UCSF

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 country's 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.