Fábio Mesquita at the Threshold of Victory

Brazil's Prognosis for a Speedy Recovery Due to "Dr. Harm Reduction's" Cure

By Al Giordano
Special to The Narco News Bulletin

May 12, 2003

SÃO PAULO, BRASIL; MAY 8, 2003: He is the House Physician of Brazil’s “Harm Reduction” movement – the effort that began, in the late 1980s, to diminish the damages caused by drug use under repressive policies – and he can smile now: his patient, the nation of Brazil, after a long illness called Drug Prohibition, is showing clear signs of getting better.

Dr. Fábio Mesquita D.R. 2003 by Al Giordano

Dr. Fábio Mesquita’s operating room is a third floor office in a satellite building of São Paulo City Hall. At 5 p.m. it remains a beehive of activity as dozens of workers are still at their posts, or coming in from the field, or on the phone, or at the keypad, hard at work in the Aids and Sexually Transmitted Diseases prevention office in one of the three great metropolises of our América.

Two journalists – Narco News Director of Strategy Adriana Veloso and your correspondent – arrive and are escorted into the conference room. Mesquita’s public relations director, New Maris, comes in, sees the digital camera on the conference table, and exclaims: “Oh, you’re going to take photos… Let me put up a poster behind where Fábio will sit.” Such precision and attention to detail are hallmarks of the manner in which Doctor Mesquita has conducted his long march in defense of the full citizenship of drug users and the public health for which he took the Hippocratic oath.

“São Paulo is the center for media in this country,” Mesquita later explains. “I greatly respect the media in Rio de Janeiro and Brasília, but we have to pay particular attention to the media here in the center, where we also have the country’s largest newspaper,” he says, in a reference to the Folha de São Paulo and its daily circulation of 327,000 copies.

Your correspondent wants to start right in: “The police persecution against you, when you began this struggle, is legendary, but I’ve never read in any media an historical account of what in fact happened….”

Mesquita will get to that. “First,” he interrupts, speaking in English, “I would like to say that it is a very great initiative to begin Narco News coverage in Portuguese. It’s very important for us. We feel very supported that you are here. It helps us a lot.”

Kind words, from a man who has access to newspapers like the aforementioned Folha to publish editorial columns, or the Diário de São Paulo where, last July 29th, he wrote:

“Those who win with the illegality of drugs are criminals, those bankers who make $400 billion dollars a year, the economies of some drug producing countries and fiscal paradises, the arms industry and the repressive apparatuses.”

“Those who lose with the illegality,” he continued, “are the Democratic State of Law and its populace, who live insecurely, with illnesses, and with their rights constantly violated… The solution at the root of the violence in the current Brazilian state will only be found with the legalization of drugs.”

These words, kind readers, were penned by an important Public Health official in the largest city in the largest country in Latin America.

Okay, let the Narco News interview with Dr. Fábio Mesquita begin…

From Repression to Acceptance

In 1989 in the port city of Santos, on the Atlantic coast of the state of São Paulo, Telma de Souza had just been elected as the city’s mayor. Along with Mayor Luíza Erundina in the city of São Paulo, they were the first major-city mayors elected from the ranks of the Workers Party (PT, in its Portuguese initials) that, today, 14 years later, governs Brazil’s executive branch under President Lula da Silva.

The country’s largest shipping harbor, Santos has a long tradition of progressive municipal government. Sometimes, conservatives have referred to the city as “the Moscow of Brazil.” Left, right, or in between, though, Santos, receiving sailors and contraband from all over the world like any other international port, had a growing public health problem with the spread of HIV, the virus commonly associated with AIDS.

The new mayor tapped a local doctor, Fábio Mesquita, to address the problem. In the 1980s, recalls Mesquita, “half of my patients were intravenous drug users. That is how I came to the field of drugs and started to work on AIDS. We recognized, then, that Santos had the biggest epidemic, per capita, of AIDS in the country.”

“The federal government,” remembers Mesquita of those early years, “did not recognize AIDS as a disease. They said it was an invention of the media. There was also concern on the part of the tourist industry because Santos is a tourist city and there was a lot of pressure not to speak of the problem. So I became the city’s first director of the Sexually Transmitted Diseases-Aids Program. The first thing we did was to recognize that AIDS was already an acute problem. I said at the time that ‘we want to be known in Santos for our response and not for the epidemic.’”

In the first year, Mesquita’s office distributed condoms and conducted a public education campaign about safe sex. It also started a housing program for people living with HIV and sent field workers to work with sex industry workers. “We saw that half of our HIV-positive patients were, in fact, injected drug users… so we began to look at the programs already underway in Holland, in Australia, and in parts of the United States. I traveled to San Francisco, California, to study the projects begun there in needle exchange.”

“Needle Exchange” is the term commonly used for the distribution of clean syringes to injected drug users, trading them for used needles, accompanied with educational efforts to discourage the sharing of needles between users, a major source of the spread of AIDS, hepatitis and other illnesses. “We decided,” recalls Mesquita, of his second year, 1990, at the helm of the STD and AIDS prevention program, “that City Hall would support the country’s first needle-exchange program.”

Then came the repression. The city prosecutor’s office at the time, notes Mesquita, “interpreted Article 12 of the old national drug law as saying that anybody who helps another to use drugs is a drug trafficker.”

The District Attorney filed criminal charges against Mesquita, accusing the city health department of “having the same motives as drug traffickers,” Mesquita recounts. The D.A. also filed a civil lawsuit against the city government, under the argument that “drug users are troublemakers and don’t deserve the attention of the city and certainly not of the city budget. So, in 1990, I had to go to the police station for interrogations in preparation for trial.”

Santos City Hall than bargained with the prosecutors and made an agreement that the needle-exchange program would be delayed. The charges were suspended, but not dropped, giving the prosecutors the possibility of reopening the case in the future.

The criminal charges against Mesquita, though, caused a loud national polemic in the newspapers, TV, and radio, and had the affect of awakening consciousness around the country of the problem of AIDS spread by the sharing of needles among drug users.

In early 1995, the capital city of Salvador in the Northeastern state of Bahia became the first Brazilian city to actually begin distributing clean needles and, in contrast to what had occurred in Santos, state authorities tolerated the program.

The coordinator of the city of Salvador’s program was, like Mesquita, a doctor: his name was Vezzito Magalhães. But he was also the brother of the most powerful politician – indeed, the longtime political boss of Bahia state – Antônio Carlos Magalhães who is also, by training, a medical doctor. But that doctor – now a controversial federal senator – also happened to control the local police, prosecutors, indeed, the entire political apparatus. The local university in Salvador gave financial and political support to the needle exchange program. “Antônio Carlos Magalhães is a very powerful person. He has used his power in bad ways but in this case he used it for good.”

The Race Was On

State officials in the megalopolis of São Paulo looked on with envy, recalls Mesquita. “São Paulo can be arrogant and as an entity can’t stand to be second in anything,” the good doctor smiles. “Bahia was now first in needle-exchange, so the state Health Secretary bought the first shipment of syringes in 1995 and began distributing them, including in Santos.”

But while one arm of state government – that concerned with health – was handing a clean-needle to the drug user, another arm – law enforcement – tried to cut off the helping hand. The state government of the late Mário Covas, who had been an unsuccesful 1989 presidential candidate, was, in effect, “schizophrenic” diagnoses the good doctor Mesquita.

That’s when all hell broke loose. That same year, state prosecutors invaded the offices of a non-governmental organization – the Institute for AIDS Studies and Research (IEPAS, in its Portuguese initials), and revived the suspended charges against Santos City Hall. Ironically, the city had only been distributing bleach to injected drug users to be used in cleaning and disinfecting used syringes. “There were legal troubles distributing needles, but not bleach,” says Mesquita.

But by 1995, the good doctor had now been elected as City Councilor Fábio Mesquita. He had a public electoral constituency and high media visibility. So the prosecutors, instead of arresting this member of the City Council, went to arrest the then-director of harm-reduction programs in Santos, Regina Bueno. “We went together, she and I, to the police station,” Mesquita explains. “Of course, we called all the media to come with us.”

After just one day of intensive media attention and political pressure, Regina Bueno was released from prison and the charges were relaxed.

It was then that State Representative Paulo Teixeira, of the Workers Party, sponsored legislation to legalize needle-exchange and harm reduction efforts. In 1997, the legislature passed Teixera’s bill into law, but the governor, still Mário Covas, neither signed it nor vetoed it for six months. The bill just sat there, in political limbo. But the legislation’s supporters didn’t just sit around waiting for Power to give them what they wanted: they got busy internationalizing the issue.

Internationalizing the Pressure

In March of 1998, Mesquita and other Brazilians then hosted an International Harm Reduction conference in São Paulo, with more than a thousand delegates from around the world.

“We spent the weeks before the conference pressuring the governor to sign the bill,” recalls Mesquita. “And we booked the Governor’s Palace to hold the opening ceremony of the conference.”

The International Harm Reduction conference was scheduled to begin on a Saturday night. The governor signed the bill hours beforehand, on Saturday morning.

That same year the governor of the Southern Brazilian state of Santa Catarina, with its seat in Florianopolis, Paulo Afonso, of the Brazilian Democratic Movement Party (PMBD, in its Portuguese initials) had some political problems: he had been accused of corruption and the media was having a field day at his expense. There was heavy pressure on the state legislature to impeach him. “He needed an issue to divert the media,” Mesquita said, offering again the mischievous smile that breaks his serious demeanor when he speaks of how cracks in the political system have been used by the movement here to win its victories. Your correspondent gets the sense that perhaps the good doctor had more to do with the events he describes than he is letting on. “Someone suggested to the governor that if he makes a law protecting harm reduction and needle-exchange for drug users that people and the media will debate that for two or three weeks.”

The state of Santa Catarina quickly passed the law, and another Brazilian state government had now embraced the protection of harm-reduction workers. The Southernmost state of Rio Grande de Sul, from its capital of Porto Alegre, soon became the third Brazilian state to pass a harm-reduction protection law. “The legislator who sponsored the law in Rio Grande de Sul was a member of the Brazilian Social Democratic Party (PSDB, in its Portuguese initials, the party of former president Fernando Henrique Cardoso), but the governor of the state was with the Workers’ Party, his name was Adilson Troca, and his last name means ‘exchange,’ ironically. So Paulo Teixeira, the Workers Party official from São Paulo who had sponsored the harm reduction law here, traveled to Porto Alegre to convince the governor.”

Meanwhile, beginning with the second wave of repression in 1995, Mesquita’s home city of Santos had already grown impatient with the double discourse of the state and national governments. “It had cost us our patience to wait for legal resolution, so we started to go underground with needle-exchange efforts.” After all, if the state would not abide by the 1990 agreement, why should the city? You see, kind reader, the movement here did not just sit around waiting for official permission or legislation. From Salvador to Santos what forced the government’s hand was that Civil Society got out ahead of it, and began doing the job itself.

The City of São Paulo Today:
27,000 Clean Needles a Month

In fourteen years, the landscape has radically improved for the work of Doctor Fábio Mesquita and the many other Harm Reduction pioneers in this country called “Brasil.”

Today he works at the head of a large city department, dedicated to distribute clean needles, condoms, clean crack pipes (because the sharing of pipes among crack users, who often develop open sores on or in the mouth, also spreads hepatitis and other diseases), educational materials, and that trains citizens and other public officials in working with drug users.

No longer threatened with prison, he instead receives financial and political support from the government. The new national drug law passed in January 2002, although it has many negative aspects, especially in the area of what drug war hawks misname as “therapeutic justice” (the process by which drug users are forced into “treatment” programs that are very lucrative for the private-sector industry and lobby behind them), did, at least, officially legalize and protect Harm Reduction workers and programs from police repression.

And just in the nick of time, notes Mesquita, because now heroin is coming to Brazil. Until recently, 90 percent of the injected drug use in Brazil involved cocaine. The other ten percent involved amphetamines, barbiturates and other tranquilizers, and heroin. Brazil’s cocaine explosion, explains Doctor Mesquita, is a direct result of U.S.-imposed drug policies. As Mesquita has written:

“As the result of the War on Drugs waged by the United States against the main cocaine-producing countries (Colombia, Bolivia, Peru) in the eighties, the latter countries began to export to other neighboring countries in addition to Brazil, such as Argentina, Chile and Paraguay. The difference between the users’ practices in the developed and developing countries is that the former take it pure, while the latter mix it with other substances such as bicarbonate of soda. Injecting cocaine produces effects that are similar to those of crack, and there are many undesirable consequences. Although dependency on crack occurs faster than with other drugs, injected cocaine produces even faster effects and leads to greater dependency, as well as entailing greater risks of HIV transmission and overdosing. One of the worst problems is the craving: cocaine is injected much more frequently than heroin. The same syringe is used as a rule by the same person as many as 10 to 15 times.”

That the same needle is used, on average, ten or fifteen times, sheds important light on another statistic: That the City of São Paulo now distributes 27,000 clean needles per month. Multiply that by ten or fifteen uses per needle among the poor, especially addicts, who can’t afford to buy clean needles with their entire purse going to pay the high prices of drugs under prohibition, and the math is impressive: That’s 270,000 to 405,000 games of “HIV Russian Roulette” that are stopped cold by this intelligent and humane city drug policy.

Mesquita says it is hard to count how many drug users there are in the city or nationwide: “There is no data on the number of users in Brazil,” he explains.

Asked about the recent statement by the state of Rio de Janeiro’s new Public Safety Secretary (and First Husband) Anthony Garotinho that there are “700,000” drug users in Rio de Janeiro, and that families have to control their children more because drug users are “financing terrorism,” Doctor Mesquita responds: “He’s crazy. It’s very hard to believe him. There are at least five million users of various drugs in Rio de Janeiro!”

Plan Colombia’s Impact on Brazil

Now that the US-imposed “Plan Colombia” military intervention is in full swing, Mesquita notes that it is having a negative impact on Brazil and other neighboring countries, in part because the US-sponsored aerial herbicide spraying has caused many Colombian farmers to switch from harvesting coca to harvesting poppy. “Colombia now provides 80 percent of the heroin consumed in the United States,” notes Mesquita. “Brazil, Paraguay, Uruguay, and Argentina find ourselves in the route.”

Heroin has never been particularly popular among Brazilians. “In São Paulo or Rio, it has a niche among the wealthy. It is more expensive than cocaine. One shot of heroin costs 100 reals (about $40 U.S. dollars), which is… very expensive compared to the average Brazilian’s income.”

Still, the concern is that just as cocaine has begun to enjoy popularity in Mexico, a country where the coca leaf does not grow, because of the simple fact that Mexico lies along the cocaine trail, that the same could occur in Brazil with the Colombian heroin explosion: a direct and negative consequence of US-imposed drug policies on other countries.

But as Doctor Mesquita and other Brazilians are witness, the price of obeying the impositions of U.S. policy is growing higher than the price would be to take a new and healthier path in drug policy of the kind proposed recently by the Lula Government in Brazil: Decriminalization.

“We Are Very Optimistic”

Asked whether he thinks that the Lula government can succeed in its efforts to decriminalize drug use in Brazil, Mesquita answers, “I think it is a process, of course. The PT (Workers Party of President Lula) has a reputation for being the most serious about drug issues. There is a very strong internal debate in the PT. And it is a very democratic debate of ideas within the government.”

The fact that the debate has spilled over into public and media view, says Mesquita, is very encouraging. “I would worry more if the debate and decisions were being made behind closed doors.”

“What we’ve seen is fast progress on the city level, by some city governments controlled by the PT,” he takes inventory: “The cities of Recife, Porto Alegre and São Paulo are governed by the PT. Porto Alegre has had this for ten years. The PT has governed São Paulo and Recife, now, for two years. It is in these places that we’ve seen the fast growth of Harm Reduction policies, and the hope is that this can be repeated on the national level.”

Attorney General Márcio Thomaz Bastos receives proposals from Fábio Mesquita last January 30th in Brasilia. D.R. Marcello, Jr., Agência Brasil

“Of course,” notes Mesquita, “we had a very big expectation that the announcement of a change in drug policy would be made last December, before the new administration took office.”

There came a point, last January, when Mesquita and other advocates of a humane and democratic drug policy openly pressured the Lula government through the media. On January 20th, Mesquita wrote a column for the giant daily Folha de São Paulo, titled “And the Public Policy on Drugs?”

“Brazil has an important role internationally on this issue based on its policy and strategy of Harm Reduction,” wrote Mesquita. “That’s why we are waiting for President Luiz Inácio Lula da Silva to announce that the SENAD (the Brazilian drug czar’s office, will have “a civilian of the highest order and that he will begin the discussion with Brazilian society, with a basis in the experiences of the local PT governments and Civil Society, on what directions should be taken with the public drug policy in the country over the next four years. That’s why we hope for a strong, realistic, and humane policy will conquer over fear of the issue, the common view among Brazilians that feel helpless and impotent before such an important phenomenon in the life of the country.”

Ten days later, Mesquita was received by the new Attorney General, Márcio Thomaz Bastos, in Brasília, for a meeting in which the nation’s top law enforcer invited the press to come and photograph the two men together: a signal was thus sent; a signal that Bastos and Lula himself later began to concretize with their recent comments, and those of other administration officials, in favor of drug decriminalization.

“Lula has a program,” Mesquita, the 14-year-veteran of fighting for changes in drug policy, explains. “And it means a big change. We are very optimistic.”

Doctor Harm Reduction’s giant patient – the country of Brazil – is indeed getting better after its critical bout with a contagion named drug prohibition. But that doesn’t mean that Mesquita and his troops are letting their guard down.

The interview ends at 6:30 p.m. The city office building that is home to Mesquita’s base of operations has closed and locked the front door; the security guard in the lobby has already gone home, and to exit the building the reporters must go through the basement, through a mostly-empty underground parking garage, to get to the street. But in the STD-AIDS prevention office of Doctor Fábio Mesquita, the troops are still hard at work. Dozens of them have not yet left their posts on a Thursday night. For Mesquita and his team, this work is not merely a job; it is a mission. And even on the verge of potential victory, after the long march of so many years from repression to acceptance, this movement will not sleep until the long dark night of drug prohibition gives way to a new day in human history; the new day under construction, but already reaching high into the heavens… from below.

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