In the center of the muddy courtyard beyond the plywood gate is a rusted-out car that three kids have turned into their playground. Outside, their mother and father meet with a pair of outreach workers. The man is an active heroin user; the woman hasn’t used drugs for several years. The workers ask them questions: Have the police been bothering you? Have you had this wound on your foot checked out? The group exchange jokes and words of encouragement, like friends helping each other out.
Before they leave, the outreach workers offer advice on how to stay safe while injecting drugs, then offer the man kits containing sterile needles, syringes, alcohol swabs and condoms. They also give him a few vials of naloxone, a medicine that can reverse fatal opioid overdose. Then, after saying their goodbyes, they return to the streets of Ciudad Juárez.
I witnessed versions of this scene play out over and over earlier this month while accompanying outreach workers from the organization Programa Compañeros. They were visiting with people who inject drugs — mostly men between 30 and 50 years old, many of whom were tenuously housed in makeshift shacks.
These visits occurred on the same day that President Trump delivered an Oval Office speech invoking the specter of drugs flooding into the U.S. as justification for building a border wall. It was a study in contrasts: The president spreading fear and misinformation, while just south of the border a dignified, street-level effort is under way to address drug use and help keep people healthy and safe.
Trump has asserted that a border wall is key to solving America’s drug and overdose problems, a claim that has little basis in fact. Synthetic opioids, primarily fentanyl, are the drugs most commonly involved in overdose deaths in the United States and the main source of these drugs is China. When drugs are smuggled from Mexico, it’s usually in cars, trucks and fishing boats at legal ports of entry — something a wall would do nothing to stop.
By comparison, harm reduction endeavors in Mexican border towns like Juárez and Tijuana have a long record of stopping deadly consequences of opioids and connecting people to life-saving treatment. Programa Compañeros’ approach, like that of other harm reduction organizations, involves peers working directly with vulnerable populations, including those at risk for or living with HIV/AIDS.
These workers teach people how to stay healthy and reduce harm to themselves, their peers and the broader community. It’s a strategy that emerges from an acknowledgment that abstinence-based approaches don’t work for many and that people can make positive and healthy decisions for themselves and others while still using drugs. Despite hardliners’ claims that such strategies encourage drug use, the evidence collected — from studies in the U.S. and across the globe — says this is not the case. Instead, these programs have been proven to reduce the spread of blood-borne infections and connect people to drug treatment programs.
Programa Compañeros case managers offer the people they work with strategies on how to adhere to medications, monitor their overall health status and seek medical care. They maintain community sites for collecting and distributing needles and run a clinic with an on-site physician, dentist, library, laundry and food services and child support.
Recently, they’ve partnered with another community organization to facilitate community inclusion and reconciliation between people who use and don’t use drugs in two Juarez neighborhoods.
The results of this practical, hands-on approach have been remarkable. A 2015 study found that over three-quarters of Programa Compañeros participants sought health care within one month of receiving an HIV diagnosis and in 99 percent of these cases the outreach workers were seen as instrumental in treatment enrollment. In addition, more than 90 percent of the participants felt that the outreach had improved their ability to care for themselves.
While Donald Trump’s focus on the border began with his presidential campaign, Programa Compañeros workers have been reducing the harms related to drug use — and the drug war itself — since 1988. The vast majority of these workers have used drugs themselves and bring with them a wealth of lived experience and empathy.
This is not to say that Juárez is peaceful. Just a week before I arrived, several people there had been beheaded by one of the cartels as a gruesome warning to those who would defy them. People who use drugs are increasingly targets of violence from organized criminal groups as well as from local law enforcement.
But while Programa Compañeros is working to increase safety, law enforcement approaches decrease it: multiple studies including ones from Juárez and Tijuana, have shown that rather than deter drug use, punitive and abusive police actions lead to increased and riskier drug use behaviors and practices.
As I accompanied the outreach workers, everyone maintained an almost tireless optimism, offering encouragement to others. In the face of violence and poverty, they demonstrated a spirit of survival and community. In the face of fatal overdose, they saved lives with naloxone.
On the streets of Juárez, it was clear that faith, connection and health care were far more powerful in addressing problems at the border than divisive political rhetoric and calls for steel or concrete barriers. While the U.S. president showboated on TV, the outreach workers emerged as heroes, saving lives without fanfare, one at a time.