International Journal of Drug Policy 12 (2001) 27–30

Response

Notes from South America

Timothy Ross *Fundacion Renacer, AA 33830, Bogota, Colombia

www.elsevier.com/locate/drugpo

Friedman et al., (2001) have a centraltheme of ‘‘what do you do with governmentsthat are non-compliant’’, and suggestions forseeking opportunities for new ways to formalliances to pressure non-compliant govern-ments into adopting harm reduction ap-proaches or to generate action in the face ofofficial opposition. They describe case histo-ries of such alliances, though only from de-veloped countries, and call for sharinginformation on similar work and other kindsof alliances.

Their approach appears somewhat culture-bound and, from a Latin-American perspec-tive, leaves out of the discussion suchproblems as the limited power of many Latingovernments to implement any real policytowards drug use and users, the overwhelm-ing impact on the political arena of drugproduction, trafficking and related corrup-tion, and United States interventions. Devel-oping harm reduction activities and alliancesin these constraining circumstances may in-volve different styles, and to avoid the addi-tional dangers of being tarred as a

troublemaker, can necessitate avoiding ties toclass-based or political organisations. Colom-bia, Ecuador, Peru, Bolivia, Nicaragua,Guatemala, El Salvador, Panama and severalCaribbean nations have deep-rooted instabil-ity, fragile institutions, and histories of insur-rection, revolution, invasion, military coupsor de facto regimes. Non-military left-wingmovements are largely fragmented and basedin weak and divided labour movements,while armed Marxist forces in Colombia andPeru, as well as right-wing war-lords andsectors of the security forces, have becomedeeply entangled with the production andmarketing of marijuana, coca and cocaine,opium and heroin. The Colombian ArmedRevolutionary Forces (FARC) are now sowell-financed and equipped from the drugtrade that they frequently win battalionstrength engagements with the regular armyand are the effective government or co-gov-ernment in large areas — at least a quarterof all municipalities. Attempting to fightthem dominates state policy and actions, atthe cost of falling social investment, increas-ing human rights violations and deterioratingpublic perception of the efficacy and legiti-macy of the government. The ‘‘partial col-

* Tel.: +57-1-2810210; fax: +57-1-3346889.E-mail address: timothy@latino.net.co (T. Ross).

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T. Ross / International Journal of Drug Policy 12 (2001) 27–3028

lapse of the state’’ entailed by the politicalviolence that started in the 1940s and 1950s(Oquist, 1980), is now widely feared to beturning into complete collapse and threaten-ing to spill across the borders into neighbour-ing countries.

Colombia is the most extreme example inthe region. With the per capita homicide ratevariously calculated at between 92 and 179per 100 000 (World Bank, 2000), and takingmurder as a proxy for all forms of violence, itis understandable that drug related mortalityand morbidity should have a low governmentpriority. Much urban violence, however, isclosely linked to alcohol and drug misuse andto illicit drug dealing. In deteriorated innercity areas and rapidly growing shack-townsresidents may have little training or skills,and few possibilities of escaping un- or un-der-employment, street crime and long-termpoverty (Wilson et al., 1987), forming anunderclass whose numbers are increased dailyby displaced peasant farmers fleeing the ruralviolence, excluded from the job market, andwith virtually no welfare network to cushionthem. Economic recession, sharply reducedpublic spending and privatisation of healthcare further reduce access to mainstream so-ciety. Drug dealing, mugging and other formsof property crime, and prostitution are sig-nificant options for the youth of the under-class, and their life expectancy on the street islow. In central Bogota a street youth canexpect to die by 25, at the hands of thepolice, private death squads or gang enemies,of overdose, AIDS or accident. The drug useris publicly equated with violent crime, stig-matised and excluded, and scapegoated as theprinciple cause of a pervasive urban fear(Nino et al., 1998). Friedman et al. state thatsuch scapegoating is a means of dividingopposition forces and hardening support forreactionary policies. I would suggest, how-ever, that there are also genuine reasons for

fear and real links between drug use, povertyand violence, but as inter-related products ofcorrupt and incompetent rule. Police ‘‘socialcleansing’’, harassment, arbitrary arrest, bru-tality and extortion of street drug users, inthe name of suppressing crime, only legit-imises violence and the deviant role andmakes entry to treatment and mainstream lifeless feasible: in effect, harm maximisation.

In this context harm reduction might seemutopian, but in fact is a fruitful element in thework of client-centred NGOs networkingwith mid-and low-level professionals in statebodies. Friedman et al. suggest that govern-ments wilfully and wittingly choose to letusers die as one tactic of a divide-and-rulepolicy and economic efficiency. Rather it islaissez-faire Latin American bureaucratic in-ertia and reluctance to invest for longer-termpublic health and economic gains that limitdrug user access to health care and socialservices.

Without deploying the language or theoret-ical underpinnings of harm reduction, someeffective programmes with harm reductionoutcomes have coalesced around ‘sober-party’ (‘‘rumba sana’’) campaigns, aimed atgenerating rave, rock and salsa events with-out the traditional heavy drinking and druguse, and associated violence. These involvecity authorities, district administrations, bar-rio residents’ organisations and youthgroups, with co-operation from local bandsand businesses. Free music and no-cost orlow-cost non-alcoholic drinks are the initialdraw, but the lighter and more care-free fiestaatmosphere in the absence of the usual intox-icated fist and knife fights makes them attrac-tive alternatives for very large numbers ofyoung people.

Though harm reduction principles are of-ten ignored or paid only lip service at deci-sion-making levels, their low-key andincremental incorporation into daily practice

T. Ross / International Journal of Drug Policy 12 (2001) 27–30 29

from street level upwards can slowly turnthem into de facto policy. Advocacy for druguser health access rights seems to work bestand is hardest to resist when it is part of abroader argument for public health gains.Methadone, for example, used only to belegally available in Colombia for cancer paincontrol. In late 1999 and early 2000, soonafter reporting (probably belated) of confi-rmed cases of HIV infection through injec-tion drug use, senior Health Ministry officialswere discreetly lobbied by a small alliance ofmid-level staff, an outreach worker and ahandful of heroin users. Their straightfor-ward public health protection argument ledto authorisation of methadone in substitutiontreatment. Without any publicity that couldhave provoked negative reactions, it has be-come an accepted option.

Similar linkages between small street com-munity NGOs and local hospital staff, tryingto overcome exclusion from public healthcare for those who have no identity cards orfixed addresses — the majority of high riskstreet drug users — has put pressure on theBogota Health Department to by-pass obsta-cles established by city Welfare Departmentregulations and to improve access for themost severely marginalised, falling into linewith internationally accepted principles ofreadily available and flexible treatment op-tions (United Nations, 2000). Constitutionalrights to health care were cited but the publichealth argument was the clincher.

Fighting for drug users’ health rights as ahigh-risk special population, can, however, beseen as divisive and damaging to a broaderclass-based struggle to preserve health andother social services that are being whittledaway. With the steady downturn in the econ-omy, in poor districts medical wards are be-ing closed and entire hospitals shut down. Asone senior government official asked: ‘‘Howcould I justify an expenditure on needle ex-

change for a few when we cannot even guar-antee universal vaccinations?’’

Where drug user interests can merge withmore obviously political campaigns is in thearea of human rights. Social cleansing andpolice violence against dependent drug user-dealers in the central Bogota streets haveproduced reactions of sympathy and solidar-ity from others who work in public spaces,including street peddlers, cigarette, newspa-per and lottery sellers, and in the media.Police violence has caused many users toexpress identification with the guerrillas whofight the security forces, and has led somepeer leaders to an implicitly political stanceby giving evidence on death squad activity tohuman rights investigators and the press. In-creased death threats from the policemen im-plicated in this violence, against peer leaders,NGO workers, journalists and official investi-gators, create group solidarity, and push thisgroup towards the broader human rightsmovement — and the dangers that entails.

Some other quasi-political coalitions are tobe seen, as IDU-involved punk gangs, whodespite their frequent brawls with rival skin-head groups and violent round-ups by police,have links with a nascent pacifist and anti-draft movement, with anti-MacDonaldsdemonstrators and with animal rights groupsprotesting against bull-fights. But these arestill far from the class-based political al-liances proposed by Friedman et al. Suchcoalitions would invite dangerous attentionless from regular police than from militaryintelligence and paramilitary groups, whilefor most barrio associations and labour or-ganisations, the drug user is seen as the au-thor of violence and a destructive enemy ofcommunity development. As Friedman et al.rightly point out, many residents of poorworking class communities only want to ex-pel users and dealers: they can easily becomeallies of the police or of paramilitary vigilante

T. Ross / International Journal of Drug Policy 12 (2001) 27–3030

groups. Where there is little government pres-ence, local authorities are often right-wingvigilantes or guerilla-run militias that dealwith drug use by street corner executions.

Harm reduction work in such a contextrequires a particular sensitivity to class issuesand the unwanted attention that may be en-tailed in involvement with other activists. Totry to work openly within a broader move-ment of ‘‘forces of general social unrest’’where human rights, labour and communityleaders are frequently assassinated can meanrisking retaliations. Such conditions in un-stable developing countries mean that fight-ing to obtain social justice in the drug fieldhas to be pragmatic and cautious: it is initself a subversive act.

References

Friedman SR, Southwell M, Bueno R, Paone D, ByrneJ, Crofts N. Harm reduction – a historical viewfrom the left. International Journal on Drugs Policy2001;12(1):3–14.

Nino S, Lugo N, Rozo C, Vega LA. Territorios delMiedo en Santafe de Bogota. Imaginarios de losciudadanos, Bogota, TM Editores, 1998.

Oquist P. Violence, conflict and politics in Colombia.New York: Academic Press, 1980.

United Nations. Preventing the transmission of HIVamong drug abusers. Annex to the Report of EighthSession of ACC Subcommittee on Drug Control.New York, 2000

Wilson WJ. The truly disadvantaged: the inner city, theunderclass and public policy. Chicago: University ofChicago Press, 1987.

World Bank. Violence in Colombia. Building Sustain-able Peace and Social Capital. Washington, 2000.

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