It seems that the lawmakers only went as far as the social conventions would allow (versus legalization). Based on research evidence, there are no reported changes in patterns of marijuana use in youth between states who have decriminalized marijuana and those that have not. Thus, it is questionable as a deterrent, at best. And, there are some reported major problems with decriminalization:
* It leaves the illegal supplier in place. This means more availability to the young makes use more dangerous, activates the “gateway,” and many of the other woes.
* It still entails law enforcement costs. Some indications from decriminalization trials in England are that many police are more willing to make stops when they know the offender won’t go to prison. There is no indication that this has decreased use. It’s a small source of revenue, but one unlikely to compensate for wasted police time and inconsequential when compared to potential sales taxes.
* It deprives the state of tax revenues. Potential revenue could be used for tax relief, education or treatment.
* It cannot make much difference in use. Above we saw that where decriminalization took place, the removal of what many thought was a deterrent had no apparent effect on use or attitudes. It is a shorter step in terms of theoretical deterrence to move to legalization. We stress that if some 75% have tried marijuana by age 22, there’s very little room for an increase of any consequence.
* It sustains the hypocrisy inherent in the double standard for alcohol. ((The Drug Policy Forum of Texas, n.d)
Drug users are considered intolerable in Latin America. Legal sanctions are used to deal with the problem, using such tactics as suppression and mandatory abstinence-based treatment. Most of the countries in Latin America have detailed drug laws and corresponding legislation. Until a short time ago, harm-reduction policies were totally disorganized and inefficient, and needle-exchange programs were rare (Weissennbacher, et al., 2000). With the exception of their effort to promote abstinence, few non-governmental organizations were involved in activities focused on prevention for drug users that inject. Still today, harm-reduction related events are essentially limited to Brazil and Argentina (Mesquita, et al., 2000) Infection control strategies in Brazil that are related to the use of psychoactive drugs is strongly supported by the Ministry of Health (Marques & Doneda, 1998). Beginning in 1997 the Southern Cone, which is comprised of such areas as Argentina, Chile, and Paraguay, analytical findings and interventions related to HIV in injecting drug users began. In Buenos Aires, the non-governmental organization, Intercambios, created a quick assessment and response study, and characterized community interventions with the first needle exchange program in Argentina (Touze et al., 1999). The non-governmental organization, International Disaster Emergency Service (I.D.E.S), created a study to ascertain substance use and sex information, attitudes and practices in Uruguay (Latorre, Osimani, & Scarlatta, 1999). In Paraguay, PREVER, a non-governmental organization, contacted drug users who reported injecting drugs up to ten times a day. Of those that were contacted, PREVER found that 15 percent were HIV positive and/or reported engaging activities that are considered high risk (ONUSIDA-PREVER, 1999).
According to the online journal article, HIV and Drug Injection Use in Latin America,
“In 2000, the regional project ‘HIV Prevention among Injecting Drug Users in the Southern Cone’ began with the participation of NAP and non-governmental organization from each country. Its objective is the adoption of legal instruments that can facilitate prevention activities. It hopes to sensitize journalists and policy- makers, promote access to healthcare networks for injection drug users, promote research and intervention projects, and involve communities in interventions, particularly drug users and their networks. Argentina implemented preventative interventions that included syringe and condom distribution. In addition, it developed a seroprevalence study for HIV and hepatitis B and C. Chile developed a rapid assessment and response study and educational activities for communities and injection drug users. Paraguay worked to plan interventions in prisons. Uruguay began an ethnographic study of IDU, and surveyed the healthcare services available to drug users and HIV-positive individuals. All projects trained healthcare professionals. In 2002, the United Nations Office for Drug Control and Crime Prevention (UNDCP) and UNAIDS are HIV and injection drug use in Latin America supporting the second phase, integrating Brazil into its activities” (Rodriguez, Dec. 2002, p.S37)
In spite of its shared culture, South America is comprised of great diversity. The area is home to economies that range from weak, like that of Bolivia, to very strong economic countries like Argentina and Brazil. Even within the more developed countries, deep societal and regional disproportions are noticeable (Hacker, Malta, Enriquez, & Bastos, 2005) and have had an effect on responses to the HIV/AIDS epidemic on a local and national level, resulting both astounding success and regrettably slow advancement. Until recently, legal sanctions were used to handle the problems that arose with substance abuse.
Despite the successful of many initiatives, the harmful use of illicit drugs, especially cocaine, has been on the rise in different parts of South America, and has been associated with the spread of HIV/AIDS and other sexually transmitted and blood-borne infections. The situation is of special concern in southern Brazil (Pechansky et al., 2006) and the Southern Cone (i.e. Argentina and Uruguay). While injecting drug is a well known major risk factor for hepatitis C and HIV infections, non-injecting drug use has been described as a risk factor for both infections, with consistent findings of higher prevalence of HIV and Hepatitis C infection among non-injecting cocaine users than in the general population (Caiaffa et al., 2006; Howe et al., 2005). The harms and risks associated with non-injecting drug use have been seldom targeted by integrated harm reduction initiatives in South America.
Colombia is the world’s leading coca cultivator and largest producer of coca derivatives; supplying most of the US market and the great majority of cocaine to other international drug markets (Thoumi, 2003). A recent report by Stimson et al. (2006) evaluated the impact of the World Health Organization’s rapid assessment and response method in several settings, including in Bogota. According to the study, Colombia does not have government programs aimed at preventing health problems in drug using and specifically drug injecting populations. The authors identified three main gaps in the available interventions targeting drug using population in Colombia: (1) need to develop policies and actions to prevent transition to injecting drug user and address the risks involved in injecting drug user; (2) need to develop educational and preventive policies addressing specific problems and gaps in information levels and risk perceptions of drug users; (3) need to develop programs and actions to reduce the adverse health consequences of drug use.
In Uruguay, around 80% of drug treatment centers are private and strictly oriented toward abstinence (Osimani, 2003). During 2000, UNAIDS and UNDCP developed a project in Argentina, Chile, Paraguay and Uruguay to foster a broader response to HIV/AIDS and drug use in the Southern Cone countries. The project funded a series of activities in the fields of prevention and care for drug users and vulnerable populations; awareness creation for the general public as well as for specific groups; research in the four countries under a common approach developed jointly with governmental institutions, non-governmental organizations, UNAIDS and UNDCP (Riley, 2003). In 2001, IDES organized an intervention program targeting the injecting and non-injecting drug users and their sexual partners who frequented a high-risk neighborhood. The intervention provided training, information materials, and condoms, but did not provide injection paraphernalia, since there is no legal support for such an activity in Uruguay. To the best of my knowledge, until now, Uruguay does not provide sterile syringes and needles to injecting drug users, regardless of the growing injecting drug user population accessed by researches and interventions targeting general drug using population.
Brazilian HIV/AIDS prevention and drug policies have had a significant impact upon activities in most countries of South America. The first effort to implement harm reduction policies in Brazil occurred in the city of Santos in 1989. Needle exchange initiatives were interpreted as a means to “stimulate the consumption of drugs”. The first syringe exchange program in South America was implemented in Salvador, Bahia, in 1994, 5 years after that first abortive effort (Fonseca, Ribeiro, Bertoni, & Bastos, 2006). The drug scene in Brazil is experiencing substantial changes, but the current drug of choice among the Brazilian injecting drug users population is still cocaine (Cintra, Caiaffa, & Mingoti, 2006) with recent increases in the use of both cocaine powder and crack alongside newer synthetic drugs (Almeida & Silva, 2005) and the further spread of more traditional forms of drug use such as solvent sniffing (Thiesen & Barros, 2004).
The HIV/AIDS epidemic has been especially dynamic in Brazil. After a period of continuous spread of HIV among the so-called “general population” (although with a clear bias toward the dispossessed) since the mid-1990s, the epidemic is currently following a pattern we can tentatively call “partial (re)concentration”. Some particularly vulnerable populations, far from the mainstream social groups who possess greater capacity for mobilization and advocacy, have been especially affected. The spread of HIV/AIDS to these more vulnerable groups such as men who have sex with other men (MSM)-injecting drug users, women-injecting drug users and injecting drug users living in dire poverty are relatively invisible to lay opinion, the media and many policymakers, but they will be especially disadvantaged because of social inequality, gender inequality and homophobia (Cardoso, Caiaffa, & Mingoti, 2006). Preliminary compilations of available information indicate that more than one hundred syringe exchange programs currently operate within Brazil in different regions, states and municipalities. These programs are being implemented by universities, governmental institutions, such as health secretaries and non-governmental organizations (Fonseca et al., 2006). No other South American country has officially endorsed syringe exchange programs, other than those implemented in Argentina. Despite funding restrictions and lack of managerial expertise of most syringe exchange programs, support for harm reduction initiatives is growing in Brazil. Advocacy activities and lobbying have helped to pass several state laws permitting the implementation of syringe exchange programs and similar activities. A recent evaluation of Brazilian syringe exchange programs operation was conducted in 2004/2005. The study reported that the 45 Brazilian syringe exchange programs evaluated usually face coverage and monitoring difficulties and struggle to find and maintains trained personnel, as the majority of Brazilian needle exchange programs personnel work on a part-time basis. In order to improve harm reduction initiatives in Brazil, the authors highlight the need to develop local and regional databanks, conduct regular monitoring and evaluation studies and develop incentives/sanctions to foster accountability of initiatives (Fonseca et al., 2006).