Can Ecuador stop the spread of abusive, underground clinics?

More than 500 people have been rescued in Ecuador this year from 20 clinics that physically and psychologically abused patients in the name of 'treating' drug addiction, alcoholism, and homosexuality.

When Ecuadorean student Zulema Constante was kidnapped in broad daylight, her father looked on. "Everything's all right, my child. Don't worry," he called to her as she was wrestled screaming into a waiting car.

Ms. Constante knew immediately what was happening and where she was going – to a clandestine clinic to be forcibly "cured" of her homosexuality. Ultimately escaping with the help of her girlfriend earlier this year, Constante's case launched a new drive by the Ecuadorean government to close down unregulated clinics across the country in which patients are physically and psychologically abused in the name of treating drug addiction, alcoholism, homosexuality, and other behaviors deemed socially undesirable.

More than 500 people have been rescued this year from more than 20 clinics where they suffered torture and degrading treatment, the Ecuadorean government announced last month. Its action against abusive facilities is an important step for human rights in a continent still bound by conservative beliefs about addiction and sexuality, observers say. But such institutions will likely never be eradicated while government-provided services remain sorely lacking.

"Across Latin America people are being detained and abused in the name of treatment," says Daniel Wolfe, director of the Open Society Foundation's International Harm Reduction Program. "Ecuador is really the first country to have taken this affirmative action, and has framed it very clearly in the language of human rights."

Electric shocks and beatings are among the documented "treatments," and two people died at clinics last year. Dozens of people in Ecuador are being prosecuted for crimes including kidnapping and torture.

"We are talking here about a mafia, a network that operates on a national level, violating human rights in every province," said Ecuador's openly gay health minister, Carina Vance, last month in announcing the latest results in the country's renewed push to shutter clandestine clinics. “We have lesbians who have reported what the clinics called ‘sex therapy,’ but which consists of being raped by men."

It's not an issue limited to Ecuador. A report earlier this year on Guatemalan clinics documented drug-addicted inmates captured off the street by "hunting groups" and being deliberately trampled on and locked up in small cages.

In Peru, 27 people died at a clinic last year after starting a fire in an attempt to escape. In Brazil, schemes in Rio de Janeiro and Sao Paulo to round up homeless people and forcibly treat them for crack addictions have been criticized as thinly-veiled forms of social cleansing.  

Many abusive clinics are run by religious organizations, Mr. Wolfe says, and, often in cases of alcohol and drug use, arise in response to a lack of state treatment for addiction.

"Many people in these centers are put there by family members who are at their wits end and haven't been offered any good options," says Wolfe. "When it comes to addiction no one knows what to do and so they default to what is available." 

'Everything they asked me'

Constante's fellow inmates at a facility ten hours away from Guayaquil in a remote jungle region were female drug addicts – she was the only lesbian. The women were forced to follow a strict daily routine of constant praying and menial tasks, including cleaning toilets with their hands and eating food infested with maggots, Constante reported after her escape. 

"They didn't let us sleep and played with our minds all day, every day," says Constante, who had told her family two months before her kidnap that she was gay. "They told me that I was bad, going against nature, that I was hurting my family, being manipulated by my girlfriend," she says.

She saw people that resisted direction being beaten, so "did everything they asked me, everything I could to survive until I could escape or someone saved me."

Thanks to her girlfriend launching a public campaign drawing attention to her disappearance, Constante's family arranged for her to take a trip away from the clinic in order to prove claims she had gone missing were a lie. During the journey back home she escaped. 

Silvia Buendia, a lawyer and gay rights activist in Ecuador who helped in the rescue operation, has praised Ecuadorean authorities for shutting down the clinic in which Constante was held, and taking legal action against those who ran it.

Efforts to close down unregulated clinics began in 2011 following public outrage over the case of Paula Zirrit, a woman who during two years at a different clandestine facility was raped and locked in pitch-black, heated rooms.

Constante's escape and subsequent media campaign sparked a new, more widespread government crackdown earlier this year, says Ms. Buendia, "but every time one clinic is closed, a new one opens a week later."  

"People must be educated to understand that homosexuality is not an illness" and that drug addicts are not sinners, she says.

President Rafael Correa has taken steps to improve the lives of Ecuador's most vulnerable populations by spending heavily on welfare, housing, and education, and under his leadership the country has introduced trailblazing pro-gay legislation including the introduction of hate crimes to the penal code.

But while many of his policies are highly progressive, Mr. Correa has declared himself "very conservative when it comes to moral issues," and said that gay marriage and adoption are immoral. Gay rights activists say he has not done enough.

"He's basically said to us ‘I've done as much as I can do for you, don't ask me for any more,’” says Buendia. "But I think eventually he will come around, as the gay rights movement strengthens day by day. Ecuador is on the right path."

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