- Email: [email protected]
Notes from South America
International Journal of Drug Policy 12 (2001) 27 – 30 www.elsevier.com/locate/drugpo
Response
Notes from South America Timothy Ross * Fundacio´n Renacer, AA 33830, Bogota, Colombia
Friedman et al., (2001) have a central theme of ‘‘what do you do with governments that are non-compliant’’, and suggestions for seeking opportunities for new ways to form alliances to pressure non-compliant governments into adopting harm reduction approaches or to generate action in the face of official opposition. They describe case histories of such alliances, though only from developed countries, and call for sharing information on similar work and other kinds of alliances. Their approach appears somewhat culturebound and, from a Latin-American perspective, leaves out of the discussion such problems as the limited power of many Latin governments to implement any real policy towards drug use and users, the overwhelming impact on the political arena of drug production, trafficking and related corruption, and United States interventions. Developing harm reduction activities and alliances in these constraining circumstances may involve different styles, and to avoid the additional dangers of being tarred as a * Tel.: +57-1-2810210; fax: + 57-1-3346889. E-mail address: [email protected] (T. Ross).
troublemaker, can necessitate avoiding ties to class-based or political organisations. Colombia, Ecuador, Peru, Bolivia, Nicaragua, Guatemala, El Salvador, Panama and several Caribbean nations have deep-rooted instability, fragile institutions, and histories of insurrection, revolution, invasion, military coups or de facto regimes. Non-military left-wing movements are largely fragmented and based in weak and divided labour movements, while armed Marxist forces in Colombia and Peru, as well as right-wing war-lords and sectors of the security forces, have become deeply entangled with the production and marketing of marijuana, coca and cocaine, opium and heroin. The Colombian Armed Revolutionary Forces (FARC) are now so well-financed and equipped from the drug trade that they frequently win battalion strength engagements with the regular army and are the effective government or co-government in large areas — at least a quarter of all municipalities. Attempting to fight them dominates state policy and actions, at the cost of falling social investment, increasing human rights violations and deteriorating public perception of the efficacy and legitimacy of the government. The ‘‘partial col-
0955-3959/01/$ - see front matter © 2001 Elsevier Science B.V. All rights reserved. PII: S 0 9 5 5 - 3 9 5 9 ( 0 1 ) 0 0 0 6 6 - 4
28
T. Ross / International Journal of Drug Policy 12 (2001) 27–30
lapse of the state’’ entailed by the political violence that started in the 1940s and 1950s (Oquist, 1980), is now widely feared to be turning into complete collapse and threatening to spill across the borders into neighbouring countries. Colombia is the most extreme example in the region. With the per capita homicide rate variously calculated at between 92 and 179 per 100 000 (World Bank, 2000), and taking murder as a proxy for all forms of violence, it is understandable that drug related mortality and morbidity should have a low government priority. Much urban violence, however, is closely linked to alcohol and drug misuse and to illicit drug dealing. In deteriorated inner city areas and rapidly growing shack-towns residents may have little training or skills, and few possibilities of escaping un- or under-employment, street crime and long-term poverty (Wilson et al., 1987), forming an underclass whose numbers are increased daily by displaced peasant farmers fleeing the rural violence, excluded from the job market, and with virtually no welfare network to cushion them. Economic recession, sharply reduced public spending and privatisation of health care further reduce access to mainstream society. Drug dealing, mugging and other forms of property crime, and prostitution are significant options for the youth of the underclass, and their life expectancy on the street is low. In central Bogota´ a street youth can expect to die by 25, at the hands of the police, private death squads or gang enemies, of overdose, AIDS or accident. The drug user is publicly equated with violent crime, stigmatised and excluded, and scapegoated as the principle cause of a pervasive urban fear (Nin˜o et al., 1998). Friedman et al. state that such scapegoating is a means of dividing opposition forces and hardening support for reactionary policies. I would suggest, however, that there are also genuine reasons for
fear and real links between drug use, poverty and violence, but as inter-related products of corrupt and incompetent rule. Police ‘‘social cleansing’’, harassment, arbitrary arrest, brutality and extortion of street drug users, in the name of suppressing crime, only legitimises violence and the deviant role and makes entry to treatment and mainstream life less feasible: in effect, harm maximisation. In this context harm reduction might seem utopian, but in fact is a fruitful element in the work of client-centred NGOs networking with mid-and low-level professionals in state bodies. Friedman et al. suggest that governments wilfully and wittingly choose to let users die as one tactic of a divide-and-rule policy and economic efficiency. Rather it is laissez-faire Latin American bureaucratic inertia and reluctance to invest for longer-term public health and economic gains that limit drug user access to health care and social services. Without deploying the language or theoretical underpinnings of harm reduction, some effective programmes with harm reduction outcomes have coalesced around ‘soberparty’ (‘‘rumba sana’’) campaigns, aimed at generating rave, rock and salsa events without the traditional heavy drinking and drug use, and associated violence. These involve city authorities, district administrations, barrio residents’ organisations and youth groups, with co-operation from local bands and businesses. Free music and no-cost or low-cost non-alcoholic drinks are the initial draw, but the lighter and more care-free fiesta atmosphere in the absence of the usual intoxicated fist and knife fights makes them attractive alternatives for very large numbers of young people. Though harm reduction principles are often ignored or paid only lip service at decision-making levels, their low-key and incremental incorporation into daily practice
T. Ross / International Journal of Drug Policy 12 (2001) 27–30
from street level upwards can slowly turn them into de facto policy. Advocacy for drug user health access rights seems to work best and is hardest to resist when it is part of a broader argument for public health gains. Methadone, for example, used only to be legally available in Colombia for cancer pain control. In late 1999 and early 2000, soon after reporting (probably belated) of confirmed cases of HIV infection through injection drug use, senior Health Ministry officials were discreetly lobbied by a small alliance of mid-level staff, an outreach worker and a handful of heroin users. Their straightforward public health protection argument led to authorisation of methadone in substitution treatment. Without any publicity that could have provoked negative reactions, it has become an accepted option. Similar linkages between small street community NGOs and local hospital staff, trying to overcome exclusion from public health care for those who have no identity cards or fixed addresses — the majority of high risk street drug users — has put pressure on the Bogota´ Health Department to by-pass obstacles established by city Welfare Department regulations and to improve access for the most severely marginalised, falling into line with internationally accepted principles of readily available and flexible treatment options (United Nations, 2000). Constitutional rights to health care were cited but the public health argument was the clincher. Fighting for drug users’ health rights as a high-risk special population, can, however, be seen as divisive and damaging to a broader class-based struggle to preserve health and other social services that are being whittled away. With the steady downturn in the economy, in poor districts medical wards are being closed and entire hospitals shut down. As one senior government official asked: ‘‘How could I justify an expenditure on needle ex-
29
change for a few when we cannot even guarantee universal vaccinations?’’ Where drug user interests can merge with more obviously political campaigns is in the area of human rights. Social cleansing and police violence against dependent drug userdealers in the central Bogota´ streets have produced reactions of sympathy and solidarity from others who work in public spaces, including street peddlers, cigarette, newspaper and lottery sellers, and in the media. Police violence has caused many users to express identification with the guerrillas who fight the security forces, and has led some peer leaders to an implicitly political stance by giving evidence on death squad activity to human rights investigators and the press. Increased death threats from the policemen implicated in this violence, against peer leaders, NGO workers, journalists and official investigators, create group solidarity, and push this group towards the broader human rights movement — and the dangers that entails. Some other quasi-political coalitions are to be seen, as IDU-involved punk gangs, who despite their frequent brawls with rival skinhead groups and violent round-ups by police, have links with a nascent pacifist and antidraft movement, with anti-MacDonalds demonstrators and with animal rights groups protesting against bull-fights. But these are still far from the class-based political alliances proposed by Friedman et al. Such coalitions would invite dangerous attention less from regular police than from military intelligence and paramilitary groups, while for most barrio associations and labour organisations, the drug user is seen as the author of violence and a destructive enemy of community development. As Friedman et al. rightly point out, many residents of poor working class communities only want to expel users and dealers: they can easily become allies of the police or of paramilitary vigilante
30
T. Ross / International Journal of Drug Policy 12 (2001) 27–30
groups. Where there is little government presence, local authorities are often right-wing vigilantes or guerilla-run militias that deal with drug use by street corner executions. Harm reduction work in such a context requires a particular sensitivity to class issues and the unwanted attention that may be entailed in involvement with other activists. To try to work openly within a broader movement of ‘‘forces of general social unrest’’ where human rights, labour and community leaders are frequently assassinated can mean risking retaliations. Such conditions in unstable developing countries mean that fighting to obtain social justice in the drug field has to be pragmatic and cautious: it is in itself a subversive act.
.
References Friedman SR, Southwell M, Bueno R, Paone D, Byrne J, Crofts N. Harm reduction – a historical view from the left. International Journal on Drugs Policy 2001;12(1):3– 14. Nin˜o S, Lugo N, Rozo C, Vega LA. Territorios del Miedo en Santafe de Bogota´. Imaginarios de los ciudadanos, Bogota´, TM Editores, 1998. Oquist P. Violence, conflict and politics in Colombia. New York: Academic Press, 1980. United Nations. Preventing the transmission of HIV among drug abusers. Annex to the Report of Eighth Session of ACC Subcommittee on Drug Control. New York, 2000 Wilson WJ. The truly disadvantaged: the inner city, the underclass and public policy. Chicago: University of Chicago Press, 1987. World Bank. Violence in Colombia. Building Sustainable Peace and Social Capital. Washington, 2000.
Response
Notes from South America Timothy Ross * Fundacio´n Renacer, AA 33830, Bogota, Colombia
Friedman et al., (2001) have a central theme of ‘‘what do you do with governments that are non-compliant’’, and suggestions for seeking opportunities for new ways to form alliances to pressure non-compliant governments into adopting harm reduction approaches or to generate action in the face of official opposition. They describe case histories of such alliances, though only from developed countries, and call for sharing information on similar work and other kinds of alliances. Their approach appears somewhat culturebound and, from a Latin-American perspective, leaves out of the discussion such problems as the limited power of many Latin governments to implement any real policy towards drug use and users, the overwhelming impact on the political arena of drug production, trafficking and related corruption, and United States interventions. Developing harm reduction activities and alliances in these constraining circumstances may involve different styles, and to avoid the additional dangers of being tarred as a * Tel.: +57-1-2810210; fax: + 57-1-3346889. E-mail address: [email protected] (T. Ross).
troublemaker, can necessitate avoiding ties to class-based or political organisations. Colombia, Ecuador, Peru, Bolivia, Nicaragua, Guatemala, El Salvador, Panama and several Caribbean nations have deep-rooted instability, fragile institutions, and histories of insurrection, revolution, invasion, military coups or de facto regimes. Non-military left-wing movements are largely fragmented and based in weak and divided labour movements, while armed Marxist forces in Colombia and Peru, as well as right-wing war-lords and sectors of the security forces, have become deeply entangled with the production and marketing of marijuana, coca and cocaine, opium and heroin. The Colombian Armed Revolutionary Forces (FARC) are now so well-financed and equipped from the drug trade that they frequently win battalion strength engagements with the regular army and are the effective government or co-government in large areas — at least a quarter of all municipalities. Attempting to fight them dominates state policy and actions, at the cost of falling social investment, increasing human rights violations and deteriorating public perception of the efficacy and legitimacy of the government. The ‘‘partial col-
0955-3959/01/$ - see front matter © 2001 Elsevier Science B.V. All rights reserved. PII: S 0 9 5 5 - 3 9 5 9 ( 0 1 ) 0 0 0 6 6 - 4
28
T. Ross / International Journal of Drug Policy 12 (2001) 27–30
lapse of the state’’ entailed by the political violence that started in the 1940s and 1950s (Oquist, 1980), is now widely feared to be turning into complete collapse and threatening to spill across the borders into neighbouring countries. Colombia is the most extreme example in the region. With the per capita homicide rate variously calculated at between 92 and 179 per 100 000 (World Bank, 2000), and taking murder as a proxy for all forms of violence, it is understandable that drug related mortality and morbidity should have a low government priority. Much urban violence, however, is closely linked to alcohol and drug misuse and to illicit drug dealing. In deteriorated inner city areas and rapidly growing shack-towns residents may have little training or skills, and few possibilities of escaping un- or under-employment, street crime and long-term poverty (Wilson et al., 1987), forming an underclass whose numbers are increased daily by displaced peasant farmers fleeing the rural violence, excluded from the job market, and with virtually no welfare network to cushion them. Economic recession, sharply reduced public spending and privatisation of health care further reduce access to mainstream society. Drug dealing, mugging and other forms of property crime, and prostitution are significant options for the youth of the underclass, and their life expectancy on the street is low. In central Bogota´ a street youth can expect to die by 25, at the hands of the police, private death squads or gang enemies, of overdose, AIDS or accident. The drug user is publicly equated with violent crime, stigmatised and excluded, and scapegoated as the principle cause of a pervasive urban fear (Nin˜o et al., 1998). Friedman et al. state that such scapegoating is a means of dividing opposition forces and hardening support for reactionary policies. I would suggest, however, that there are also genuine reasons for
fear and real links between drug use, poverty and violence, but as inter-related products of corrupt and incompetent rule. Police ‘‘social cleansing’’, harassment, arbitrary arrest, brutality and extortion of street drug users, in the name of suppressing crime, only legitimises violence and the deviant role and makes entry to treatment and mainstream life less feasible: in effect, harm maximisation. In this context harm reduction might seem utopian, but in fact is a fruitful element in the work of client-centred NGOs networking with mid-and low-level professionals in state bodies. Friedman et al. suggest that governments wilfully and wittingly choose to let users die as one tactic of a divide-and-rule policy and economic efficiency. Rather it is laissez-faire Latin American bureaucratic inertia and reluctance to invest for longer-term public health and economic gains that limit drug user access to health care and social services. Without deploying the language or theoretical underpinnings of harm reduction, some effective programmes with harm reduction outcomes have coalesced around ‘soberparty’ (‘‘rumba sana’’) campaigns, aimed at generating rave, rock and salsa events without the traditional heavy drinking and drug use, and associated violence. These involve city authorities, district administrations, barrio residents’ organisations and youth groups, with co-operation from local bands and businesses. Free music and no-cost or low-cost non-alcoholic drinks are the initial draw, but the lighter and more care-free fiesta atmosphere in the absence of the usual intoxicated fist and knife fights makes them attractive alternatives for very large numbers of young people. Though harm reduction principles are often ignored or paid only lip service at decision-making levels, their low-key and incremental incorporation into daily practice
T. Ross / International Journal of Drug Policy 12 (2001) 27–30
from street level upwards can slowly turn them into de facto policy. Advocacy for drug user health access rights seems to work best and is hardest to resist when it is part of a broader argument for public health gains. Methadone, for example, used only to be legally available in Colombia for cancer pain control. In late 1999 and early 2000, soon after reporting (probably belated) of confirmed cases of HIV infection through injection drug use, senior Health Ministry officials were discreetly lobbied by a small alliance of mid-level staff, an outreach worker and a handful of heroin users. Their straightforward public health protection argument led to authorisation of methadone in substitution treatment. Without any publicity that could have provoked negative reactions, it has become an accepted option. Similar linkages between small street community NGOs and local hospital staff, trying to overcome exclusion from public health care for those who have no identity cards or fixed addresses — the majority of high risk street drug users — has put pressure on the Bogota´ Health Department to by-pass obstacles established by city Welfare Department regulations and to improve access for the most severely marginalised, falling into line with internationally accepted principles of readily available and flexible treatment options (United Nations, 2000). Constitutional rights to health care were cited but the public health argument was the clincher. Fighting for drug users’ health rights as a high-risk special population, can, however, be seen as divisive and damaging to a broader class-based struggle to preserve health and other social services that are being whittled away. With the steady downturn in the economy, in poor districts medical wards are being closed and entire hospitals shut down. As one senior government official asked: ‘‘How could I justify an expenditure on needle ex-
29
change for a few when we cannot even guarantee universal vaccinations?’’ Where drug user interests can merge with more obviously political campaigns is in the area of human rights. Social cleansing and police violence against dependent drug userdealers in the central Bogota´ streets have produced reactions of sympathy and solidarity from others who work in public spaces, including street peddlers, cigarette, newspaper and lottery sellers, and in the media. Police violence has caused many users to express identification with the guerrillas who fight the security forces, and has led some peer leaders to an implicitly political stance by giving evidence on death squad activity to human rights investigators and the press. Increased death threats from the policemen implicated in this violence, against peer leaders, NGO workers, journalists and official investigators, create group solidarity, and push this group towards the broader human rights movement — and the dangers that entails. Some other quasi-political coalitions are to be seen, as IDU-involved punk gangs, who despite their frequent brawls with rival skinhead groups and violent round-ups by police, have links with a nascent pacifist and antidraft movement, with anti-MacDonalds demonstrators and with animal rights groups protesting against bull-fights. But these are still far from the class-based political alliances proposed by Friedman et al. Such coalitions would invite dangerous attention less from regular police than from military intelligence and paramilitary groups, while for most barrio associations and labour organisations, the drug user is seen as the author of violence and a destructive enemy of community development. As Friedman et al. rightly point out, many residents of poor working class communities only want to expel users and dealers: they can easily become allies of the police or of paramilitary vigilante
30
T. Ross / International Journal of Drug Policy 12 (2001) 27–30
groups. Where there is little government presence, local authorities are often right-wing vigilantes or guerilla-run militias that deal with drug use by street corner executions. Harm reduction work in such a context requires a particular sensitivity to class issues and the unwanted attention that may be entailed in involvement with other activists. To try to work openly within a broader movement of ‘‘forces of general social unrest’’ where human rights, labour and community leaders are frequently assassinated can mean risking retaliations. Such conditions in unstable developing countries mean that fighting to obtain social justice in the drug field has to be pragmatic and cautious: it is in itself a subversive act.
.
References Friedman SR, Southwell M, Bueno R, Paone D, Byrne J, Crofts N. Harm reduction – a historical view from the left. International Journal on Drugs Policy 2001;12(1):3– 14. Nin˜o S, Lugo N, Rozo C, Vega LA. Territorios del Miedo en Santafe de Bogota´. Imaginarios de los ciudadanos, Bogota´, TM Editores, 1998. Oquist P. Violence, conflict and politics in Colombia. New York: Academic Press, 1980. United Nations. Preventing the transmission of HIV among drug abusers. Annex to the Report of Eighth Session of ACC Subcommittee on Drug Control. New York, 2000 Wilson WJ. The truly disadvantaged: the inner city, the underclass and public policy. Chicago: University of Chicago Press, 1987. World Bank. Violence in Colombia. Building Sustainable Peace and Social Capital. Washington, 2000.