Letter from Manguinhos: A global call to protect harm reduction in Latin America

At a time when rights violations and threats to democracy are deepening, it is necessary to defend the fundamental role of care. With this in mind, we present this Letter from Manguinhos[1], a region of the city of Rio de Janeiro, Brazil, where Fiocruz[2] and, much more drastically, many favelas and poor communities have been constantly hit by despicable and violent war-on-drugs policies that criminalize drug users and authorize warlike actions on whole populations, like in so many other marginalized regions across Latin America and the world.

The world is currently witnessing a rise in conservative forces which, in Latin America, has translated into the weakening of democratic processes; the deepening of socioeconomic inequities; and an exacerbation of social breakdown and segregation. Taken together, such dynamics risk undermining fundamental rights. One emblematic example is the recent intervention that took place in the District of Luz, in the city of São Paulo. For four years, a multisectoral project inspired by the principles of harm reduction aimed to articulate actions to guarantee the right to housing, work / income and care in the region known as "cracolândia." A police operation aimed at "social cleansing" took place in May 2017, using moral panic to serve the interests of real estate speculators. This was followed by weeks of violence and arbitrary actions against socially vulnerable people living in extreme poverty, labeled as "crack addicts." A public policy focusing on care, health and promoting rights was thus replaced with repression and rights violations.

Such arbitrariness is not limited to Brazil – similar cases can be found in many areas of Latin America, where the presence of drugs serves as a pretext for territorial intervention. Other forms of structural violence include difficulties in accessing public services, murders, incarceration, exposure to infectious diseases, lack of access to medicines and absence of policies that aim to protect citizens’ rights.

Because of their focus on promoting health, citizenship, the right to access the city, social justice and drug users’ human rights, harm reduction policies have not been exempt from the effects of the conservative juncture. The current drug policy model is implemented selectively, by specifically criminalizing, imprisoning and stigmatizing the poorest groups living in marginal regions, homeless people, black and/or indigenous people, as well as women and youth.

Successful approaches focusing on care reject the interventionist violence defended by conservative policies. The evidences, ethic and political knowhow of harm reduction reject policies that fail to recognize the diversity of human experience and only rely on biomedical rationality and the criminalization of what is considered to be divergent behaviors. The harm reduction interventions that we are carrying out in our daily lives across the continent - and perhaps in other parts of the world - represent a concrete alternative to failed binary and simplistic concepts and interventions. It is nevertheless necessary to move even further towards a multisectoral harm reduction approach that is capable of articulating support for drug policy reform with the struggles of women, blacks, indigenous peoples, LGBTI and youth.

Given this situation, we propose a harm reduction approach grounded in decriminalization and emancipation, in which subjective and corporeal experiences are no longer exposed to repressive and disciplinary actions. Harm reduction is a powerful tool to question current models of control, and includes the promotion and respect for the freedom and autonomy of people who use drugs.

We consider it urgent to share our experiences and resistance, and promote a dialogue in Latin America - and elsewhere - with the view of consolidating our argument in defense of public harm reduction policies as they relate to drug policy reform.

The following organizations and institutions sign the Letter from Manguinhos:

1. Institutional Program on Alcohol, Crack and other Drugs of Oswaldo Cruz Foundation - PACD/Fiocruz (Brazil)
2. International Drug Policy Consortium – IDPC
3. Harm Reduction International – HRI
4. Transnational Institute - TNI
5. Brazilian Association of Harm Reduction Workers – ABORDA (Brazil)
6. Brazilian Platform on Drug Policy - PBPD (Brazil)
7. Brazilian Association of Collective Health – ABRASCO (Brazil)
8. Brazilian Association of Mental Health – ABRASME (Brazil)
9. Brazilian Network for Harm Reduction and Human Rights – REDUC (Brazil)
10. Intercambios Asociación Civil (Argentina)
11. Enfoque Territorial (Paraguay)
12. Programa Andrés Rosario (Argentina)
13. Asociación Costarricense para el Estudio e Intervención em Drogas – ACEID (Costa Rica)
14. Acción Técnica Social – ATS (Colombia)
15. Intercambios Puerto Rico (Puerto Rico)
16. International Network of People who Use Drugs - INPUD
17. Pares en Acción-Reacción Contra la Exclusión Social - PARCES (Colombia)
18. Centro Cáritas de Formación para la Atención de las Farmacodependencias y Situaciones Críticas Asociadas (Mexico)
19. Associação Brasileira Multidisciplinar sobre Drogas - ABRAMD (Brazil)
20. Grupo Tortura Nunca Mais Rio de Janeiro – GTNM/RJ (Brazil)
21. É De Lei (Brazil)
22. Iniciativa Negra por uma Nova Política de Drogas – INNPD (Brazil)
23. Coletivo Intercambiantes (Brazil)
24. Associação Redes de Desenvolvimento da Maré (Brazil)
25. Agência Piaget para o Desenvolvimento - APDES (Portugal)
26. Federación Andaluza Enlace (Spain)
27. Drug Policy Alliance – DPA (United States)
28. Washington Office on Latin America – WOLA (United States)
29. Stop The Drug War (United States)
30. Canadian Drug Policy Coalition (Canada)
31. International Centre for Science in Drug Policy – ICSDP (Canada)
32. South Indian Harm Reduction Network – SIHRN (India)
33. Transform Drug Policy Foundation (United Kingdom)
34. Release (United Kingdom)
35. Union for Improved Services, Communication and Education (Ireland)
36. Alliance for Public Health (Ukreine)
37. Teenswatch Community Harm Reduction (Kenia)
38. Centro de Prevención de las Adicciones de Bariloche (Argentina)
39. Fundación Latinoamérica Reforma (Chile)
40. Empower India (India)
41. Centro de Orientación e Investigación Integral - COIN (Dominican Republic)
42. Students for Sensible Drug Policy (Jamaica)
43. Forum Droghe (Italy)
44. Adaptation Association (Bulgaria)
45. Penington Institute (Australia)
46. Fédération Bruxelloise Francophone des Institutions pour Toxicomane – FEDITO (Belgium)
47. Association de lutte contre le sida – ALCS (Marocos)
48. Amitiel Welfare Society (Pakistan)
49. Global Call to Action Against Poverty - GCAP (Burundi)
50. Areal (Slovenia)
51. Students for Sensible Drug Policy (Australia)
52. Association des Guides du Congo – AGC (Congo)
53. Multidisciplinary Association for Psychedelic Studies - MAPS (United States)
54. Help Not Handcuffs (United States)
55. Washington Heights Corner Project (United States)
56. New York Harm Reduction Educators (United States)
57. Community Insite (United States)
58. Broken No More (United States)
59. Students for Sensible Drug Policy - SSDP (United States)
60. Elementa Consultoría en Derechos (Colombia)
61. Canadian HIV/AIDS Legal Network (Canada)
62. Sociedad Psiquedélica México (Mexico)
63. Acción Andina (Bolivia)
64. Andean Information Network - AIN (Bolivia)
65. AFEW International (Netherlands)
66. Equis Justicia para las Mujeres (Mexico)
67. Puente, Investigacion y Enlace - PIE (Bolivia)
68. Estudiantes por una Política Sensata de Drogas (Costa Rica)
69. Fondo Lunaria Mujer (Colombia)
70. Proyecto Punto Fijo (Puerto Rico)
71. Asociación de Vecinos La Teja Barial (Uruguay)
72. ReverdeSer Colectivo (Mexico)
73. Observatorio de cultivos y cultivadores declarados ilícitos - OCCDI (Colombia)
74. Corporación Humanas - Centro Regional de Derechos Humanos y Justicia de Género (Colombia)
75. Justiça Global (Brazil)
76. Instituto Helena Greco de Direitos Humanos e Cidadania (Brazil)
77. Aliança Nacional LGBTI (Brazil)
78. Conselho Regional de Serviço Social do Rio de Janeiro (Brazil)
79. Coletivo Balance de Redução de Danos (Brazil)
80. Associação Brasileira de Estudos Sociais sobre o Uso de Psicoativos - ABESUP (Brazil)
81. Laboratório de Estudos Interdisciplinares sobre Psicoativos – LEIPSI (Brazil)
82. Centro de Pesquisa, Intervenção e Avaliação em Álcool e Drogas – CREPEIA (Brazil)
83. Grupo Dignidade (Brazil)
84. Centro de Referência sobre Drogas e Vulnerabilidades Associadas da UNB Ceilândia (Brazil)
85. Rede Nacional de Feministas Antiproibiocionistas - RENFA (Brazil)
86. Associação Multidisciplinar de Estudos sobre a Maconha Medicinal - AMEMM (Brazil)
87. Grupo Interdisciplinar de Estudos sobre Substâncias Psicoativas - GIESP/UFBA (Brazil)
88. Fórum Intersetorial de Drogas e Direitos Humanos de São Paulo - FIDDH (Brazil)
89. Fórum Estadual de Redução de Danos de São Paulo - FERD (Brazil)
90. Acción Semilla (Bolivia)
91. Dispositivo de Abordaje Territorial Rosario - DIAT (Argentina)
92. New Parents for Addiction Treatment & Healing – New PATH (United States)
93. Moms United to End the War on Drugs (United States)
94. Grief Recovery After Substance Passing – GRASP (United States)
95. Katal Center for Health, Equity, and Justice (United States)
96. Movimento pela Legalização da Maconha – MLM (Brazil)
97. Latin American Network of People who Use Drugs – LANPUD
98. Central de Cooperativas e Empreendimentos Solidários - UNISOL (Brazil)
99. Associação Inclui Mais (Brazil)
100. Grupo de Estudos sobre Álcool e Outras Drogas – GEAD/UFPE (Brazil)
101. Laboratório de Estudos e Pesquisas em Saúde Mental e Atenção Psicossocial – LAPS/ENSP/Fiocruz (Brazil)
102. Grupo de Trabalho em Saúde Mental - GTSM/EPSJV/Fiocruz (Brazil)
103. Projeto Integrado Saúde Mental, Desinstitucionalização e Abordagens Psicossociais (Brazil)
104. Coletivo Pró-Frente em Defesa do SUS e da Reforma Psiquiátrica do Rio de Janeiro (Brazil)
105. Canadian Harm Reduction Network (Canada)
106. Associação Psicodélica do Brasil (Brazil)
107. Women's Global March
108. Youth Rise
109. Foundation for Alternative Approaches to Addiction – FAAAT
110. Asia Catalyst

[1] Manguinhos, a neighborhood in which the Oswaldo Cruz Foundation (Fiocruz) is located, began to form itself in the beginning of the 20th century, after the removal of favelas and slums from the city center, part of the process of sanitation and modernization of the city of Rio de Janeiro. Today, Manguinhos brings together more than 40,000 inhabitants, and is one of many popular territories victimized by the multiple forms of violence engendered in the context of war on drug policy throughout Latin America.

[2] Oswaldo Cruz Foundation (Fiocruz) is the largest brazilian health research institution, founded in the year of 1900. Its main campus in Rio de Janeiro is located a few steps away from many large favelas. Since 2009, it has been more strongly engaging in debate, research and public policy development aiming drug policy reform, as well as supporting the harm and risk reduction approach towards problematic drug use. On may of 2017, the institution organized, through its Institutional Progam on Alcohol, Crack and other Drugs, the Latin American Seminar on Harm Reduction at the Brazilian National School of Public Health, during which the present letter was drafted together with other Latin American organizations.