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Armed Violence and Illicit Drug Trade. An integrative literature review on Brazil.
Authors: Mayalu Matos Silva - mayalu.silva@fiocruz.br - Department of Studies on Violence and Health Jorge Careli/Ensp/Fiocruz - ORCID: 0000-0002-0345-1902

Patrícia Constantino - patricia.constantino@fiocruz.br - Department of Studies on Violence and Health Jorge Careli/Ensp/Fiocruz - ORCID: 0000-0001-5835-0466

Abstract:
The article maps the relationship between armed violence (AV) and the illicit drug trade (IDT) in Brazil through an integrative review focused on empirical research. The sample included 20 articles, categorized according to year of publication and fieldwork, objectives, methods, study location and results. The results were interpreted based on thematic content analysis and showed that the relationship between IDT and AV occurs mainly through Organized Armed Violence. However, this violence spreads, affecting society, especially residents of peripheral areas. The following stood out: Availability of Firearms (FA), with a broad presence in the IDT environment; Illegality and violence, highlighting the need to use FA for the IDT due to its illegality and militarized perspective of repression; State action, thematizes the absence of preventive public security in peripheral areas and the violent, corrupt and ineffective action of the State; Armed territorial dominance, shows the strength of the organized IDT groups and the effects on the population; Young black people: primary victims and perpetrators, highlights the vulnerability of these young people to AV and also Health impacts. The militarized and violent policy has not been offering results to control the phenomenon. New approaches are needed to deal with the issue, centered on the perspective of health and human dignity.

Keywords
Illicit Drug Trade, Gun Violence, Drug Control, Homicides, Health Disparate, Minority and Vulnerable Populations

Acknowledgements
This paper was carried out during Mayalu Matos Silva\'s doctoral research internship at the Centre for Social Studies of the University of Coimbra under the supervision of Bruno Sena Martins and with the support of the Coordination of Improvement of Higher Education Personnel (CAPES). The translation was carried out with the support of VDPI/ENSP.

Brazil faces a major challenge as to armed violence (AV). Considering firearm homicide (FAH), one of the main indicators of this type of violence, in 2021, the country ranked 11th with the highest rates, out of 86 countries1*. The concept of AV has sought to encompass the complexity of a phenomenon that concerns the widespread presence and use of firearms (FA) in society, and is broader than the traditional definition of armed conflicts: a contested incompatibility that concerns government and/or territory where the use of armed force between two parties, of which at least one is the government of a state1.
From the 1990s onwards, conflicts between states lost momentum to intra-state conflicts, a phenomenon marked by the ease with which civil society can acquire and use FA without a specific political objective2. AV is beginning to be observed in contexts of formal peace, especially on the periphery of capitalism and especially in Latin America (LA)3. In this region, Organized Armed Violence (OAV)4 stands out, an intermittent situation that results from the actions of armed civilian groups (ACG) with territorial control that seek illegal economic gains and which may challenge the state to ensure these gains5. However, AV is broader; it can be exercised by gang members, members of private security forces, state forces, ordinary individuals, among others6. Thus, it concerns the large presence of FA in society and the violence disseminated by its use, both by state forces and armed civilians, especially criminal groups, but which is widespread in society. This phenomenon is expressed through the use or threat of FA for violence, control of territory, clashes, stray bullets, snipers, among others7. Besides homicides, AV has serious impacts on people\'s health and social actions in the territories where it is present8.

1* Cf. https://ourworldindata.org/grapher/homicide-rates-from-firearms?tab=table
This article examines one aspect of this phenomenon, i.e. AV and its relationship with the illicit drug trade (IDT) in Brazil. It should be noted that there is no necessary relationship between AV and IDT, but it can be shaped by specific determinants and LA has been considered one of the regions most affected by this relationship, with the highest regional rate of intentional homicides in the world: 19.91 in 2021, against a global rate of 5.792*. It should be noted that LA is the main region for the production and sale of cocaine, a lucrative drug that has a privileged trade route to Europe in Brazil9. The War on Drugs has been applied in the region since its inception in the 1970s. This proposal, which emerged in the US, was based on the repression, militarization and demonization of drugs – especially cocaine – and has marked drug policies in Latin America and Brazil10. Criminalization has thus been the main state strategy for dealing with the drug issue11, an approach that has seen few results and many social consequences12,13.
In Brazil, while on the one hand we are seeing this intensive use of militarized resources, on the other hand we are seeing the development of IDT, which develops alongside other forms of crime. The strong presence of AV has serious consequences13 for society, such as the high rates of FAH, which in Brazil are significantly related to IDT14.
Criminal insecurity has the particularity of being aggravated by the intervention of state forces in view of the routine use of lethal violence by the police, which trivializes the brutality of the state and causes a climate of terror among the working classes, targeted by these operations15. Thus, we are interested in observing which relationships between AV and IDT are discussed in Brazilian academic literature.



2* Cf: https://dataunodc.un.org/dp-intentional-homicide-victims-est).

Methodology

In this sense, we opted for an integrative review, a systematic method that allows us to include studies with different methodologies16 to provide an overview and also a synthesis of results, in the case of this review, with an exploratory objective. We worked with two groups of descriptors, one related to AV and the other to IDT, as described below:
Table 1

Duplicate articles were excluded and the sample was screened separately by each author, first by reading the titles and abstracts and then full articles following the criteria:
a) Inclusion: empirical research articles on Brazil, with fieldwork that addresses aspects of AV and/or IDT and/or relates these topics in the discussion, written in Portuguese, English and Spanish.
b) Exclusion: articles that did not mention AV and IDT in their fieldwork or discussion, articles carried out outside Brazil, review articles, essays and reviews, theses, dissertations, undergraduate papers, books and official documents.
The samples were compared, resulting in 17 articles. After reading them, we carried out a new search, considering that public security, a key issue relating to this
topic, was poorly represented in this sample, although the descriptors "War on drugs", "Drug policy" and "Drug repression" were used. To this end, we used the two groups of descriptors from the previous search, referring to AV on the one hand and IDT on the other, combining each one with the term public security so as to highlight it:
Table 2
Table 3

Screening was carried out following the methodology already described, resulting in 3 articles in search 2 and 0 articles in search 3, for a total of 20 articles, which were categorized and analyzed according to year of publication and fieldwork, objectives, methods, study location and results. The results on the relationship between AV and IDT were interpreted using thematic content analysis17: in the pre-analysis, a floating reading was carried out focusing on the results and discussion, making up the corpus of analysis; then categories of meaning were created, based on the classification of the most frequent topics, followed by the organization of the information, analysis of the results and critical interpretation.
Results

The articles range in time from 1998 to 2018, with an increase in academic production on the subject: 1990s: 1, 2000s: 6, 2010s: 13. Most of the publications were in the field of Public Health: 10, with 3 international publications (USA, Germany and England); followed by Social Sciences: 5, with one publication in Portugal; Psychology: 3. In addition to 1 article published in a Brazilian Multidisciplinary journal (Communication, Health, Education) and in an Australian journal about Drugs.
Most of the papers was carried out in the Southeast, with 10 articles: 2 on the capital of Rio de Janeiro (RJ) and 1 on the state of RJ (ERJ); 3 on the capital of São Paulo (SP) and 1 on the city of Ribeirão Preto/SP (RP/SP); 2 on Belo Horizonte/MG (BH) and 1 on its metropolitan region (RMBH). In second comes the Northeast (NE), with 6 articles: 1 on the NE region; 1 on the state of Pernambuco (PE), 1 on the city of Paulista/PE (PA/PE); 1 on the capital Salvador/BA (SSA) and 2 on the capital Fortaleza/CE (FOR). The Southern region had 4 articles, 1 on the municipalities of Paraná (PR), 1 on the state of Santa Catarina (SC), 1 on the city of Jaraguá do Sul/SC (JS/SC) and 1 on the city of Porto Alegre/RS (POA). Brazil (BR) is covered in 1 article. Papers from the North and Central-West regions were not selected.
The main indicator of violence used in the quantitative and quanti-quali studies was homicides. Data from death certificates were used in 9 articles: 4 articles specified the study with FAH 18,19,20,21 and 5 articles worked with homicides in general. Of these, Lima et al. 22 made the relationship with FA in the discussion of the data, Sant\'anna et al.23, Zaluar and Barcellos24, Barcellos and Zaluar25 and Silva26 from the qualitative part of the fieldwork. Two articles used police data on homicides: police reports20 and police investigations20,27, and one article used court cases28. The relationship with FA and IDT was present in these documents. It should be noted that, in this sample, only 3 papers
specify the use of the indicator of deaths by legal intervention18,19,24, which is measured differently from homicides committed by civilians, both in health data – processed by the Ministry of Health\'s Mortality Information System (SIM/MS) through death certificates – and in police data – processed from police reports. Mentions of violence committed by State agents were mainly mentioned in the qualitative fieldwork.
They also addressed the phenomenon of homicide and/or possession, use and threat by FA, from homicide perpetrators28, drug dealers27, victims29, family members 23,30 and friends of victims 30, young delinquents31,32,33, students26, young people living in violent neighborhoods34, homeless young people35 and, moreover, various professionals26,30,34. To this end, interviews were used in 11 articles 23,26,27,28,29,30,31,32,33,34,35 and 3 focus groups26,30,34. Further, work was carried out in peripheral neighborhoods marked by violence and/or drug trafficking: 2 victimization research24, 1 survey24, 2 participant observations28,35, 2 intervention research30,34, as well as 4 ethnographies24,25,33,36. Mention of IDT and FA appears above all in qualitative studies23,24,25,26,27,28,29,30,31,32,33,34,35,36, and also in the discussion of some quantitative studies18,19,21,22.
Table 4

The results showed that the relationship between IDT and AV is mainly based on OAV, but that this violence spreads and affects society as a whole, especially residents of the peripheries. The following categories stood out: Availability of FA; Illegality and violence; State action; Armed territorial control; Young black men: the main victims and perpetrators and Impact on health.


Availability of FA

The high profits of IDT make it possible to acquire and facilitate the presence of FA in the drug trafficking environment35,37, making the trafficking of FA and their illegal possession by ACG key factors in this equation,19,20,21,22,24,25,26,27,28,37. Szwarcwald and Castilho18 point to the spread of FA among increasingly younger groups and the proliferation of homicides in ERJ from the 1980s onwards, linked on the one hand to the need for organized crime to militarily control IDT points18,24 and on the other to the growing presence of armed ordinary citizens, frightened by insecurity.
Zaluar and Barcellos24 also highlight the availability of FA for young favela residents in Rio de Janeiro and Sant\'Anna et al.23 point out as a vulnerability factor that 21% of adolescents victims of homicide in POA used to use FA. Kodato and Silva28 point out that the homicides perpetrated by the young people they interviewed were almost entirely committed by FA, which are easily accessible. Mclennan et al.32 report in their sample that young people have easy access to FA. Sapori et al.27 outline that the chances of a homicide being perpetrated by FA in Belo Horizonte are 3.5 times higher than those perpetrated by other means.


Illegality and violence

The illegality of IDT26,27 is pointed out as a factor that encourages the growth of a specific and violent culture of conflict resolution. Illegality does not prevent the
the market from developing, but it does make it develop in an illicit and criminal manner, and the presence of FA is essential to protect the lucrative criminal business27,36, both from other ACG interested in its profits and from the police, who will crack down on illicit acts24,35, which makes residents of territories controlled by IDT especially vulnerable to AV.
It should be noted that, in these territories, the exercise of power is based on an extra-legal and violent logic of conflict resolution27,28,30,32,33,34,35 that makes AV banal35. This is related both to territorial disputes for IDT18,24,27,35, and to relationships of abuse of power within territories of ACG control, in relation to settling debts related to the sale or consumption of drugs35 and controlling robberies and other crimes within these places27,34,36. It should be noted that committing property crimes in these places increases the risk of suffering homicidal violence34,35. In Santa Catarina, Vieira33 draws attention to adolescents accounts of the banality of death in drug trafficking.
Sapori et al.27 point out that the despotic practices of violence in Belo Horizonte are not limited to IDT issues, but are often incorporated as commonplace in these localities, causing simple misunderstandings to be settled using extreme solutions, leading to the banalization of homicides. Kodato and Silva28 talk about the phenomenon of adolescents killed by ACG by mistake, mistaken for someone else.


State action

The lack of effective preventive public security in peripheral territories is mentioned in SSA35, RJ24, PA/PE26 and FOR30,34 as an important factor that enables IDT. On the other hand, these places are marked by violent police action, as a result of the increased militarization and ostentatious policing required by the War on Drugs, to the detriment of actions to integrate security forces and intelligence30. As Benicio30 points out, the
violence is trivialized as acceptable to settle conflicts and is publicly demanded as a security policy, being referred to as one of the factors for the production of AV and intensification of homicides in the periphery of FOR, both of young people, especially blacks, and also of police officers, which Zaluar24 also reports in RJ.
In this sense, emphasis is given to the criminalization of peripheral, poor and black youth, socially identified as the "internal enemy" and a killable body24,30,34. The stigmatization of the territory as a violent place, controlled by drug dealers, criminalizes the entire local youth population, which becomes the target of arbitrary police actions without distinction. This process, together with ostentatious police violence and the lack of preventive policing in the peripheries, causes distrust and a loss of legitimacy for the police in these places, favoring the violent territorial control of ACG26,30,34. Zaluar24 points out that the image of the PM/RJ as violent and corrupt reached over 70% among young people and 92% among young people aged 15 to 19.
Another point that stands out is the inefficiency of the state in attributing responsibility for homicides in the peripheries28,30,34 or among the homeless population35, which are trivialized as IDT settling accounts, or even "social hygiene"28, not deserving the attention of the public authorities, thus contributing to the banality of this phenomenon.
Growing insecurity and distrust of the police institution are cited as the motto for the expansion of private forms of security. These have given rise to other ACG that use AV, known as "militias", in RJ24 and FOR34, and extermination groups in PA/PE26, in many cases involving members of state forces24,26.
Another aspect is the corruption of law enforcement agents24,25,26,35, who, through active participation, complicity and impunity, ensure the presence of FA and the continuity of IDT. These illicit activities, practiced by state agents, increase mistrust and the feeling of insecurity among the population26 and reinforce IDT35.
Armed territorial control

This violence is not equally distributed throughout the cities, but is located in certain peripheral areas, configured as territories controlled by ACG that operate in IDT in BH27,37, PE22, SSA35 and RJ24,25, which increases the risk of territorial disputes between rival ACG 26,31. Territorial control implies that, in these places, the power of force is exercised by groups different from the state, which will be retaliated against with violent repression by the state.
Zaluar and Barcellos24 point out that the rivalry between ACG that sell drugs in RJ has given rise to an arms race. This has been going on for decades and is expressed in the map presented by the authors of the ACG spatial distribution in Rio de Janeiro between 2005 and 2010, especially in territories inhabited by the black population.
The authors show that areas located close to major traffic routes, ports, airports and Armed Forces weapons depots are those with the highest concentrations of FAH, resulting from armed conflicts for local control – above all between IDT groups, but also with the police and militias25 – as they offer better logistics for obtaining and distributing FA and drugs.
This territorial dispute is also reported in PA/PE26, FOR30,34, SSA35 and BH31, highlighting the fragmented nature of rival criminal groups in the capital of Minas Gerais, which increases the potential for violent conflicts, whether of a personal, territorial or criminal nature.
An important aspect is the violation of the right to come and go of the residents of these places, who often lose their lives for crossing territorial boundaries or even by simply living in a certain locality and being identified in some way with a rival faction despite not even being involved with IDT24,27,30,34. This situation also prevents them from attending leisure spaces and social facilities such as schools and health centers34, in addition to
being evicted from their homes and communities, increasing the number of homeless people in FOR30.

A noteworthy aspect is the management of violence by groups linked to IDT, showing the strength of these groups and a process that is autonomous from state public security. In São Paulo, although territorial control and the use of FA are reported, this violent dispute between rival groups and also with the police has not been verified, which has been attributed to PCC\'s control and its guideline to reduce homicidal violence and ensure fewer risks for economic activity during the first decade of the 21st century36.

In FOR, this management was also referred to through the phenomenon described as "pacification", a local agreement between ACG that took place between 2015 and mid-2016, characterized by the prohibition of the cycle of revenge and homicide practices30,34. This process reduced violence between ACG, increased conflicts with the police and also exacerbated the violent power of each group in their territories, showing the arbitrariness of "pacification" and, moreover, the need to spectacularize the imposition of order by force34. The significant decrease in homicides during this period shows the seriousness of the phenomenon of rivalry between ACG in the peripheries of FOR and points to the difficulty the state has in exercising control of force in these places, ensuring non-violent forms of mediation34.


Young black men: main victims and perpetrators

The key aspect is that this violence mainly affects young18,19,21,25,29,37 and black men20,23,24,28,29,30,31,32,34. Zilli31 observes that perpetrators and victims of homicide have the same sociodemographic profile (young, black, poor and with little formal education), live in the same neighborhood (favelas and periphery neighborhoods) and kill and die as a result of violent conflicts in their own territories. Kodato and Silva28 and
Sapori et al.27 point out that adolescents are placed on the front line of drug trafficking, being used as killers and assuming responsibility for the crimes. Kodato and Silva28 and Sant\'anna et al.23 highlight a victimization cycle of young people: involvement in offences, apprehensions by the police, stints in institutions, involvement in drug trafficking, use and carrying of heavy weapons, killing and death.


Impacts on health

With regard to the impact on health, Freitas et al.29 show that young people injured by PAF are often admitted to hospital at a referral hospital in the Northeast, with frequent disabilities and functional limitations. The presence of drug trafficking in the peripheries, as a job market for vulnerable young people, is highlighted by several authors19,23,26,27,36, often related to conflicts with FA that victimize these young people29,33. Auger et al.21 also highlight the magnitude of injuries and disabilities by PAF, which are related to economic and social losses for the country.


Discussion

Goldstein38 highlights that one of the possible relationships between the issue of drugs and violence concerns aggressive patterns of interaction in the system of distribution and use of illicit substances. The fact that it operates outside the law and the dispute over profits means that extreme measures of violence, especially FAH, are commonplace in regulating this market, giving rise to what he called systemic violence. However, as Garzón-Vergara39 points out, the existence of IDT does not necessarily translate into high levels of lethal violence, but this relationship is strengthened by two main aspects: the access to FA and the weakness of the state\'s legitimate authority, both highlighted in this review.
It should be emphasized that the most damaging consequences of this relationship disproportionately affect a very specific group, made up of peripheral and poor populations, especially young black people with low levels of education. The drug market in BR is strengthened by the structural precariousness of means of subsistence and functions as an important place of work and social insertion for the black and vulnerable youth19,23,26,27,29,33,36. This market\'s relationship with the FA incites a systemic violence that seems to be concentrated at the bottom of the IDT chain of command.
For Wacquant15, the spread of FA and the development of a structured drug economy, linked to international trafficking, represent the growth of predatory economies that absorb those excluded from the formal economy. They are responding to the social insecurity generated by neoliberal economic policies, which since the 1980s have been reducing wage labor and collective protections. This process is exacerbated in countries similar to BR, where the marked social and economic inequalities and the incipient democratic tradition, combined with the FA market, strengthen criminal violence.
Valencia40 proposes the term gore capitalism to refer to explicit and unjustified violence, often related to organized crime, which is constituted as a tool of necro-empowerment – processes of transforming contexts of vulnerability into possibilities of self-empowerment – which are born from perverse practices based on violence. This process, however, is part of an economic structure that sustains it and is therefore a hidden result of neoliberal globalization processes, taking on a central role on the borders of the hegemonic capitalist economy. Thus, the author points out that this violence is not limited to the individuals who commit it, but is linked to a social structure that makes life precarious for a large part of the world\'s population, especially in the global south.
Mbembe41, through the concept of necropolitics, seeks to circumscribe experiences of material destruction of bodies and populations, as ways of operationalizing political space through violence, in historical contexts marked by colonialism and racism. In these contexts, the exercise of the right to kill, although also exercised by the state, is no longer its monopoly; other means to exercise power coexist, such as de facto legal bodies that hold the right to exercise violence. The author draws attention to the demarcation of transnational capital movements, which concentrate activities related to the extraction of valuable resources, and which become spaces of war and death. This operation, marked by technologies of destruction and put into practice by ACG that control territories and act behind the state, is also characteristic of IDT.
As Garzón-Vergara39 points out, in the case of IDT, this violence is related to disputes between groups, turf wars and the use of force to impose an informal order on communities. However, to make matters more complex, this territorial control can also reduce the incidence of homicides when there is regulation of violence in these places or some kind of agreement between rival groups, a fact that has also been documented in Brazilian literature30,34,36.
Another aspect of this process concerns the role of the state: both the inability to establish a legitimate monopoly on the use of force and the relative rates of impunity for violent crimes allow IDT freedom to act39. In this sense, the War on Drugs in Latin America, its focus on military and police operations, are factors that end up driving violence.
Wacquant15 points out to the intensification of police and judicial intervention in street crime, which aims to remedy the economic and social "less state" with the police and penitentiary "more state", relegating the issue of security to the criminal dimension. In the case of BR, this author highlights the trivialized use of lethal violence by the
police, which delegitimizes the role of public security among the popular classes, mostly black, who are the target of these brutal operations.
Zaluar42 also draws attention to the inefficiency of repressive action, focused on small traders from the lower classes and not on the big drug dealers and money launderers. The ineffectiveness of preventive public security in favela and peripheral areas, the corruptive capacity of drug trafficking and the violent actions of the police thus lead to a lack of credibility for this institution42. However, the way to reduce homicides lies in the legitimacy of the state in guaranteeing fundamental rights and not in relying on violent repression, which historically has not been able to influence the behavior of criminal organizations in LA39.
The process of prohibition, criminalization and demonization that surrounds the issue of drugs contributes to the growth of a dark market that develops into a predatory and violent economy. On the other hand, this process contributes to the strengthening of a stigmatized image, especially of those who work at IDT who, as Reis and Guareschi43 point out, occupy the role of "internal enemy", which socially legitimizes the arbitrariness against their bodies. However, this stigma often falls on entire populations inhabiting these territories, especially young black men, who end up being the target of criminal suspicion and/or violent acts by the state. Thus, while the participation of young people in violent acts mobilizes public opinion and feeds punitivism, the victimization of these same young people and their vulnerability to this cycle of violence occupy a secondary place in the public debate31.


Final considerations

This review shows a worrying and persistent scenario of the relationship between AV and IDT in Brazil, which prioritizes the issue of drugs as a crime, to the detriment of a public health
perspective, reiterating a model of drug policy based on the exclusion of those involved in IDT. This encourages the dark development of this market and makes its gears increasingly marginalized and marked by FA. In this process of emphasizing militarization, spirals of violence are incited, especially against the most underprivileged classes.
While we must avoid improper causal relationships, it is essential that the characteristics of this violent process be observed, which permeate the relationship between deprivation of livelihoods, institutional precariousness, predatory markets, FA, the intensity of violence, racism and the criminalization of poverty. Thus, the relationship between AV and IDT is linked to structural issues in a colonized and racist society, deepening its processes of inequality.
We urgently need to deconstruct this machine for destroying people, questioning the processes that engender this situation. There are no easy answers, but after decades of trying, we need to look at the harmful impacts and insufficient results of this militarized approach and develop a more rational way of dealing with these issues, above all from the perspective of human health and dignity.


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