Its staggeringly big business in Spain, where demand is being met by traffickers. Can a groundbreaking team turn the tide?
On a sunny morning in Madrid, two young women duck down a side street, into a residential block and up to an apartment front door. Then they start knocking. Marcella and Maria spend a lot of time banging on doors and yelling through letterboxes all over the city. Most of the time, these doors never open. When they do, the two women could find themselves in trouble. Their job on the frontline of Spains fight against sex trafficking is a dangerous one; both have been assaulted and threatened. Yet they keep on knocking, because they have been on the other side of those doors, forced to sell their bodies for a handful of euros, dozens of times a day, seven days a week.
To say that prostitution is big business in Spain would be a gross understatement. The country has become known as the brothel of Europe, after a 2011 United Nations report cited Spain as the third biggest capital of prostitution in the world, behind Thailand and Puerto Rico. Although the Spanish Socialist party, which two weeks ago won another term in government, has promised to make it illegal to pay for sex, prostitution has boomed since it was decriminalised here in 1995. Recent estimates put revenue from Spains domestic sex trade at $26.5bn a year, with hundreds of licensed brothels and an estimated workforce of 300,000.
Supporters of decriminalisation claim it has brought benefits to those working in the trade, including making life safer for women. Yet this vastly profitable and largely unregulated market has also become infested with criminality, turning Spain into a global hub for human trafficking and sexual slavery.
Prostitution becomes sex trafficking when one person moves, detains or transports someone else for the purpose of profiting from their prostitution using fraud, force or coercion. In the UK, thousands of women are thought to be trapped in sexual servitude, but the scale of the problem in Spain is staggering. Until 2010, the law didnt even recognise human trafficking as a crime. Now the Spanish government estimates that up to 90% of women working in prostitution could be victims of trafficking or under the control of a third party such as a pimp who is profiting from them. Between 2012-2016, security forces in Spain rescued 5,695 people from slavery but acknowledge that thousands more remain under the control of criminals.
Since it passed its first anti-trafficking laws in 2010, the government has been scrambling to get on top of this crisis, spending millions of euros on an emergency plan to target the individuals and gangs operating with impunity. In 2015, it went further and created formal alliances between security forces, prosecutors, judges and NGOs, to rescue victims and prosecute the perpetrators. Survivors such as Maria and Marcella now find themselves playing a crucial part in bringing the battle to the criminals who once sold and exploited them. But can Spains new alliance of defenders really turn the tide against the traffickers?
I meet Maria and Marcella, both in their mid-20s, in the offices of Apramp, an organisation set up to protect, reintegrate and assist women in prostitution. Apramp helped them escape their traffickers, and they are now among its outreach workers. Their day job is to identify potential trafficking victims and try to offer them a way out. They find women they think might need help on the streets, in hostess clubs, and in some of the 400 residences they say are operating as informal brothels in Madrid.Read More
The chef and TV presenter talked about revolution, parenting, abuse and Trump voters in what is believed to be the last interview before his death
Anthony Bordains final interview has shed light on the chefs thoughts on travel, culture and politics. The piece, which surfaced on independent publication Popula on Sunday, includes Bourdains takes on Bill Clintons behaviour in office, Obamas performance as US president and his own daydreams about the demise of Harvey Weinstein (Bourdains partner, Asia Argento, was one of the first to accuse the former movie mogul of rape).
But Bourdain also spoke about other things, such as the joy that comes from friendship, and how to think about parenting. Here are some of the highlights:
I much prefer people who just showed up in Paris and found their own way without any particular itinerary, who left themselves open to things happening. To mistakes because thats the most important part of travel.
On talking to strangers
You go to a place like Beirut and you find yourself talking to a Muslim woman. If youre a journalist tasked with an agenda, you know, youre there to report a story, and you come right out with it. Youre going right into some very difficult areas. Whereas I have the luxury, Im there to eat! Presumably. Im there to eat, and Im asking very simple questions.
What makes you happy? What do you like to eat, where do you like to go to get a few drinks; you know? What do you miss about the place when you go away? And I find, again and again, just by spending the time, by asking very simple questions, people have said the most astonishing things to me. Often things that would be very uncomfortable for them outside of that casual context.
I know very much what wont make me happy. The perfect car will not make me happy. The perfect house will probably make me sad, and terrified
Im a renter by nature. I like the freedom to change my mind about where I want to be in six months, or a year. Because Ive also found you might have to make that decision you cant always make that decision for yourself.
My happiest moments on the road are always off-camera, generally with my crew, coming back from shooting a scene and finding ourselves in this sort of absurdly beautiful moment, you know, laying on a flatbed on those things that go on the railroad track, with a putt-putt motor, goin across like, the rice paddies in Cambodia with headphones on this is luxury, because I could never have imagined having the freedom or the ability to find myself in such a place, looking at such things.
To sit alone or with a few friends, half-drunk under a full moon, you just understand how lucky you are; its a story you cant tell. Its a story you almost by definition, cant share. Ive learned in real time to look at those things and realise: I just had a really good moment.
On cycles of abuse
You know a lot of the chefs, all of the really bastard chefs, most the really oppressive ones, the old school ones, were abused children, were abused by their parents, were abused and neglected, physically, mentally, in every possible way, and then became just like their abuser, and would perpetuate the system.
A lot of chefs never really understood, or understood only really belatedly; theyd been powerless for much of their careers. I dont know. For most of my career, chefs were creatures without power. To talk about power imbalance, is in retrospect, there was one. But I think we all saw ourselves at outcasts, as weak, except in our little bubble in the kitchen.
On Trump voters
The contempt and the ridicule which has been heaped on places like West Virginia, which is the heart, demographically, of enemy territory, as far as New York liberals like us are concerned This is something we fucked up in the sixties. We were fighting against cops and construction workers cops and construction workers were exactly who we fucking needed! They were the first to die, in Vietnam. We werent gonna!
Somebody at the White House press briefing has to sacrifice their job and say: You utter piece of shit! Do you really expect us to swallow that steaming load of horseshit? How do you live with yourself? You should be ashamed. Give me one guy to throw themselves on a fire like that, lose access, lose the gig at the White House, for that infinitely repeatable meme. Give me that. Just give me that. Someone to stand up.
On not being an artist
From the very beginning Ive always and only made the television I wanted to make, and as soon as I could I told whoever was involved to go fuck themselves, and somehow landed on my feet someplace else, with somebody who was willing to indulge me in even grander fashion. So I havent had to deal with the grim reality of well, you either do the Best Burgers in America show, or you have no work at all! I havent had to live with that. I havent had to be particularly nice to people I dont like. Ever.
We cannot choose the leaders of our revolutions, theyre all deeply flawed and they will all all revolutions will be corrupted
The minute everybody in the room agrees with you, youre in a bad place, so Im a big believer in change just for its own sake, just to show that you can change, to move forward incrementally, but aint nobody gonna make everything better. Whoever has the intestinal fortitude or the megalomaniac instincts sufficient to lead any kind of a revolution will inevitably disappoint horribly.
The best revolutionaries of course are martyrs who died before they could turn into disgusting, self-serving, corrupt pieces of shit. As they all do.
Asia [Argento] said this to me: children create themselves independently of us. All you can do is show, like in my case, my daughter feels loved. She knows shes loved. She has good self-esteem. Very important. And good martial arts skills. So she knows she can take any boy in her age group. Thats all I can do as a father I cant pick her music, her boyfriends, whatever, however shes going to turn out. I can give her these basic things.
On the imagined death of Harvey Weinstein
My theory of how he goes is uh, hes brushing his teeth in a bathroom, hes naked in his famous bathrobe, which is flapping open, hes holding his cell phone in one hand because you never know who on the Weinstein board has betrayed him recently, and hes brushing his teeth he suddenly gets a massive fucking stroke he stumbles backwards into the bathtub, where he finds himself um, with his robe open feet sticking out of the tub, and in his last moments of consciousness as he scrolls through his contacts list trying to figure out who he can call, who will actually answer the phone.
And he dies that way, knowing that no one will help him and that he is not looking his finest at time of death.Read More
White gangs are less covered by the media and less punished even though 53% of gang members in Mississippi are white
When he was 13, three white teenage boys beat Benny Ivey. They aimed for his chest as his back pressed against the wall of his friends house in Florence, Mississippi. The skinny blond adolescent had to show he was tough enough to become a Black Gangster Disciple.
It was 1989, the height of the crack era, and many white kids wanted to join black gangs that did not welcome them, so they initiated each other into home-grown copycat versions.
Ivey lived in a trailer park, and the thought of wearing the gangs colors black and blue made him excited to be part of something beyond his chaotic family.
None of them knew the first thing about being in a gang, and yet many kids lusted after it, even some wholived in nice homes with their families, Ivey says now. Others grew up like he did: the child of poor crack and opioid addicts, ripe to be ensnared by a world promising brotherhood, loyalty and respect.
Iveys future was not in a black organization, however it was in one of the oldest and largest white gangs in the US, the Simon City Royals.
A lot of us were raised in the pits, and thats where almost all gang life begins, he says.Read More
The long read: Decades worth of research proves that chemicals used to make bacon do cause cancer. So how did the meat industry convince us it was safe?
There was a little cafe I used to go to that did the best bacon sandwiches. They came in a soft and pillowy white bap. The bacon, thick-cut from a local butcher, was midway between crispy and chewy. Ketchup and HP sauce were served in miniature jars with the sandwich, so you could dab on the exact amount you liked. That was all there was to it: just bread and bacon and sauce. Eating one of these sandwiches, as I did every few weeks, with a cup of strong coffee, felt like an uncomplicated pleasure.
And then, all of a sudden, the bacon sandwich stopped being quite so comforting. For a few weeks in October 2015, half the people I knew were talking about the news that eating bacon was now a proven cause of cancer. You couldnt miss the story: it was splashed large in every newspaper and all over the web. As one journalist wrote in Wired, Perhaps no two words together are more likely to set the internet aflame than BACON and CANCER. The BBC website announced, matter-of-factly, that Processed meats do cause cancer, while the Sun went with Banger out of Order and Killer in the Kitchen.
The source of the story was an announcement from the World Health Organization that processed meats were now classified as a group 1 carcinogen, meaning scientists were certain that there was sufficient evidence that they caused cancer, particularly colon cancer. The warning applied not just to British bacon but to Italian salami, Spanish chorizo, German bratwurst and myriad other foods.
Health scares are ten-a-penny, but this one was very hard to ignore. The WHO announcement came on advice from 22 cancer experts from 10 countries, who reviewed more than 400 studies on processed meat covering epidemiological data from hundreds of thousands of people. It was now possible to say that eat less processed meat, much like eat more vegetables, had become one of the very few absolutely incontrovertible pieces of evidence-based diet advice not simply another high-profile nutrition fad. As every news report highlighted, processed meat was now in a group of 120 proven carcinogens, alongside alcohol, asbestos and tobacco leading to a great many headlines blaring that bacon was as deadly as smoking.
The WHO advised that consuming 50g of processed meat a day equivalent to just a couple of rashers of bacon or one hotdog would raise the risk of getting bowel cancer by 18% over a lifetime. (Eating larger amounts raises your risk more.) Learning that your own risk of cancer has increased from something like 5% to something like 6% may not be frightening enough to put you off bacon sandwiches for ever. But learning that consumption of processed meat causes an additional 34,000 worldwide cancer deaths a year is much more chilling. According to Cancer Research UK, if no one ate processed or red meat in Britain, there would be 8,800 fewer cases of cancer. (That is four times the number of people killed annually on Britains roads.)
The news felt especially shocking because both ham and bacon are quintessentially British foods. Nearly a quarter of the adult population in Britain eats a ham sandwich for lunch on any given day, according to data from 2012 gathered by researchers Luke Yates and Alan Warde. To many consumers, bacon is not just a food; it is a repository of childhood memories, a totem of home. Surveys indicate that the smell of frying bacon is one of our favourite scents in the UK, along with cut grass and fresh bread. To be told that bacon had given millions of people cancer was a bit like finding out your granny had been secretly sprinkling arsenic on your morning toast.
Vegetarians might point out that the bacon sandwich should never have been seen as comforting. It is certainly no comfort for the pigs, most of whom are kept in squalid, cramped conditions. But for the rest of us, it was alarming to be told that these beloved foods might be contributing to thousands of needless human deaths. In the weeks following news of the WHO report, sales of bacon and sausages fell dramatically. British supermarkets reported a 3m drop in sales in just a fortnight. (It was very detrimental, said Kirsty Adams, the product developer for meat at Marks and Spencer.)
But just when it looked as if this may be #Bacongeddon (one of many agonised bacon-related hashtags trending in October 2015), a second wave of stories flooded in. Their message was: panic over. For one thing, the analogy between bacon and smoking was misleading. Smoking tobacco and eating processed meat are both dangerous, but not on the same scale. To put it in context, around 86% of lung cancers are linked to smoking, whereas it seems that just 21% of bowel cancers can be attributed to eating processed or red meat. A few weeks after publishing the report, the WHO issued a clarification insisting it was not telling consumers to stop eating processed meat.
Meanwhile, the meat industry was busily insisting that there was nothing to see here. The North American Meat Institute, an industry lobby group, called the report dramatic and alarmist overreach. A whole tranche of articles insisted in a commonsense tone that it would be premature and foolish to ditch our meaty fry-ups just because of a little cancer scare.
Nearly three years on, it feels like business as usual for processed meats. Many of us seem to have got over our initial sense of alarm. Sales of bacon in the UK are buoyant, having risen 5% in the two years up to mid-2016. When I interviewed a product developer for Sainsburys supermarket last year, she said that one of the quickest ways to get British consumers to try a new product now was to add chorizo to it.
And yet the evidence linking bacon to cancer is stronger than ever. In January, a new large-scale study using data from 262,195 British women suggested that consuming just 9g of bacon a day less than a rasher could significantly raise the risk of developing breast cancer later in life. The studys lead author, Jill Pell from the Institute of Health and Wellbeing at Glasgow University, told me that while it can be counterproductive to push for total abstinence, the scientific evidence suggests it would be misleading for health authorities to set any safe dose for processed meat other than zero.
The real scandal of bacon, however, is that it didnt have to be anything like so damaging to our health. The part of the story we havent been told including by the WHO is that there were always other ways to manufacture these products that would make them significantly less carcinogenic. The fact that this is so little known is tribute to the power of the meat industry, which has for the past 40 years been engaged in a campaign of cover-ups and misdirection to rival the dirty tricks of Big Tobacco.
How do you choose a pack of bacon in a shop, assuming you are a meat eater? First, you opt for either the crispy fat of streaky or the leanness of back. Then you decide between smoked or unsmoked each version has its passionate defenders (I am of the unsmoked persuasion). Maybe you seek out a packet made from free-range or organic meat, or maybe your budget is squeezed and you search for any bacon on special offer. Either way, before you put the pack in your basket, you have one last look, to check if the meat is pink enough.
Since we eat with our eyes, the main way we judge the quality of cured meats is pinkness. Yet it is this very colour that we should be suspicious of, as the French journalist Guillaume Coudray explains in a book published in France last year called Cochonneries, a word that means both piggeries and rubbish or junk food. The subtitle is How Charcuterie Became a Poison. Cochonneries reads like a crime novel, in which the processed meat industry is the perpetrator and ordinary consumers are the victims.
The pinkness of bacon or cooked ham, or salami is a sign that it has been treated with chemicals, more specifically with nitrates and nitrites. It is the use of these chemicals that is widely believed to be the reason why processed meat is much more carcinogenic than unprocessed meat. Coudray argues that we should speak not of processed meat but nitro-meat.Read More
The long read: Crime families have cashed in on the refugee industry
Joy, a young Nigerian woman, was standing in the street outside the sprawling, overcrowded Cara di Mineo reception centre for asylum seekers in central Sicily, waiting for someone to pick her up when I met her. It was late summer 2016, and the weather was still hot. She said she was 18, but looked much younger. She was wearing a faded denim jacket over a crisp white T-shirt and tight jeans, and six or seven strings of colourful beads were wrapped around her neck. A gold chain hung from her left wrist, a gift from her mother.
As we spoke, a dark car came into view and she took a couple of steps away from me to make sure whoever was driving saw her, and saw that she was alone. There were a handful of other migrants loitering along the road. The approaching car didnt slow down, so Joy came back over to me and carried on our conversation.
The oldest of six children, Joy (not her real name) told me she had left her family in a small village in Edo state in Nigeria at the age of 15, and gone to work for a wealthy woman who owned a beauty salon in Benin City. She had since come to suspect that her parents had sold her to raise money for their younger children. They probably had no choice, she said as she looked down the road toward the thick citrus groves that hid the coming traffic.
There were six other girls who worked for the woman, whom Joy said they called their maman, meaning mother. When Joy turned 16, she went through a ceremony that bound her to the mamanby a curse: if she disobeyed the maman, her family would die. A few weeks later, she was told she was moving to Italy, where she would work for her mamans sister. She believed she would be working in a hair salon. She was given 45 (40) and a phone number to call once she got to Italy but no name, no address, and no documents.
Joys new life would turn out to be nothing like what she had expected. Instead of working for a hairdresser, she fell into the trap set by traffickers who lure women into slavery and prostitution. More than 80% of women brought to Europe from Nigeria are unknowingly sponsored by sex traffickers who have paid for their journey, according to the International Organization for Migration (IOM). The rest will have paid the smugglers to get them to Europe, but once they get there, will be unlikely to escape the sex-trafficking rings.
After an appalling journey, via Tripoli, which took nearly three weeks, Joy arrived at the port of Augusta on Sicilys east coast. She had no papers or passport. All she had was an Italian phone number, which her maman had stitched into the sleeve of her jacket. When the migrants got off the boat, an armed military policeman in a bulletproof vest stood guard as another patted them down and took knives from some of the men. Those with documents were taken to a large tent lined with army cots. One woman handed out shoes and flip-flops, and another gave them bruised yellow apples from a large metal tub. An officer used a black marker pen to write a number on the migrants left hands. Joy was number 323.Read More
The youngsters at Cal Farleys Ranch in Texas were subjected to years of abuse. But the institutions feeble response has been a slap in the face to survivors
Steve Smith was just eight when his mother left him in the care of Cal Farleys Boys Ranch, a Texas institution for at-risk children. From the moment he got there in 1959, the place didnt sit right with him.
I cried probably more than any boy that I know that came out [of] there, just homesick, and I didnt take it very well.
Almost immediately upon his arrival, Steve was subject to the first of many beatings. For the following decade, he endured regular and arbitrary violence at the hands of staff. He also had to watch helplessly as his younger brother, Rick, was beaten by adults until he couldnt stand.
Along with the physical punishment, Steves pets were killed, and his friends were worked to the bone in atrocious conditions. Some boys, including Rick Smith, were also sexually abused while under the care of the ranch.
The ordeal has permanently damaged their lives.
At the kitchen table in his immaculate home in the Amarillo suburbs, Steve, now almost 70, goes through all of the details of what happened to him without showing much pain. Hes a tough man he served in the Vietnam war and was wounded in the line of duty and his piercing blue eyes only sprout tears twice.
The first time is when he describes how a succession of dogs he owned, all called Boots, were killed by staff members. The other is when he talks about what happened to his younger brother Rick, and how powerless he was to help him.
Rick, Steve, and six other men the Guardian spoke to named staff members responsible for the abuse, which lasted from the 1950s until at least the early 1990s. They say the abuse went beyond them, and was systemic, affecting hundreds of others who went through the ranch.
They say Lamont Waldrip, a long-serving superintendent, was one of the worst abusers. Last month, at the behest of a wealthy donor who wrote a cheque for $1m to build a new dormitory, the ranch named the new building Waldrip House.
The ranchs current CEO, Dan Adams, acknowledged the weight of the accusations against Waldrip, who died in 2013, but he said that other boys had had very different experiences with him and admired and liked him.
For the survivors who want to make the ranch accountable for the abuse and have been encouraged to break their silence after Steve Smith brought them together in a Facebook group this is an unbearable affront.
A very wealthy ranch and a revoltRead More
Unravelling the central mystery of my childhood taught me the uncomfortable truth about toxic male behavior and what I, as a man, must do about it
Ive fallen out of touch with a lot of childhood friends, but how it happened with my Christie was different more sudden, and at the time, inexplicable.
Christie was my best friend. Her mother, Suzanne, was my mothers best friend since high school. In adulthood, they would get together for coffee once a week. I can still remember the times I spent listening to both of them hold forth on politics and relationships at the kitchen table while Christie and I would play hide and seek.
But one day, Suzanne stopped returning my mothers calls. Christie stopped coming over too.
My mom struggled with depression and it was a hard blow for her. I was always protective of her growing up, and I remember feeling angry, blindsided and hurt. Christie was my best friend, after all.
After a long decline from early-onset dementia, my mother died two years ago. She and Suzanne had never reconciled.
A year later, my half-brother Todd died at the age of 52 from a heroin overdose.
When I was in town for Todds funeral, Christie got in touch and soon afterward, her mother invited me over for dinner. And over glasses of beer and wine, Suzanne told me a series of painful truths that helped unravel one of the central mysteries of my childhood.
In the same conversation, I learned that my brother was a sexual predator, and that my mother was a rape victim.
Suzanne told me that Todd and a group of his friends had sexually assaulted Christies half-sister, Denise, in our home. Denise would have been about 11 at the time.
Suzanne couldnt bring herself to tell my mom because my mom was fragile, dealing with continuous conflict between my father and my two half-brothers, and had herself been raped as a teenager by an ex-boyfriend.
Not knowing what to do, she decided to cut ties and stopped talking to my mother. Christie, meanwhile, said she felt pressured at the time into not talking to me.
After our conversation, I felt numb for days. I pushed it to the back of my mind and did nothing for months. But then the Harvey Weinstein scandal broke out.
It prompted me to asked myself some hard questions. There have been women in my life I could have treated better, and missed occasions where I could have stepped up to the plate to be a better man.
Then I thought about my mother, who started a feminist book club when I was a child; womens rights were important to her. What Suzanne had told me that my mom had been raped, and that her parents refused to believe her or act on it made sense to me, and I was able to confirm parts of it by talking to her sisters. What could I, as a man, do to seek a small amount of justice for the women in my life?
Ultimately, it was a tweet from @sansdn, a feminist Twitter user in Sydney, Australia, that spurred me to action.
I decided to do just that.
First, I spoke to a few of Todds friends. I didnt tell them about Denises story, but asked if they could share anything about Todds relationship with women when he was young.
One friend jokingly told a story about how his girlfriend woke one morning after a party to find Todd on top of her, and that he had to pull Todd off her. Man, Todd could be crazy! he said, thinking Id laugh with him.
In his book The Macho Paradox, Jackson Katz argues that sexual assault is a mens issue. Men commit the vast majority of rapes, and men have a special responsibility to hold both themselves and other men accountable for how they treat women and girls.
Men have to think about what role they play, and how they can use whatever platform of influence they have to make it unacceptable for men to act out in sexist and harmful ways, Katz told me. Not because they are nice guys, helping out the women, but because they have a responsibility as men in a sexist society. If they dont speak out, and they dont use whatever influence they have, then in a sense they are part of the problem.
But, as San pointed out, its all-too-easy to do that in a tweet or a Facebook post, when the man in question is a celebrity who is being publicly shamed.
The real work begins where you can have most impact closer to home.
And so I reached out to Denise, and she told me that she wanted to tell her story. As she would explain to me later, she wanted other victims to know about the importance of speaking up quickly about sexual assault so they can find the support they need.
We agreed to meet in person at her home in the western suburbs of Philadelphia, not far from where I grew up.
It was time to go home again. I caught a flight the next day.
Whenever we threw cookouts at our home, the adults would gather at the backyard patio, while the kids would go off and play, sometimes in Todds room in the basement.
Denise isnt sure exactly how old she was when it happened, but as far as he can remember, Todd was about 15, and she was 11 or 12. She knew Todd and his friends, and trusted them. She recalls Todd as the leader when a group of his friends encircled her and pinned her to a chair.
I didnt know what to do. It was very scary. All I see is me on the chair and all their hands everywhere on me, Denise told me. I dont hear what theyre saying. I got to the point where I was actually gonna threaten to spit on them. They didnt like that, but then I thought I cant really spit on them cause then theyll get mad at me, so again I felt powerless.Read More
The long read: Since it decriminalised all drugs in 2001, Portugal has seen dramatic drops in overdoses, HIV infection and drug-related crime
When the drugs came, they hit all at once. It was the 80s, and by the time one in 10 people had slipped into the depths of heroin use bankers, university students, carpenters, socialites, miners Portugal was in a state of panic.
lvaro Pereira was working as a family doctor in Olho in southern Portugal. People were injecting themselves in the street, in public squares, in gardens, he told me. At that time, not a day passed when there wasnt a robbery at a local business, or a mugging.
The crisis began in the south. The 80s were a prosperous time in Olho, a fishing town 31 miles west of the Spanish border. Coastal waters filled fishermens nets from the Gulf of Cdiz to Morocco, tourism was growing, and currency flowed throughout the southern Algarve region. But by the end of the decade, heroin began washing up on Olhos shores. Overnight, Pereiras beloved slice of the Algarve coast became one of the drug capitals of Europe: one in every 100 Portuguese was battling a problematic heroin addiction at that time, but the number was even higher in the south. Headlines in the local press raised the alarm about overdose deaths and rising crime. The rate of HIV infection in Portugal became the highest in the European Union. Pereira recalled desperate patients and families beating a path to his door, terrified, bewildered, begging for help. I got involved, he said, only because I was ignorant.
In truth, there was a lot of ignorance back then. Forty years of authoritarian rule under the regime established by Antnio Salazar in 1933 had suppressed education, weakened institutions and lowered the school-leaving age, in a strategy intended to keep the population docile. The country was closed to the outside world; people missed out on the experimentation and mind-expanding culture of the 1960s. When the regime ended abruptly in a military coup in 1974, Portugal was suddenly opened to new markets and influences. Under the old regime, Coca-Cola was banned and owning a cigarette lighter required a licence. When marijuana and then heroin began flooding in, the country was utterly unprepared.
Pereira tackled the growing wave of addiction the only way he knew how: one patient at a time. A student in her 20s who still lived with her parents might have her family involved in her recovery; a middle-aged man, estranged from his wife and living on the street, faced different risks and needed a different kind of support. Pereira improvised, calling on institutions and individuals in the community to lend a hand.
In 2001, nearly two decades into Pereiras accidental specialisation in addiction, Portugal became the first country to decriminalise the possession and consumption of all illicit substances. Rather than being arrested, those caught with a personal supply might be given a warning, a small fine, or told to appear before a local commission a doctor, a lawyer and a social worker about treatment, harm reduction, and the support services that were available to them.
The opioid crisis soon stabilised, and the ensuing years saw dramatic drops in problematic drug use, HIV and hepatitis infection rates, overdose deaths, drug-related crime and incarceration rates. HIV infection plummeted from an all-time high in 2000 of 104.2 new cases per million to 4.2 cases per million in 2015. The data behind these changes has been studied and cited as evidence by harm-reduction movements around the globe. Its misleading, however, to credit these positive results entirely to a change in law.
Portugals remarkable recovery, and the fact that it has held steady through several changes in government including conservative leaders who would have preferred to return to the US-style war on drugs could not have happened without an enormous cultural shift, and a change in how the country viewed drugs, addiction and itself. In many ways, the law was merely a reflection of transformations that were already happening in clinics, in pharmacies and around kitchen tables across the country. The official policy of decriminalisation made it far easier for a broad range of services (health, psychiatry, employment, housing etc) that had been struggling to pool their resources and expertise, to work together more effectively to serve their communities.
The language began to shift, too. Those who had been referred to sneeringly as drogados (junkies) became known more broadly, more sympathetically, and more accurately, as people who use drugs or people with addiction disorders. This, too, was crucial.
It is important to note that Portugal stabilised its opioid crisis, but it didnt make it disappear. While drug-related death, incarceration and infection rates plummeted, the country still had to deal with the health complications of long-term problematic drug use. Diseases including hepatitis C, cirrhosis and liver cancer are a burden on a health system that is still struggling to recover from recession and cutbacks. In this way, Portugals story serves as a warning of challenges yet to come.
Despite enthusiastic international reactions to Portugals success, local harm-reduction advocates have been frustrated by what they see as stagnation and inaction since decriminalisation came into effect. They criticise the state for dragging its feet on establishing supervised injection sites and drug consumption facilities; for failing to make the anti-overdose medication naloxone more readily available; for not implementing needle-exchange programmes in prisons. Where, they ask, is the courageous spirit and bold leadership that pushed the country to decriminalise drugs in the first place?
In the early days of Portugals panic, when Pereiras beloved Olho began falling apart in front of him, the states first instinct was to attack. Drugs were denounced as evil, drug users were demonised, and proximity to either was criminally and spiritually punishable. The Portuguese government launched a series of national anti-drug campaigns that were less Just Say No and more Drugs Are Satan.
Informal treatment approaches and experiments were rushed into use throughout the country, as doctors, psychiatrists, and pharmacists worked independently to deal with the flood of drug-dependency disorders at their doors, sometimes risking ostracism or arrest to do what they believed was best for their patients.
In 1977, in the north of the country, psychiatrist Eduno Lopes pioneered a methadone programme at the Centro da Boavista in Porto. Lopes was the first doctor in continental Europe to experiment with substitution therapy, flying in methadone powder from Boston, under the auspices of the Ministry of Justice, rather than the Ministry of Health. His efforts met with a vicious public backlash and the disapproval of his peers, who considered methadone therapy nothing more than state-sponsored drug addiction.
In Lisbon, Odette Ferreira, an experienced pharmacist and pioneering HIV researcher, started an unofficial needle-exchange programme to address the growing Aids crisis. She received death threats from drug dealers, and legal threats from politicians. Ferreira who is now in her 90s, and still has enough swagger to carry off long fake eyelashes and red leather at a midday meeting started giving away clean syringes in the middle of Europes biggest open-air drug market, in the Casal Ventoso neighbourhood of Lisbon. She collected donations of clothing, soap, razors, condoms, fruit and sandwiches, and distributed them to users. When dealers reacted with hostility, she snapped back: Dont mess with me. You do your job, and Ill do mine. She then bullied the Portuguese Association of Pharmacies into running the countrys and indeed the worlds first national needle-exchange programme.
A flurry of expensive private clinics and free, faith-based facilities emerged, promising detoxes and miracle cures, but the first public drug-treatment centre run by the Ministry of Health the Centro das Taipas in Lisbon did not begin operating until 1987. Strapped for resources in Olho, Pereira sent a few patients for treatment, although he did not agree with the abstinence-based approach used at Taipas. First you take away the drug, and then, with psychotherapy, you plug up the crack, said Pereira. There was no scientific evidence to show that this would work and it didnt.
He also sent patients to Lopess methadone programme in Porto, and found that some responded well. But Porto was at the other end of the country. He wanted to try methadone for his patients, but the Ministry of Health hadnt yet approved it for use. To get around that, Pereira sometimes asked a nurse to sneak methadone to him in the boot of his car.
Pereiras work treating patients for addiction eventually caught the attention of the Ministry of Health. They heard there was a crazy man in the Algarve who was working on his own, he said, with a slow smile. Now 68, he is sprightly and charming, with an athletic build, thick and wavy white hair that bounces when he walks, a gravelly drawl and a bottomless reserve of warmth. They came down to find me at the clinic and proposed that I open a treatment centre, he said. He invited a colleague from at a family practice in the next town over to join him a young local doctor named Joo Goulo.
Goulo was a 20-year-old medical student when he was offered his first hit of heroin. He declined because he didnt know what it was. By the time he finished school, got his licence and began practising medicine at a health centre in the southern city of Faro, it was everywhere. Like Pereira, he accidentally ended up specialising in treating drug addiction.Read More
Exclusive: as evidence emerges that schizophrenia could be an immune system disease, two-year trial will use antibody drug currently used for MS
British scientists have begun testing a radically new approach to treating schizophrenia based on emerging evidence that it could be a disease of the immune system.
The first patient, a 33-year old man who developed schizophrenia after moving to London from Cameroon a decade ago, was treated at Kings College Hospital in London on Thursday, marking the start of one of the most ambitious trials to date on the biology of the illness and how to treat it.
During the next two years, 30 patients will receive monthly infusions of an antibody drug currently used to treat multiple sclerosis (MS), which the team hopes will target the root causes of schizophrenia in a far more fundamental way than current therapies.
The trial builds on more than a decades work by Oliver Howes, a professor of molecular psychiatry at the MRC London Institute of Medical Sciences and a consultant psychiatrist at the Maudsley Hospital in south London. Howess team is one of several worldwide to have uncovered evidence that abnormalities in immune activity in the brain may lie at the heart of the illness for some patients, at least.
In the past, weve always thought of the mind and the body being separate, but its just not like that, said Howes. The mind and body interact constantly and the immune system is no different. Its about changing the way we think about mental illnesses.
Recent work by Howes and colleagues found that in the earliest stages of schizophrenia, people experience a surge in the number and activity of immune cells in the brain. As well as fighting infection, these cells, called microglia, have a gardening role, pruning unwanted connections between neurons. But in schizophrenia patients, the pruning appears to become more aggressive, leading to vital connections being lost.
We studied people in that [initial] phase of the illness and saw microglial changes, said Howes. It shows that its something [happening] very early on and seems to be driving the illness.
The most extensive pruning appears to occur in the frontal cortex, the brains master control centre, and also the auditory regions, which could explain why patients often hear voices. The frontal cortex indirectly controls the brains levels of dopamine a surge in this brain chemical is thought to explain the delusions and paranoia experienced by those with schizophrenia.
Nearly all existing medications work by blocking dopamine, which can bring psychotic symptoms under control, but fail to protect the brains basic architecture from damage.
The current drugs are based on 1950s technology; they all still work in exactly the same way, said Howes. They are only able to target the delusion side of things. Its like getting a sledgehammer and squashing it down.Read More
Many Dalit students regard university as a place of ridicule and abuse. Amrit Dhillon investigates the aftermath of two suicides and asks: is it time to make campus caste discrimination a criminal offence?
Vikas Kumar Moola has been troubled by two questions ever since his best friend Muthu Krishnan, a postgraduate history student at Jawaharlal Nehru University (JNU), killed himself on 13 March. What could I have done to stop it? Should I have done more to help him make friends?
Theirs was an old and close friendship based on caste (both are Dalits, the lowest rung of the Hindu caste system), poverty, missed meals, penny pinching and dreams. I knew he was unhappy, he was lonely, but what else did I miss? asks Moola, a PhD sociology student at JNU.
List typical characteristics of Dalit students across India, and you can tick them all off against Krishnans name. They are first-generation school-goers; they come from rural homes with no toilets or electricity; their command of English is often weak; and their poor, rural origins imply a lack of social sophistication.Read More