Priscila Carolino was nearly due with her fifth child when she sauntered into the public hospital for her weekly checkup. Fidgety and talkative, she quickly made her presence known in the waiting room, asking to touch other patients' pregnant bellies and inquiring about their love lives. After her visit, unhappy with her doctor's recommendations, Carolino yelled across the room, calling herself a fat cow.
Like many women in the waiting area, 29-year-old Carolino carried a paper that deemed her pregnancy alto risco, or high risk. She lives in a densely populated area in São Paulo known as Cracolândia — or Crackland. She claims to have stopped using crack cocaine during this pregnancy, but she frequently smokes cigarettes and marijuana.
There are an estimated 1 million crack users in Brazil, the largest number in the world, and for many politicians and voters, Cracolândia is symbolic of the country's drug epidemic. It is composed of several blocks in the center of South America's largest city, and at points in its history, it has drawn upward of 2,000 people looking to buy or sell crack cocaine.
Since the area is so visible and politically important, Cracolândia has drawn sizable government resources. For much of the last two decades, Brazil's politicians and police forces took a strongman approach, arresting drug users and shutting down streets. After watching operations fail time and again, Brazil has now adopted a different method.
As opposed to the tactics used in the US in the 1980s, Brazil is offering resources to rehabilitate drug users rather than criminalize them. Lieutenant William Thomaz, who patrols Cracolândia, said his unit considers crack users to be "sick people who need social services" rather than criminals. (The selling of drugs, though, remains strictly illegal.) He has also talked to his force about the particular challenges that women in Cracolândia face.
Thomaz and his colleagues can now refer crack users to a city program called De Braços Abertos, or With Open Arms, which began in January 2014. Drawing from harm-reduction philosophy, it works with more than 400 Cracolândia residents, including Carolino.
The Open Arms program, which is unique in South America, is designed to reduce dependence on crack — though it may not result in total abstinence. Participants receive food, housing in nearby hotels, and basic medical services in exchange for work. São Paulo's Mayor Fernando Haddad says that these basic services help remove stressors that can cause people to seek drugs.
More controversially, the Open Arms program offers participants jobs to sweep the neighborhood streets. Haddad says the custodial jobs are part of a "therapeutic process and the recovery of citizenship."
Participants are paid every Friday, and can do what they please with their earnings — including buying crack. Critics worry that this approach will keep users trapped in a vicious circle of addiction and poverty. Harm-reduction advocates, meanwhile, say that the jobs help crack users set and maintain daily schedules, which can alter their relationship with drugs.
Cracolândia was born in the late 1980s. The story goes that a bus station in the city center fell out of use, and people began congregating there to sell, buy, and use crack cocaine. As businesses started disappearing from the city center, crack became more pervasive. Traffickers began to control much of the activity, including doling out punishment.
"Some streets were no longer under the surveillance of police," said Francisco Inácio Bastos, who conducts crack-cocaine research with the Oswaldo Cruz Foundation. "So these places were occupied by [drug] trafficking and attracted users from many different neighborhoods of the city."
Brazil has an immense, sometimes lawless border with Colombia, Peru, and Bolivia, all of which mass-produce coca leaves. In rural Brazilian towns, small factories — and sometimes home kitchens — cookers turn coca paste into low-quality crack rocks. The drug then reaches São Paulo with the help of micro-traffickers, who carry small quantities of crack cocaine around the city. This supply chain is virtually untraceable. As a result, crack is plentiful and cheap enough in Cracolândia — a hit costs as little as five Brazilian reals, or two US dollars — to satisfy demands of low-income drug users.
Police said that today Cracolândia's population has dropped to about 500 — partially because of government programs like Open Arms. The program's representatives claim, based on anecdotal evidence, drug consumption has decreased in Cracolândia since the inception of the program. Even so, drug traffickers still control much of everyday life. For instance, Carolino's hotel is known to be rife with illegal activity, but police are not allowed to enter without a search warrant.
An estimated 30 percent of Cracolândia's residents are women, who are particularly marginalized. "Women crack users are in an even more vulnerable situation because they usually have sex in exchange for crack," said Bruno Gomes, who leads a nonprofit in Cracolândia called É de Lei. "A lot of men like to go [to Cracolândia] because the women are easy and cheap, and you can do whatever you want with them. So they suffer a lot of violence."
Isabelly Santana, a transgender woman who has lived in Cracolândia for two years, has seen this firsthand. "No one treats women well here," she said. "We have to stay chill. We shouldn't say anything to the police [if we experience violence], because people who do that are snitches."
Open Arms representatives say that the income women earn in their program could decrease the need for sex work. But Santana told me that she earns significantly more from sex work than from sweeping. She only occasionally shows up to her custodial job, though she acknowledged that the routine has made her days more stable and her drug cravings less severe.
Both she and Carolino were particularly thankful to have the hotel rooms. For Cracolândia's women, accustomed to the injustices of the streets, privacy is paramount.
At first glance, Carolino looks and sounds nothing like the stereotypical image of a marginalized woman. Though she is petite, she is unafraid to dole out her brand of justice. The first time I met her, she was chasing a man with a stick, her shirt rolled up to reveal a very pregnant belly. He had broken a promise, she said, and she needed to teach him a lesson.
Underneath her self-assurance, though, Carolino has a dark past, which is quite common among women in Cracolândia. Her brothers were killed when she was younger. She was in two physically abusive relationships, which caused her to eventually flee her hometown of Rio de Janeiro. She does not have legal protection against her abusers, so she ran to a place that felt far away and anonymous.
Around Cracolândia you see a sizable number of pregnant bellies — possibly because of gender-based violence and limited access to birth control. However, there are startlingly few children in the district. Cracolândia's hotels are not considered homes, and children in the area are not permitted to remain with homeless mothers. Instead, most babies born to Cracolândia residents are either given up for adoption or shipped off to family members. In compliance with the law, Carolino was told that she would have to give up her child, despite new efforts to help pregnant women.
"People think that [women in Cracolândia] would be bad mothers," said Dartiu Xavier da Silveira, a drug-addiction researcher at the Federal University of São Paulo. "That's not true. Alcohol is much more aggressive to the brain of the child than crack is. It's unbelievable, but it's true. I think that most of them can keep their babies, if they are helped."
Of course, if women keep their children in Cracolândia, that means they will grow up in one of the most challenging environments imaginable. Adults have an unwritten rule to never smoke in front of children, whom they affectionately call anjos, or angels. But some residents told me about children who became addicted to crack from the age of eight.
In spite of the Open Arms program, most people familiar with Cracolândia believe the area will continue to exist — but it could change dramatically in coming years. There are rumors of future plans for real estate development, which may push drug use underground. And the recent social programs in Cracolândia have had some incremental benefits in the neighborhood. Still, challenges remain: Drug traffickers have enormous clout in the area, and some local politicians seem more interested in revitalizing downtown than they do in healing addiction.
Cautiously optimistic about Cracolândia's future, a local pastor successfully advocated for Carolino to be allowed to keep her baby. Only time will tell whether she will be able to calm her temper and become as good a mother as he believes she can be — and whether the baby has a chance of living a drug-free life.
"I want to keep this son with me," Carolino said, while still pregnant. She was rocking her new stroller back and forth. "I stopped smoking crack for him."
All photos by Almudena Toral
This article also appeared in the February issue of VICE magazine.
Sarika Bansal and Almudena Toral traveled to Brazil with a grant from the International Reporting Project.