to cytology results. It is important to devise specific counseling interventions to reduce the psycho-social impact of HPV-Testing as primary screening and its potential effect on completion of the diagnosis/ treatment process.

Developing SMS Content to Promote Papanicolaou Triage Among Women Who Performed HPV Self-collection Test: Qualitative Study.

BACKGROUND: SMS interventions are effective in promoting a variety of health behaviors; however, there is limited information regarding the use of SMS for cervical cancer screening and follow-up care. The Application of Communication and Information Technologies to Self-Collection study aims to evaluate a multicomponent mobile health intervention to increase triage adherence among women with human papillomavirus (HPV)-positive self-collected tests in Jujuy, Argentina. Here, we describe the formative results used to design the content of the SMS to be tested in the trial. OBJECTIVE: This study aimed to understand the cultural and contextual elements, women's beliefs, and perceptions regarding the use of SMS by the health care system and women's preferences about the message content. METHODS: We conducted five focus groups (FGs), stratified by rural or urban residence and age. All participants were aged 30 years or older and had performed HPV self-collection. Participatory techniques, including brainstorming, card-based classification, and discussions were used to debate the advantages and disadvantages of messages. We openly coded the discussions for agreements and preferences regarding the SMS content. Messages for both HPV-negative and HPV-positive women were validated through interviews with health authorities and 14 HPV-tested women. The final versions of the messages were pilot-tested. RESULTS: A total of 48 women participated in the FGs. Participants rejected receiving both negative and positive HPV results by SMS because, for them, the delivery of results should be done in a face-to-face interaction with health professionals. They stressed the importance of the SMS content informing them that results were available for pick up and reflecting the kind of relationship that they have with the community health workers and the nearest health center. Women considered that a personalized SMS was important, as was the use of a formal yet warm tone. Owing to confidentiality issues, not using the word "HPV" was also a key component of the desired SMS content; therefore, the final message included the term "self-collection" without the mention of HPV infection. Results from the validation stage and pilot test showed high acceptability of the final version of the message. CONCLUSIONS: The results suggest that SMS is accepted when notifying women about the availability of the HPV test result, but it should not replace the delivery of results in face-to-face, doctor-patient encounters. In addition, messages must be tailored and must have a persuasive tone to motivate women to adhere to the triage.

Accesibilidad y adherencia al tratamiento de mujeres que usan sustancias psicoactivas en cuatro ciudades de la República Argentina / Accessibility and adherence to treatment of women who use psychoactive substances in four cities of the República Argentina

INTRODUCCIÓN La perspectiva de género posibilita comprender los obstáculos a la accesibilidad, visibilizar las dificultades en el acceso y a la permanencia en tratamientos. OBJETIVO Comparar prácticas y trayectorias de consumo de sustancias psicoactivas (SP) legales e ilegales, el acceso a los servicios de salud y la adherencia a tratamientos de mujeres de 18 a 65 años de cuatro núcleos urbanos de la República Argentina. METODOLOGÍA Se desarrolló un estudio comparativo-transversal, de enfoque cualitativo. Se utilizaron entrevistas semi-estructuradas a dos muestras; (a) mujeres usuarias SP de 18 a 65 años residentes en 4 centros urbanos; (b) profesionales del campo de la salud mental que hayan atendido a mujeres usuarias SP. Las comparación se focalizó en dos ejes; uno geográfico y otro en el entrecruzamiento entre la perspectiva de las mujeres y de los profesionales. Las dimensiones comparadas fueron; los obstáculos y los facilitadores de la accesibilidad y de la adherencia a los tratamientos por usos problemáticos de SP. RESULTADOS El patrón de consumo de SP presenta diferencias por grupos de edad según las sustancias utilizadas y la historia del consumo. El alcohol es la sustancia omnipresente, de uso invisibilizado. La demanda de tratamiento se produce a partir de una desestabilización afectiva, en contextos de violencia de género y/o frente a la extracción de hijos. El acceso a los servicios se ve obstaculizado por el patrón de consumo solitario. Se registran oportunidades perdidas por los servicios de salud para intervenciones tempranas. La adherencia está tensionada por el ideal de género (madre cuidadora); motiva a la permanencia a la vez que la necesidad de cumplir este rol incentiva la deserción. DISCUSIÓN Este proyecto aporta evidencia empírica desde una perspectiva interdisciplinaria que posibilita un fortalecimiento de las políticas públicas en esta materia desde la perspectiva de género

La dimensión temporal del consumo de drogas: análisis sociológico desde una categoría clave para el estudio de los procesos de salud-enfermedad-atención-cuidado / The temporal dimension of drugs: a sociological analysis based on a category key to the study of health-disease-care processes

RESUMEN Se analizan las dimensiones temporales que modulan los sentidos y las prácticas de varones y mujeres policonsumidores de sustancias psicoactivas de 18 a 35 años residentes en el Área Metropolitana de Buenos Aires. Desde un enfoque cualitativo, se realizaron 29 entrevistas en profundidad individuales, analizadas mediante un proceso de comparación constante de análisis entre las categorías generadas a partir de los datos y conceptos teóricos. Del análisis emergen prácticas y sentidos que regulan las diversas temporalidades que atraviesan el consumo de drogas, como los sentimientos vinculados a los ritmos corporales, las frecuencias entre cada consumo, las fases del ciclo de vida en las que se va a contratiempo, o las temporalidades inespecíficas que vuelven a un "momento" adecuado para el consumo. Prácticas que requieren una especial atención sobre el tiempo para denotar la flexibilidad que les permita consumir sin ser consumistas, drogarse sin ser adicto.

ABSTRACT The temporal dimensions that shape the senses and practices of men and women who are poly-consumers of psychoactive substances, 18-35 years of age, and living in the metropolitan area of Buenos Aires were analyzed. Using a qualitative approach, 29 individual in-depth interviews were carried out and then analyzed through a constant comparative analysis process between the categories generated from the data obtained and the theoretical concepts. From the analysis, practices and meanings emerge that regulate the diverse temporalities that underlie drug consumption: feelings related to body rhythms, periods between consumptions, the timing of phases of the life cycle, or unspecific temporalities that become an adequate "moment" for consumption. These practices require that particular attention be paid to time, as this enables the flexibility to consume without being a consumer, to use drugs without being addicted to them.

[The temporal dimension of drugs: a sociological analysis based on a category key to the study of health-disease-care processes]. / La dimensión temporal del consumo de drogas: análisis sociológico desde una categoría clave para el estudio de los procesos de salud-enfermedad-atención-cuidado.

The temporal dimensions that shape the senses and practices of men and women who are poly-consumers of psychoactive substances, 18-35 years of age, and living in the metropolitan area of Buenos Aires were analyzed. Using a qualitative approach, 29 individual in-depth interviews were carried out and then analyzed through a constant comparative analysis process between the categories generated from the data obtained and the theoretical concepts. From the analysis, practices and meanings emerge that regulate the diverse temporalities that underlie drug consumption: feelings related to body rhythms, periods between consumptions, the timing of phases of the life cycle, or unspecific temporalities that become an adequate "moment" for consumption. These practices require that particular attention be paid to time, as this enables the flexibility to consume without being a consumer, to use drugs without being addicted to them.

Primeros debates sobre legislación del uso de drogas en Argentina a comienzos del siglo XX: la propuesta del Dr. Leopoldo Bard y su contexto sociohistórico / First debates regarding the legalization of drug use in Argentina at the start of the 20th century: the proposal of Dr. Leopoldo Bard and its sociohistorical context

Este trabajo analiza los discursos del médico higienista argentino Leopoldo Bard a partir de tres publicaciones que realizó entre 1923 y 1933 sobre toxicomanías. Las mismas condensan los debates en torno al papel del Estado, de las políticas públicas nacionales, regionales y, particularmente, la influencia norteamericana en Argentina a través de su figura. Las medidas legislativas y políticas de la época, de indudable corte represivo, fueron significativas para los avances del Estado en la esfera privada, la creciente importancia de los cuerpos profesionales en la definición de fronteras materiales y simbólicas sobre lo socialmente aceptable, incluyendo lo relativo al consumo de drogas. También se destacan los múltiples propósitos que parecen satisfacer estas políticas: en el plano local habilitan otras formas de represión de los conflictos derivados de la inmigración mientras que, en el internacional, complacen a los requerimientos norteamericanos.

This paper analyzes the discourses of Argentine doctor and public health professional Leopoldo Bard using three texts on drug abuse published between 1923 and 1933. These texts embody the debates of the time regarding the role of the State, public policies at the national and regional level and, particularly, the US influence in Argentina exerted through the figure of Dr. Bard. The legislative measures and policies of that time, undoubtedly of a repressive character, were key in the State's advances into the private sphere and in the increasing importance of professional organizations in the definition of the material and symbolic borders of the socially acceptable, including those related to drug use. The multiple purposes these policies seem to satisfy are also highlighted: at the local level they enable other forms of repressing conflicts arising from immigration, while at the international level they appease US requirements.

Primeros debates sobre legislación del uso de drogas en Argentina a comienzos del siglo XX: la propuesta del Dr. Leopoldo Bard y su contexto sociohistórico / First debates regarding the legalization of drug use in Argentina at the start of the 20th century: the proposal of Dr. Leopoldo Bard and its sociohistorical context

Este trabajo analiza los discursos del médico higienista argentino Leopoldo Bard a partir de tres publicaciones que realizó entre 1923 y 1933 sobre toxicomanías. Las mismas condensan los debates en torno al papel del Estado, de las políticas públicas nacionales, regionales y, particularmente, la influencia norteamericana en Argentina a través de su figura. Las medidas legislativas y políticas de la época, de indudable corte represivo, fueron significativas para los avances del Estado en la esfera privada, la creciente importancia de los cuerpos profesionales en la definición de fronteras materiales y simbólicas sobre lo socialmente aceptable, incluyendo lo relativo al consumo de drogas. También se destacan los múltiples propósitos que parecen satisfacer estas políticas: en el plano local habilitan otras formas de represión de los conflictos derivados de la inmigración mientras que, en el internacional, complacen a los requerimientos norteamericanos.(AU)

This paper analyzes the discourses of Argentine doctor and public health professional Leopoldo Bard using three texts on drug abuse published between 1923 and 1933. These texts embody the debates of the time regarding the role of the State, public policies at the national and regional level and, particularly, the US influence in Argentina exerted through the figure of Dr. Bard. The legislative measures and policies of that time, undoubtedly of a repressive character, were key in the States advances into the private sphere and in the increasing importance of professional organizations in the definition of the material and symbolic borders of the socially acceptable, including those related to drug use. The multiple purposes these policies seem to satisfy are also highlighted: at the local level they enable other forms of repressing conflicts arising from immigration, while at the international level they appease US requirements.(AU)

First debates regarding the legalization of drug use in Argentina at the start of the 20th century: the proposal of Dr. Leopoldo Bard and its sociohistorical context. / Primeros debates sobre legislación del uso de drogas en Argentina a comienzos del siglo XX: la propuesta del Dr. Leopoldo Bard y su contexto sociohistórico.

This paper analyzes the discourses of Argentine doctor and public health professional Leopoldo Bard using three texts on drug abuse published between 1923 and 1933. These texts embody the debates of the time regarding the role of the State, public policies at the national and regional level and, particularly, the US influence in Argentina exerted through the figure of Dr. Bard. The legislative measures and policies of that time, undoubtedly of a repressive character, were key in the State's advances into the private sphere and in the increasing importance of professional organizations in the definition of the material and symbolic borders of the socially acceptable, including those related to drug use. The multiple purposes these policies seem to satisfy are also highlighted: at the local level they enable other forms of repressing conflicts arising from immigration, while at the international level they appease US requirements.

Este trabajo analiza los discursos del médico higienista argentino Leopoldo Bard a partir de tres publicaciones que realizó entre 1923 y 1933 sobre toxicomanías. Las mismas condensan los debates en torno al papel del Estado, de las políticas públicas nacionales, regionales y, particularmente, la influencia norteamericana en Argentina a través de su figura. Las medidas legislativas y políticas de la época, de indudable corte represivo, fueron significativas para los avances del Estado en la esfera privada, la creciente importancia de los cuerpos profesionales en la definición de fronteras materiales y simbólicas sobre lo socialmente aceptable, incluyendo lo relativo al consumo de drogas. También se destacan los múltiples propósitos que parecen satisfacer estas políticas: en el plano local habilitan otras formas de represión de los conflictos derivados de la inmigración mientras que, en el internacional, complacen a los requerimientos norteamericanos.