In this article, we use syndemic theory to examine socio-structural factors that result in heightened vulnerability to HIV infection and drug addiction among Dominican deportees who survive post-deportation through informal tourism labor. Through an ongoing NIDA-funded ethnographic study of the syndemic of HIV and problematic drug use among men involved in tourism labor in the Dominican Republic, we argue that the legal and political-economic context of the global deportation regime contributes to structural vulnerabilities among deportees in the Dominican Republic, most of whom are men with histories of incarceration in the United States and/or Puerto Rico. While Dominican laws and institutional practices work conjointly with foreign policies to reconfigure non-criminal deportees as hardened criminals unworthy of full citizenship rights, the informal tourism economy provides one of the few absorption points for male deportee labor, linking the deportation regime directly to the Caribbean tourism industry.

Background-Like other epidemics, the current heroin epidemic in Santo Domingo, Dominican Republic is a largely invisible and devastating social problem linked to numerous structural and social determinants of health. Methods-In this article, we connect a community-based participatory research methodology-"PhotoVoice"-with the theoretical orientation of critical medical anthropology to identify local interpretations of complex social and structural factors that are most salient to the well-being of local Dominican populations affected by drug addiction. Results-Specifically, we describe Proyecto Lentes (Lens Project), a PhotoVoice initiative launched in 2014, which brought together active drug users to visually unveil and critically analyze the micro-and macro-factors shaping the marginalized and stigmatized drug addiction epidemic in Santo Domingo. Conclusions-While the synthesis of PhotoVoice and critical medical anthropology provides a powerful political analysis tool, this fusion is particularly apt in its ability to capture the "invisible voices" of marginalized communities, potentially contributing to future policy reform and social empowerment.

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Health research on tourism has expanded over the past two decades, focusing on understanding how the social, economic, and political configuration of tourism zones might contribute to health vulnerabilities among the diverse populations that interact in these areas. While there are few studies of HIV and drug use interactions in the region, research has indicated that these two outcomes are often interwoven in tourism zones, potentially producing 'syndemics' of HIV infection and problematic drug use. One framework that has been used in public health research on tourism is one that we refer to as touristic escapism or situational disinhibition that may be heightened for some tourists while on vacation, potentially leading to the abandonment of normative constraints on behaviour and contributing to health risks such as unprotected sex or binge drinking. In this article, we draw upon tourism theory and ethnographic research with male tourism workers employed in two popular tourist areas of the Dominican Republic to explore whether touristic escapism offers insights in understanding health vulnerabilities within tourism spaces.

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