The Startling Optimism of Harm Reductionists in the Philippines

    At dusk in Cebu City, the Philippines, Jonas takes the setting sun as a signal to wrap up his outreach work and get home quickly. The streets are not safe for people who use drugs at night.

    Jonas, who asked that his name be changed, is the co-founder of IDUCARE, the only harm reduction group run exclusively by drug users in the Philippines. In 2015, frustrated by traditional HIV prevention nonprofits that often ignored or shunned people who acquired HIV through drug use, Jonas left his comfortable nonprofit job to do direct harm reduction.

    “Drug users were dying of HIV and hepatitis C because they were afraid that if they got treatment, they would have to admit to using drugs and could be targeted by police,” Jonas told Filter in a phone interview.

    IDUCARE opened a drop-in center in Cebu City, an urban center of about 1 million in the Central Visayas region of the country. There, people could seek HIV and hepatitis C prevention care and treatment, as well as overdose education. More importantly, said Jonas, it was a place for drug users to feel safe and protected.

    He had no idea how much protection they were about to need.

    On June 30, 2016, mere months after IDUCARE opened its doors, the Philippines inaugurated a new president, Rodrigo Duterte. The populist politician swept into office on a violent platform of zero tolerance towards drugs.

    “Hitler massacred 3 million Jews [sic]. Now there is 3 million, what is it, 3 million drug addicts [in the Philippines],” he said in a Davao City speech. “I’d be happy to slaughter them.”

    And slaughter he did. After taking office, Duterte granted law enforcement de facto authorization to perform extrajudicial killings of suspected drug users or sellers. Since then, Philippine police and vigilantes have murdered over 27,000 people, according to the country’s most recent Commission on Human Rights report.

    From Cebu City, IDUCARE members watched with disbelief and then alarm as Duterte’s murderous war claimed tens of thousands of their peers.

    At first, “I thought he was just saying those things for attention,” admitted Jonas. “I never thought it would go this far.”

    Harm reduction work had always been risky in the Philippines. But once the drug war started, the work became deadly.

    They have faced harassment from police, confiscation of HIV medication and fear of the nightly killing sprees.

    IDUCARE staff began taking security precautions, such as doing outreach in teams and always going home before dark. They have faced harassment from police, confiscation of the HIV treatment medication they distribute, and always, fear of the nightly killing sprees that leave the bodies of suspected drug users sprawled across dark street corners.

    But no one has given up the work.

    “We are needed now more than ever,” said Jonas. “Most of our clients are our friends. It’s our community.”


    A Growing Coalition

    IDUCARE isn’t the only organization that has stepped up to challenge the drug war at great personal risk. In late 2017, Cathy Alvarez co-founded StreetLawPH, a group of lawyers pushing for drug policy reform in the Philippines. The group also provides legal support to vulnerable communities.

    Prior to co-founding StreetLawPH, Alvarez worked as a human rights lawyer. Speaking with me while we were both visiting Thailand, she said that she was forced to consider a new path not only by the carnage of Duterte’s drug war, but by some surprising reactions from the Philippines human rights community.

    “The stigma against people who use drugs is so strong that even within human rights there are people who don’t want to be involved with people who use drugs,” she told Filter. “Some groups will only provide legal assistance to victims’ families in the case of mistaken identity.”

    “I don’t know if I could look at myself in the mirror if I don’t do anything about what is happening.”

    Alvarez couldn’t turn a blind eye to the drug war. “We can’t just leave things as they are,” she said. “I try to take extra precautions, but I don’t know if I could look at myself in the mirror as a lawyer and human rights worker if I don’t do anything about what is happening.”

    StreetLawPH and IDUCARE are among a growing number of organizations in the Philippines working not only to stop the drug war and assist its victims, but to shift the conversation on drugs towards an evidence-based, compassionate, harm reduction approach.

    NoBox, a nonprofit based in Quezon City, a large suburb of the capital, Manila, advocates for drug policy reform at the national level. (Some of its team members were previously interviewed by Filter for a short film about their work.)

    Executive Director “Ma” Inez Feria says that the killings, which shocked the international community when they began in 2016, are still ongoing, even though media coverage has slowed. However, she told Filter that the sheer horror of the war has also created opportunities for more nuanced discussions on drugs.

    “NoBox has been around since 2014 and it was always difficult to engage people in that conversation [on drugs],” said Feria. “Now, more and more people are saying ‘Wait a minute, people are getting killed. This isn’t the way to go. But what do we do?’”

    NoBox, StreetLawPH, IDUCARE and other local NGOs, many of which started as a direct response to the drug war, are encouraging these conversations. Feria explained that during community trainings, members of NoBox try to help participants unpack their biases and stereotypes about people who use drugs.

    “We create space where people can openly discuss experiences and ask questions,” she said. “We put forth the framework on harm reduction and try to help them understand how to apply it to their own lives…There is hunger to understand and to have answers.”

    Even as the killings continue, efforts are underway to advocate for bills aimed at reducing some of the harms. These include reduced sentencing for low-level drug offenses, 911 Good Samaritan laws, and implementation of drug education that is honest and useful. As well as the NGOs, community groups and churches are also working to provide support for people who use drugs and to protect them from the killings.

    “If there is one good thing that has come out of all this it is that people have started talking more about drug use and drug policy,” said Alvarez. “We are working with organizations to help increase the voices of people who use drugs in places where decisions are being made. It sounds impossible now, but we are starting to plant those seeds.”

    “I think we will soon realize that the drug war didn’t succeed and the other choice is harm reduction.”

    Jonas is even more hopeful. Ultimately, “I think the war on drugs will make things better for drug users,” he said. “Before the drug war, no one even knew what harm reduction was. I think we will soon realize that the drug war didn’t succeed and the other choice is harm reduction.”


    Troubling Questions

    The startling optimism of many harm reductionists in the midst of the bloodiest drug war in history presents food for thought.  

    The story of Duterte’s drug war is one of human cruelty. Most articles about it understandably focus on the body count and repetition of the demagogue’s most heinous quotes.

    At the same time, many responses to the atrocities are inspiring examples of human courage. Across the island nation, people who use drugs and their allies are putting their lives at risk to do what is right. If Jonas’s rosy prediction comes true, and the drug war catalyzes a national shift towards harm reduction policies, a redemption of sorts could follow—though too late for the victims and their loved ones.

    But to me, the situation in the Philippines poses a troubling set of questions. Why do 27,000 people have to die before we can even begin to shift the conversation on drugs? Why do we only see other people after we hurt them?

    Is tragedy the only way to spark change?

    The story of tragedy as a catalyst for change is repeated over and over in human history. During the 1980s and ‘90s, thousands of people died of HIV/AIDS before the modern harm reduction movement was birthed. In the United States, the overdose crisis has been claiming tens of thousands per year for the past two decades, and the country is only just starting to consider alternatives to drug prohibition.

    “Sometimes it takes a negative experience to jar people out of their comfort zones,” said Alvarez. “A crisis makes us ask difficult questions like, ‘Why is this happening and what should we be doing about it?’”

    But is tragedy the only way to spark change? If we believe it is not, then how do we cultivate communities strong and kind enough to explore difficult issues before discrimination, oppression and murder take over?

    I don’t have the answers. But to me, these are the questions whispered across the graves of every drug-war victim in the Philippines and beyond. 

    Photo of a 2016 protest at the Philippines consulate in New York City by VOCAL-NY via Flickr/Creative Commons.

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