The Politics and Practice of Harm Reduction in Argentina by Shaaa Harris DISSERTATION Submitted in Partial Sa

Out of Harm's Way: The Politics and Practice of Harm Reduction in Argentina by Shaaa Harris DISSERTATION Submitted in partial satisfactioa of the rec<«irements for the degree of .DOCTOR OF PHILOSOPHY in Medical Anthropology in the GRADUATE DIVISION of tire UNIVERSITY OF CALIFORNIA, SAN FRANCISCO Copyright (2012) by Shana Harris ii Acknowledgments Silent gratitude isnʼt much use to anyone. G.B. Stern It is an unequivocal fact that I would not have completed this dissertation without the help and support of the numerous individuals and institutions that have contributed to my professional and personal development over the years. There is no amount of pages, no amount of words that could fully express my deep and explicit gratitude. For helping turn my dissertation proposal into a reality, I thank the organizations with which I was lucky enough to conduct fieldwork in Argentina: Intercambios Asociación Civil, Asociación de Reducción de Daños de Argentina, and El Retoño. I am particularly indebted to Cristian Coman, Pablo Cymerman, Paula Goltzman, Silvia Inchaurraga, Ricardo Paveto, Graciela Radulich, Julia Recchi, Diana Rossi, Graciela Touzé, and Enrique Vivas for their time, endless patience, and prudent guidance. Without the incredible cooperation and assistance of these institutions and individuals, their colleagues, and their collaborators, this dissertation would never have come to fruition. For teaching me how to navigate the fascinatingly foreign landscape and language of Argentina, I thank Hernán Bongioanni, María Epele, Juan Cruz Gallego Heguilen, Glenda Pérez, Eleonora Pfister, Mariana Ramirez, Sebastián Rojo, and Marcela Vitarelli. Without question, their friendships are what kept me sane and grounded during the confusing and often lonely experience of fieldwork. For providing unending scholarly and personal guidance, I deeply thank my dissertation committee: Vincanne Adams, Judith C. Barker, Philippe Bourgois, and Cori iii Hayden. The time, energy, and resources they invested in my education, professional development, and mental health is truly and sincerely appreciated. I am particularly grateful to the commitment and mentorship provided from my dissertation chair, Judith C. Barker. Without her persistence and encouragement, this dissertation might never have been completed. For showing professional and administrative support from both near and far, in person and in memory, I thank Gay Becker, Kim Bissell, Nancy Burke, Dan Ciccarone, Clair Dunne, Donna Goldstein, Deborah Gordon, Dan Hayes, Sharon Kaufman, Phylis Martinelli, Carole McGranahan, Linda Neuhauser, Dorothy Porter, and Clare Talwalker. For allowing me to do what I love, I thank the organizations, institutions, and academic departments that provided me with generous financial assistance at each stage of the dissertation process. Preliminary research was supported by a Tinker Summer Field Research Grant from the Center for Latin American Studies at the University of California, Berkeley. Full-time fieldwork was funded through a Dissertation Fieldwork Grant from the Wenner-Gren Foundation for Anthropological Research, an Advanced Graduate Research Fellowship from the University of California Pacific Rim Research Program, and a Graduate Student Research Award from the Graduate Division of the University of California, San Francisco. The writing of the dissertation was supported by a Ruth L. Kirschstein National Research Service Award for Individual Predoctoral Fellows from the National Institutes of Health/National Institute on Drug Abuse and a Graduate Student Professional Development Scholarship from the Golden Gate Speranza Lodge. Finally, the presentation of dissertation material at professional conferences was supported by various units at the University of California, San Francisco, in the form of Conference Travel Awards from the Graduate Studentsʼ iv Association, the Earle C. Anthony Travel Award from the Graduate Division, and the Becker Award from the Department of Anthropology, History & Social Medicine. For illustrating the importance and joy of academic camaraderie, I thank the many friends and colleagues I have made in my many years of graduate school. I am especially appreciative of the friendships I have made with Nick Bartlett, Emily Carpenter, Jia-shin Chen, Marc Goodwin, Robin Higashi, Seth Holmes, Sarah Horton, Dan Husman, Stephan Kloos, Theresa MacPhail, Erin Mahaffey, Suepattra May Slater, Joanna Mishtal, Alfred Montoya, Amelia Moore, Thomas Ordóñez, Adelaide Papazoglou, Eric Plemons, Beatriz Reyes-Foster, Guadalupe Salazar, China Scherz, Scott Stonington, Emily Wilcox, Catherine Workman, and Antonia Young. For providing a much needed mental and emotional refuge outside of academia, I thank my friends, both old and new. In particular, I am grateful to Emily Bacon, Megan Billingsley, Annika Billqvist, Erin Ford, Becky Gambatese, Adam Grauer, Mike Hsu, Andreas Jansson, Beth Jansson, Daniel Jansson, Niklas Modin, Jenny Noonan, Lindsey Perry, Ryan Sloan, and María Vivas. And for always and unquestionably supporting me wholeheartedly, I thank my parents, Carla and Paul Harris, and my sister, Kyra Harris. You have provided me with all of the love and encouragement I could ever ask for, and I am truly fortunate to call you my family. This dissertation is for you. v Out of Harmʼs Way: The Politics and Practice of Harm Reduction in Argentina Shana Harris Abstract The emergence of HIV/AIDS in the 1980s prompted a dramatic shift in the way public health professionals around the world addressed the issue of drug use. For the first time, interventions were now developed to specifically address the transmission of blood-borne diseases among drug users. Some of the most prominent interventions were those based on “harm reduction,” a public health model that places emphasis on reducing the negative consequences of drug use rather than on eliminating drug use or ensuring abstinence. This dissertation charts the adoption and promotion of harm reduction in Argentina, a country with one of the highest rates of drug use-related HIV prevalence in all of Latin America. Tracing how harm reduction has traveled to and within Argentina since the mid-1990s, I explore how local non-governmental organizations and select government agencies utilize harm reduction to ground their work among drug users in Buenos Aires and Rosario, the metropolitan areas with the countryʼs greatest concentration of drug users. I examine ethnographically how Argentine harm reductionists approach drug use and drug-related harm from a joint “public health” and “rights” perspective, a dual focus that uniquely influences their implementation of community-based interventions as well as their promotion of drug user rights and citizenship. By analyzing such projects, this dissertation shows that 1) harm reduction strategies, programs, and policies which set out as a uniform set of practices change when they travel and 2) that the major change in Argentina is that “the social” becomes an important site for intervention. In other words, it is not just that social context changes harm reduction, but that harm reduction in Argentina is all about changing the social. In the process, harm reduction renders drug use and drug users thinkable in new, productive ways. This dissertation is based on sixteen months of ethnographic research conducted in Argentina, including two months of preliminary research in the summer of 2006 and fourteen months of full-time research from September 2007 to October 2008. Research methods included participant observation, semi-structured and structured interviews, archival data collection, and textual analysis. vi Table of Contents Acknowledgments iii Abstract vi Table of Contents vii Introduction: When Harm Reduction Travels 1 Argentina: The Fieldwork Site 3 The Importance of Travel 5 Studying Harm Reduction in Argentina 9 Chapter Preview 11 Chapter 1: Harm Reduction: A Globalizing Strategy 14 The Question of Definition 15 The “Origins” of the Approach 18 Biopolitics, Risk, and Expertise 21 New Public Health and the Neoliberal Subject 25 Beyond Public Health 29 Harm Reduction as Globalizing Strategy 31 Conclusion 34 Chapter 2: Problematizing Drugs in Argentina 36 Drug Use Patterns 37 Institutional Responses 46 Reactions to Abstinence 56 Conclusion 59 Chapter 3: The Centrality of Civil Society: The Role of Argentine 60 Non-Governmental Organizations in Harm Reduction Conceptualizing Civil Society 61 Civil Society in Argentina 64 Argentine Harm Reduction Organizations 70 The Need for Networks 89 Harm Reduction Outside of Civil Society 93 Conclusion 94 Chapter 4: A View To The Social: Harm Reduction, Latin American Style 96 Studying the Social 100 A “Latin” Kind of Intervention 103 Working in El Terreno 106 vii The Primacy of Context 111 Another Shade of Harm Reduction 115 Conclusion 122 Chapter 5: Debating Decriminalization and Drug User Subjectivity: Harm 124 Reduction and Argentine Drug Policy A Brief History of Argentine Drug Legislation 128 The Decriminalization Proposal 134 Reactions to Reform 139 An Issue of Access 144 Drug User as Rights-Bearing Citizen 147 Conclusion 153 Conclusion 155 Contributions 157 Looking Forward 158 Bibliography 160 Publishing Agreement 187 viii Introduction When Harm Reduction Travels [H]arm reduction…is not only a practical logic that characterizes our age of risk, but a fundamental way people have approached preventive health within local cultures. Mark Nichter (2003:13) The emergence of HIV/AIDS in the 1980s prompted a dramatic shift

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