Mark B. Padilla

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Mark B. Padilla, Ph.D.

I am a medical anthropologist with training in public health. For nearly twenty years, I have been conducting ethnographic and survey research on the social and political-economic structure of tourism areas in the Caribbean, focusing on the implications of tourism labor for the health and well being of local populations employed in this industry. My first long stint of ethnographic fieldwork (1999-2001) concentrated on men in the Dominican Republic who engage in sexual-economic exchanges with male and female tourists, and uses a structural lens to examine the patterning of sexuality, economy, stigma, race, migration, and vulnerability to HIV infection among these men and their partners. That work resulted in a book called Caribbean Pleasure Industry: Tourism, Sexuality, and AIDS in the Dominican Republic (University of Chicago Press, 2007).

Since 2008, I have been honored to lead new projects funded by the National Institutes of Health that have aimed to further understand the intersections of political economy, social inequality, and health in the Dominican Republic. One current project (NIDA, 1 R01 DA031581-01A1) is my largest to date, and involves an international team of collaborators at three US-based universities as well as faculty, staff, and students at the Universidad Autónoma de Santo Domingo (UASD), Dominican Republic. We are conducting team-based ethnography and surveys in two cities on the south coast, Santo Domingo and Boca Chica, focused on understanding the syndemic of HIV infection and problematic drug use among tourism workers. A goal is to raise awareness about the experiences of local workers in the tourism industry and incorporate their perspectives into policies and interventions that support the health and well being of this large and growing labor force. Our project web page has more information about the overall project and team: www.syndemicsproject.org.

As with much ethnographic research, our fieldwork drew us to a wide range of issues that are not central to our project, but which are nevertheless critical to understanding the broader conditions of health in the Dominican Republic. In the course of conducting a policy mapping of the drug prevention and treatment institutions, our team identified a group of heroin users in a poor barrio of Santo Domingo called Capotillo, where there is a growing epidemic of heroin addiction driven by recent increases in drug trafficking from South America. The Dominican Republic has become an important transit country for drugs en route to Puerto Rico, the United States, and Europe. This, in turn, has increased the local consumption of heroin. Unfortunately, the country’s drug treatment programs do not offer clinical treatment for opiate addiction, such as methadone, because of a highly restrictive law that treats opiate replacement therapies as illegal narcotics, and punishes their possession and use with significant jail time. Persons addicted to heroin are often abandoned, highly stigmatized, and treated with violence. Local residents of Capotillo who have struggled with heroin addiction requested that the Syndemics Project support them in their efforts to increase public awareness of their plight and their desperate need for appropriate therapies for heroin addiction. They asked us to help them tell their own stories and make their struggles visible to the broader society.

Beginning in 2015, these ethnographic engagements spawned a Photovoice project we call “Proyecto Lentes” (the Lenses Project) focusing on poor heroin users in Capotillo. Some additional funding from FIU’s Kimberly Green Latin American and Caribbean Center allowed us to implement this project. Photovoice is an artistic, community-based approach to social justice that combines photography and facilitated social analysis occurring over many group sessions. It permits marginalized communities to tell their stories and make themselves visible through the pictures they take and the narratives they write. Accompanying this text is a selection of the images taken by these brave and talented individuals, along with the associated analysis and recommendations developed by the photographers themselves. Please check back to our project web page for updates about this ongoing project, and to see the full exhibit, which will be shown in exhibitions in the Dominican Republic and South Florida beginning in summer, 2016.

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