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Many of these countries are transit countries for cocaine bound for the main consumer markets in North America and Europe. For the North American market, cocaine is typically transported from Colombia to Mexico or Central America by sea and then onwards by land to the United States and Canada. Colombia remains the main source of the cocaine found in Europe, but direct shipments from Peru and the Plurinational State of Bolivia are far more common than in the US market. The relative importance of Colombia seems to be in decline. In a number of other European countries, Peru and the Plurinational State of Bolivia seem to be the primary source countries of cocaine. The Regional Programme for Central America is the result of an in-depth consultation process fully supported by Member States of the region. Representatives of the States at the Ministerial Conference also presented their national priorities and requested UNODC to provide state-of-the-art advisory services and technical assistance in order to design and implement an appropriate answer to the problems of drug trafficking and related transnational organized crime. In the final declaration of the Managua Ministerial Meeting, Member States also endorsed the creation of Centres of Excellence in the region, which will gather the existing expertise in Central America and leverage it to deliver highly successful programmes and projects. The objectives are to i facilitate the coordination of regional and national policies in the field of organized crime and drug trafficking, ii develop an analysis capacity of organized crime and drug trafficking trends in the two regions, iii ensure an exchange of information amongst the partners of the mechanism and avoid duplication between technical assistance projects, iv assist countries in implementing the UN conventions on organized crime UNTOC , corruption UNCAC and the three drugs conventions, and implement effective anti-organized crime policies. Establishment of a treatment, rehabilitation and social reintegration network in Central America. The regional project aims to create a treatment, rehabilitation and social reinsertion network in Central America, in order to progressively promote an integrated approach to the needs of drug dependent persons and facilitate the consolidation of a regional treatment capacity. This initiative proposes the creation of a sustainable Network of Central American Anti-Organized Crime and Drug Prosecution Units OCN in order to strengthen the prosecuting and investigating capacities of Central American countries in handling complex and transnational cases involving drug trafficking as well as other forms of organized crime, and to enhance regional and inter-regional operational and judicial cooperation. The OCN is composed of all prosecuting officials who work in specialized organized crime and narcotic units of the participating countries. The objective of centres of excellence is to assist governments in the region to build up national and regional capacity in dealing with threats and risks stemming from illicit trafficking, drug abuse, organized crime and related violence as well as to strengthen the rule of law. Centres of excellence will also support governments in developing effective programmes by identifying areas of opportunity and areas needing immediate attention by sharing information, providing research and analysis. The Centre of Excellence in Panama City will help diagnose threats in maritime security and serve as a resource of expertise, training, data collection and analysis. It will provide strategic direction and training in search techniques, security, maritime interdiction, human trafficking and the handling of hazardous and toxic cargo. The objective is to facilitate the strengthening of statistics and analytical capacities in the above mentioned areas. The Centre of Excellence will develop and provide planning and information gathering tools, develop studies and publications, offer training and, develop databases and methodologies. The centre will also promote the exchange of standardized information between countries and the identification of good practices in the field of crime statistics. United Nations. Office on Drugs and Crime. Site Search. Mexico, Central America and the Caribbean The situation Many of these countries are transit countries for cocaine bound for the main consumer markets in North America and Europe. Establishment of a treatment, rehabilitation and social reintegration network in Central America The regional project aims to create a treatment, rehabilitation and social reinsertion network in Central America, in order to progressively promote an integrated approach to the needs of drug dependent persons and facilitate the consolidation of a regional treatment capacity. Regional Centre of Excellence on Maritime Security in Panama The objective of centres of excellence is to assist governments in the region to build up national and regional capacity in dealing with threats and risks stemming from illicit trafficking, drug abuse, organized crime and related violence as well as to strengthen the rule of law. United Nations Office on Drugs and Crime.

Santo Domingo Pact strengthens regional cooperation to fight drugs and crime in the Caribbean

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Official websites use. Share sensitive information only on official, secure websites. Like other epidemics, the current heroin epidemic in Santo Domingo, Dominican Republic is a largely invisible and devastating social problem linked to numerous structural and social determinants of health. Specifically, we describe Proyecto Lentes Lens Project , a PhotoVoice initiative launched in , which brought together active drug users to visually unveil and critically analyze the micro- and macro-factors shaping the marginalized and stigmatized drug addiction epidemic in Santo Domingo. Keywords: PhotoVoice, critical medical anthropology, injecting drug users, drug policy reform, Dominican Republic. Participatory photographic methods have been used in the social sciences and public health sciences to assess the social context of various health concerns Bourgois, ; Graham et al. PhotoVoice methodology is intended to facilitate collective awareness of broader social, political, cultural, and interpersonal factors that shape everyday experience Wang, This ontological orientation of CMA requires holistic approaches to public health and community activism, emphasizing change in the structures of institutional, legal, political-economic and social systems that are viewed as the primary drivers of health inequalities. There are three primary goals of our analysis. First, we hope to demonstrate how a CMA approach to community ethnography can work in conjunction with PhotoVoice to identify and translate into local vernaculars the complex social and structural factors most salient to the health and rights of local populations affected by drug addiction. Second, we illustrate how PhotoVoice can be adapted to active drug using populations for whom daily survival is a struggle, complicating the commitment of time and energy that comes with the development of a long-term photographic exhibit. For the men and women on our team who were struggling with addiction, there were also challenges related to withdrawal symptoms, confliict, violence, other health conditions, and the ethics of taking pictures in drug use areas. Thus, we summarize the lessons learned in successfully adapting PhotoVoice to active street-based drug users in Santo Domingo. Biehl, At the end of this paper, we return to this point to describe intersections between these theoretical considerations and discussions in visual culture regarding the impact of visual representations and their potential to both express and transform relations of power and inequality Rose, Proyecto Lentes was launched in and continues in its exhibition phase at the time of this writing; it began as a supplement to a larger ethnographic study of the social and structural context of HIV and drug abuse in the Dominican Republic, called the Syndemics Project. Seven of the volunteers at FUNDOREDA — all current or former drug users — requested support from our team to document their experiences and struggles with addiction, and to tell their stories in a way that might positively impact public dialog on the severe problems with current drug policies. Two factors are critically important for understanding the social context in which we implemented Proyecto Lentes. First, under the current Dominican drug law Law 50—88 , which focuses primarily on the harsh criminalization of drug use, clinical treatments like methadone for ORT are defined as illegal drugs equivalent to heroin or cocaine Agozino, The combination of stigmatization and intense criminalization contributes to the high rates of arrest among drug users and their frequent abuse by the police, who have been known to plant drugs on residents of poor neighborhoods like Capotillo. Dominican sociologist Lilian Bobea summarizes the situation of violence in Capotillo as follows:. Capotillo ranks among the barrios with the highest rates of victimization and homicide in the National District, which include Santo Domingo a terrifying 64 deaths per , for the zone that includes the barrio. Those who die are mostly poor young males, gunned down either by rival gangs or by the police. Bobea, , p. Indeed, several of the activist-artists who participated in Proyecto Lentes were deportees, and had experienced extreme stigmatization and abuse by the public and the police. Including four men and three women, the participants were volunteers at FUNDOREDA and beneficiaries of the services provided there, including needle exchange, donations of clean injection kits, food aid, HIV testing and psychological counseling. Based on our additional ethnographic research on drug users in the broader metropolitan area of Santo Domingo, we believe that these participants were relatively typical of street-based heroin users in lower class barrios such as Capotillo. Their status as existing clients of this non-governmental organization assisted us in maintaining contacts with these individuals over the course of the project. Matiz-Reyes — a researcher on our FIU-based team with many years of experience working with vulnerable populations in the Dominican Republic and a skilled community facilitator who had conducted a prior PhotoVoice project in Detroit, Michigan, USA Graham et al. Through 12 months of regular meetings and participatory co-learning discussions, activist-artists met with our team to learn about photographic techniques, ethical procedures, captioning, policy mapping, the selection of images to create a story, and the logistics of developing an exhibit. Approximately pictures were taken of a wide range of scenarios, following analytic, ethical, policy and artistic criteria that the group thoroughly discussed. For this reason, our analysis in this paper highlights the collective decisions of the larger group, rather than the motives or intentions of individual artists. For example, because Law 50—88, the highly punitive Dominican drug law, was determined through initial discussions to be a priority for critical commentary, the selection of images involved discussion of the best visual representations and potential captions to build an effective critique of this law. Ultimately, the consensus-building process led to the selection of forty 40 images for the exhibit, and captions were refined through detailed discussions of each. Captions for each picture were intended to guide the viewer through specific framings of a community problem or challenge. The ethnographic project was informed by syndemic theory, focusing on the structural and social determinants of the syndemic of HIV and drug use. One of the primary goals of our study was to describe the political and institutional structure of drug policies and programs in the Dominican Republic. To achieve this, we conducted key informant interviews and participant observation at 15 public and private substance use service organizations in Santo Domingo and Boca Chica the two cities upon which our study focuses. After each visit, investigators took detailed ethnographic notes. These individuals also were experts in the overall structure of drug laws and policies and the ways these policies affect drug users. Below, we draw upon their insights in our interpretations of the PhotoVoice images and captions. Next, we describe our adaptation of the PhotoVoice methodology to the daily realities and struggles for survival of people who are addicted to drugs in Santo Domingo. PhotoVoice is a community-based participatory research CBPR methodology focused on empowerment and stakeholder engagement through visual representation. Feminist and critical theories underpin the process and empower community participants to think critically about their own communities. PhotoVoice is beneficial to ethnographic research because it allows people to express their daily life-worlds in a language that is beyond the purely verbal, and to think critically about their worlds in the process of uncovering their hidden or implicit patterns and logics. The main approach to PhotoVoice facilitation involves a series of thought questions that foster reflection on the structures shaping specific scenarios or challenges. This process is also consistent with the theoretical orientation of CMA, emphasizing ethnographic analysis of broader social conditions of health. PhotoVoice methodology has been used in a few studies aimed at observing, describing and analyzing drug using contexts or communities e. Harley, ; Helm et al. However, few PhotoVoice projects have centered on active adult drug users Cordova et al. Ours is a unique example of the adaptation of PhotoVoice methodology to situations of active injecting drug use under circumstances of systematic state abuse, intense social stigmatization and the virtual absence of effective drug programs. The extremely precarious conditions faced by the Proyecto Lentes team were therefore ironically both the object of analysis for the project and the principle barriers to its successful implementation. The seven activist-artists who originally committed to the project in often faced life-endangering health conditions such as overdose, hepatitis C infection, injection-site abscesses, chronic stress, physical and sexual violence sometimes perpetrated by the police , and chronic diseases. Two of the original seven artists died of overdose during the first year of the project — an outcome that was virtually guaranteed by their inability to access clinical services due to discrimination of drug users in most medical facilities and the lack of services aimed at serving people with drug abuse problems. This resulted in the need to mourn the loss of our team members as well as to cope with inevitable delays in project implementation while we recruited and trained two additional participants. Ultimately, nine artist-activists contributed to the project. To create the PhotoVoice exhibit, formal meetings were held over the course of 12 months, following a sequence of steps that began with workshops and discussions indoors in preparation for the fieldwork, followed by photographic outings, analysis and gallery production. Figure 2 summarizes this process of training. Each step involved a minimum of two workshops, although at certain steps more meetings were required to thoroughly cover the topic, or to update individuals who had missed a session. Each meeting involved approximately two hours of discussion, during which the team shared a snack or a meal. It should be noted that between formal workshops, our investigative team maintained continual contact with the activist-artists through regular visits to the neighborhood, FUNDOREDA , and individual homes. These conditions resulted in challenges in focusing the team and several open conflicts among participants that disrupted some training sessions. Further, sheer poverty and a street-based existence severely compromised their overall health, nutrition, and ability to meet basic needs. To adapt the PhotoVoice methodology to these challenging circumstances, our team took several steps. This was significant for the participants because many of them were estranged from their own families or forcibly separated from them due to their deportation, making the PhotoVoice family a critical resource for social support. The family environment also reduced feelings that the project was a job and, instead, helped participants become more emotionally involved through sharing their own feelings and holding each other accountable. The family mindset was developed through constant interaction, including frequent dinners at the meeting site and surrounding area restaurants. Moreover, Proyecto Lentes participants met bi-weekly to discuss their photos and community endeavors, leading to a context of consistency and trust. Second, we established a donation-based food and clothing bank for street-based drug users that operated out of FUNDOREDA , allowing us to provide for some basic needs, involving family-style meals before or after each meeting. This helped address immediate concerns rather than expecting individuals to commit exclusively to the longer term goals of policy change. Third, we encouraged each member to watch over the others, to remind them of our meetings and to support one another in arriving to our meeting location. This allowed participants to be validated for their work in venues where they would typically be excluded. Finally, the anthropological approach of the larger project allowed us to be particularly responsive to local conditions and realities, and to use our ethnography to inform PhotoVoice. Since our institutional ethnography was intended to identify how policies, laws and institutions affect people who are addicted to drugs, the collaboration with the PhotoVoice family was an ideal opportunity to witness a grassroots effort by street-based drug users to express their voices in a public forum. In this section, we present six of the forty 40 images selected by the Proyecto Lentes team to represent the themes and messages determined as central to the social analysis accompanying PhotoVoice see Figure 1. Here, our focus is on how the images and captions illustrate the themes of interest to the activist-artists, as well as the ways that they link individual experiences to the larger social conditions that frame them. For brevity, we include only the English translations of the Spanish captions written by the artists, but titles are given in both languages. In representing their struggles with addiction, the artists chose several images that coalesced around the bodily wounds and scars that embody the effects of the broad social conditions that drug users face, in particular, the abandonment of these individuals by the medical establishment and the state. The difficult-to-look-at quality of this photograph combined with the critical caption re-directs our disgust toward the larger context of a generalized lack of health services designed for persons suffering from addiction. Taken in this context, then, the wounds are social as much as they are physical. Analysis: Drug consumption is the main priority for some people, simply because it relieves the pain, overcomes the lack of health services and makes you forget the lack of opportunities. Alternatives: Specialized health services for people who have their lives in the hands of inopportunity and drugs. Our ethnographic research documented many stories of the systematic denial of access to clinical services to persons suffering from drug addiction. Hospitals and clinics in the Dominican Republic are notorious for refusing treatment to drug users or those presumed to be addicts, including calling the police to encourage arrest when patients present with drug-related symptoms or overdose. Thus, individuals with abscesses like those shown in Figure 3 are also displaying stigmatizing signs of addiction, marks that further marginalize these individuals and make them more likely to be identified and targeted for violence or arrest. During our institutional ethnography, we heard repeated stories of the hyper-criminalization of drug users resulting in repeated cycles of incarceration, and of the arrest of drug users who would present at hospitals in need of medical care. One individual told us a detailed story of being handcuffed to a gurney at a local clinic when the nurse identified him as a drug user, resulting in the individual being arrested even though he was not in the possession of drugs and was merely seeking care. Most of the key informants with whom we spoke recognized the importance of reforming the law in order to more fully support the public health needs and the rights of drug users. This image thus draws links between the daily practices of injection and the policies and legal protections that would support their health and well-being through harm reduction initiatives. Analysis: Perfect team for the destruction of life. Pleasure and false calm, without norms or restrictions on the preparation of substances. Alternatives: Prevent this ghost for future generations. Reinforce harm reduction strategies for users. Support the modification of Law 50—88 for the protection of persons with addictions. One of the activist-artists who participated in the first phase of Proyecto Lentes but who tragically passed away from overdose in , produced a photo that illustrates another theme of the exhibition: the humanity of the heroin addict, presented as a challenge to stereotypes of drug users. Analysis: Amidst poverty feelings remain. Alternatives: Support programs with neighborhood groups, the church, and the state with more effective community services. Make this reality known for those who are unaware. In the context of the highly stigmatizing attitudes that tend to circulate around drug users in the Dominican Republic, such messages are a direct challenge — an appeal to the viewer to look more carefully — and underscore the resilience of these individuals despite their conditions of homelessness and addiction. The pillow, quilt and sheet show there is a bit of dignity and that hope remains. Alternatives: Early interventions beginning in school to talk about addictions. Fight poverty that exists and understand that poverty is not only economic. Several of the photographs chosen by the team for the exhibition included references to the victimization of drug users by the police and the authorities, which is one of the primary reasons that heroin use is hidden from public view and occurs in areas that do not support the effective use of harm reduction techniques. As shown by other ethnographic research on injecting drug users Bourgois, , the criminalization of drug use and the constant threat of arrest or mistreatment by the police are the primary reasons that street-based drug users often remain hidden within plain sight — injecting under a bridge, for example — and this, in turn, ensures injection occurs quickly and without necessary precautions, ultimately leading to greater health risks such as HIV infection or abscesses. In the Dominican Republic, and particularly in the neighborhood of Capotillo, abuses by the authorities are commonplace, and street-based drug users are the most frequent victims. The lower photograph reinforces this message of protest through the depiction of a defiant community member, using an image from the US invasion of as a metaphor for oppression. Analysis: The community raises its voice against corruption. Many protests against the mistreatment and abuse of authority demonstrate an evil that continues growing. Alternatives: Sensitizing the police corps. Better pay and treatment of the police to improve their work. Empowerment and citizen oversight to fight injustice. These images express the outrage we often heard from drug users which is particularly acute among addicts who are the most likely to experiences such abuses. In our ethnographic research in Capotillo, we also heard stories of police violence and corruption that are consistent with these depictions. Importantly, many of the addicts described pervasive violence perpetrated by other community members, demonstrating that such abuses extend beyond the police. Shocking stories of brutal beatings, stabbings and extrajudicial killings of homeless drug users in Capotillo circulate in these communities, demonstrating a logic of social cleansing behind such crimes, many of which remain uninvestigated and unresolved. Here, as with cases of injection wounds, the burned body becomes a site for the inscription of social wounds inflicted by the moral indignation with which drug users are typically received, and the embodied suffering that is reproduced through such social violence. Analysis: The results of addiction can be rejection and social violence. The community commits inhuman acts like burning people as punishment. Alternatives: Community education to reduce collective violence. Proyecto Lentes allowed us to tie our goal of documenting the narratives and experiences of vulnerable groups to applied outcomes by incorporating a methodology of group reflection and analysis into an ethnographic project. PhotoVoice permitted the Proyecto Lentes team to amplify the voices of persons struggling with addiction in an experience-near format that provoked critical reflection and, perhaps, has the potential to contribute to a shift in Dominican drug policy from a purely punitive model to one emphasizing harm reduction approaches. As illustrated through the example images and captions presented above, the activist-artists selected images and constructed narratives intended to address specific policy gaps and needs. Indeed, the project has been effective at translating community voices of drug users into a format capable of reaching policy audiences. As described in the introduction, part of our scientific goal is to identify best practices for incorporating PhotoVoice into an ethnographic project informed by CMA. The PhotoVoice approach also complements CMA in that it incorporates a form of critical pedagogy, fostering reflection on the causes of social ills and identifying means of addressing them. The ethnographic methods of participant observation and the flexible approach to fleldwork typical of anthropology are also apt for combination with PhotoVoice methodology, allowing the ethnographer to ground the analysis in the perspectives and words of community members. In addition, we found that the institutional ethnography of drug treatment policies and programs was highly synergistic with the PhotoVoice analysis, since both of these described similar social processes using slightly different language and media, allowing us to triangulate perspectives and contribute to more grounded ethnographic representations. Cultural studies theorists such as Paul Gilroy have examined the social work that visual images can do, for example, in perpetuating racial stereotypes or drawing upon and reinscribing difference. Gillian Rose, in her discussion of the critical visual culture approach, has remarked on the capacity of visual representations to provoke critical understandings that might rupture or disrupt societal hierarchies or inequalities Rose, The captions created by the artists further reinforce the images with reflections on these social ills, leveraging the power of the images to capture audiences affectively while canalizing particular critical interpretations. We believe this illustrates perfectly the potential role of visual methods such as PhotoVoice in applied medical anthropological projects such as ours. An additional goal of our project was to demonstrate the ways that PhotoVoice can be adapted to active drug using populations for whom daily survival is a struggle, not to mention the obligations that come with the collaborative development of a long-term photographic exhibit or the potential hazards and challenges of using cameras in drug use spaces. We described several techniques we used to adapt the method to this context, including: the creation of a familial social environment that transcended the purely practical and became a source of support and conflict resolution; the linkages of the project to a harm reduction organization FUNDOREDA that provided a central location for contacting this hard-to-reach population; the provision of clothes and food as a part of a community-led initiative; and the use of the project to provide professionalization opportunities for drug users. We believe the Proyecto Lentes provides a useful example for the adaptation of PhotoVoice to active drug using populations. In this context, we would like to end with a mention of the unexpected effects on the seven participants who completed the project over two years of implementation. In addition to participating in regular trainings that required a sense of commitment and provided a certain structure to what are often the chaotic realities of addiction, these individuals have subsequently led numerous exhibitions and told their stories at conferences, and more recently the group has proposed to conduct a school-based program using the exhibition as part of an educational curriculum on drug policy and harm reduction. At the time of this writing, they are finalizing a brochure to describe their exhibition to local teachers. Some of the team members have sought drug rehabilitation or decided to pursue educational training. While we did not set out to formally evaluate the impact of Proyecto Lentes on the activist-artists themselves, our observations support the use of participatory photography and pedagogical methods such as PhotoVoice as both a means of political analysis and as an empowerment intervention for street-based drug users. We thank Federico Mercado, Director of Fundoreda , for his support. The contents of this article are solely the responsibility of the authors and do not represent the official views of the funders. As a library, NLM provides access to scientific literature. Arts Health. Published before final editing as: Arts Health. Find articles by Mark Padilla. Find articles by Armando Matiz-Reyes. Find articles by John Vertovec. PMC Copyright notice. The publisher's version of this article is available at Arts Health. Open in a new tab. Disclosure statement The contents of this article are solely the responsibility of the authors and do not represent the official views of the funders. 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