By training ordinary community members to be neighborhood-based advocates of health and harm reduction, a unique program in Rosario, Argentina is reaching out to drug users with limited access to information and health services. Volunteers work in the streets making personal contacts and helping individuals. As one of these volunteers explained, "We don’t understand paperwork, but we do understand the suffering of the people."
According to the philosophy of harm reduction, a 100% drug free society can never be achieved. Advocates of harm reduction therefore try to treat drug users non-judgmentally while working to reduce the harms related to drug use, such as the spread of infectious diseases and overdoses. Harm reduction programs typically include health education, needle exchanges, and the distribution of condoms and bleach kits for sanitizing injection equipment.
The Center for Advanced Studies in Drug Dependency and AIDS, known by its Spanish acronym CEADS, operates the grassroots harm reduction program in Rosario. CEADS is based in the National University of Rosario. When the program began in 2000, researchers at CEADS knew that intravenous drug users made up about 40% of AIDS patients in Argentina and that about 70% of intravenous drug users shared injection equipment. Moreover 90% of drug users were not in regular contact with the health system. The researchers realized that it was vital to bring the marginalized drug users closer to the health system in order to stop the spread of HIV and Hepatitis. In order to do that, volunteers would have to go to the users, rather than waiting for the users to come to them. There were no social workers doing outreach in the community, so CEADS began to train community members to advocate for health and harm reduction in their neighborhoods.
The funding for this grassroots harm reduction initiative is irregular and project-based. When CEADS was operating the project under a grant from the United Nations Development Program (UNDP) in 2004, volunteers received a stipend. Since the UNDP grant has ended, volunteers no longer receive a stipend, and the number of volunteers who show up at regular meetings is erratic.
Cristian, a volunteer, invited me to spend a day with him and Clara, a professional social worker, in Ludueña, a shanty-town in Rosario. About 30% of Rosario’s population lives in small shacks constructed of discarded materials and crowded together, often with little access to water, sewage or electricity.
Our first stop was a government-run day care center. The staff were troubled by the underweight children of Sole, a 21-year old woman, who they were sure was using drugs. They contacted Cristian, who in turn contacted Clara, to do an intervention. After being briefed on the situation at the day care center, Clara and I walked the narrow dirt paths that separated the shacks until we found the home of Sole’s parents. The paths were strewn with plastic sandwich-sized bags with paint residue. A popular way to get high in Rosario is huffing paint fumes or glue fumes. Other common ways to get off include drinking alcohol, smoking tobacco and marijuana, and injecting cocaine base.
When we arrived at the gate to the dirt yard of Sole’s parents, Clara clapped her hands twice, a practical alternative to knocking and doorbells when a dilapidated fence surrounds a house. The parents said that they hadn’t seen their daughter in a few days, and they were taking care of her three children. Clara explained to them some of the treatment options available to their daughter and offered some cookies to the children.
As we were talking, Sole came by, and she and Clara withdrew to the side of the road. Sole explained that she was living with an aunt and, with tears streaming down her cheeks, expressed her worries about losing custody of her children. Clara told her of an out-patient clinic and at one point said, "I’m a harm reduction advocate. I won’t tell you not to do drugs. But, if you feel the need to get high, smoke marijuana don’t huff. Huffing is more dangerous."
If a user feels that they can’t quit using drugs entirely, harm reduction advocates educate the user on ways to use drugs more safely. Pony, another volunteer, told me that she has counseled youths not to rob or commit other crimes while they are high, because when high they are not thinking clearly and could unintentionally hurt the person they are robbing.
Additionally, Pony encourages using condoms and avoiding sharing syringes. After three years as a health promoter, she gets calls at home from people seeking health advice, or gets stopped on the bus by people who recognize her as someone who can provide condoms. People often want to know where to get HIV tests or addiction treatment. Pony added that people are more willing to actually follow through on obtaining services if they are accompanied by someone the first time they go. Pony also distributes pamphlets that explain the risks of mixing different drugs together.
CEADS supplies the pamphlets, condoms, and bleach kits (for disinfecting syringes) to the volunteers. CEADS also offered several courses that met once a week for two months to train volunteers. Participants were trained in communication, harm reduction, legal consequences of drug use, and prevention and treatment of STDs including HIV/AIDS.
After the trainings, the grassroots harm reduction advocates become "strategic points" in their communities according to Maxi, a volunteer. They may offer talks, workshops, and/or meetings with doctors and psychologists. One volunteer set up workshops about inhalants at a local youth center, for example. As Maxi explained, volunteers are fighting the disinformation that many marginalized people have and often the job of the volunteers is to show people that using condoms is a "a sign of love."
When I was walking along the paths of Ludueña, with Cristian, he was cheerfully greeted by nearly everyone. "It’s Friday, a good day for condoms!" he shouted while dropping off handfuls at the homes of prostitutes and other community members who would then distribute them further. It soon became apparent to me that Cristian was not "The" contact person in Ludueña. He was part of a chain that began with the Province of Santa Fe, who provided the condoms to CEADS when the UNDP grant ended.
As we walked, Cristian explained his expansive conceptualization of his work. As an advocate of health and harm reduction, he is a trusted member of the community who is often sought when people are in difficult situations. For example, once he put a victim of a gunshot wound, who was too scared to go to the hospital, in touch with a local nurse.
"We live together in poverty," said Cristian, explaining how he has gained the trust of his neighbors. Harm reduction volunteers who work in communities other than their own build up trust by visiting the communities regularly, or they themselves are drug users or have had a personal experience with AIDS.
For example, Pony’s first husband died of AIDS. She heard about the harm reduction program through a friend and said it sounded "totally right." A friendly and outgoing 42 year-old, she agreed that the other volunteers tend to be outgoing as well.
These volunteers work in the streets of the marginalized communities they serve, risking bike thefts and hold-ups, but they do not get to go to international conferences or testify at UN meetings like NGO employees do. It is the work of these trained volunteers, however, that makes a difference in the daily lives of drug users in Rosario.
Renate Lunn is a criminal defense attorney working in New York City and a regular contributor to UpsideDownWorld.org. More information (en espanol) about harm reduction in Argentina can be found at http://www.infoarda.org.ar/