Reflections on harm reduction policy and practice in South Africa

I have been working in the field of harm reduction for about ten years. I am happy to report that some encouraging changes have taken place in South Africa. Unfortunately, many of the negative consequences of our current drug policies, and their implementation, continue.  

In 2011, colleagues and I synthesised information around injecting drug use and HIV in South Africa. Our work was used to inform the National Strategic Plan on HIV, STIs and TB (2012 – 2016). Fortunately, the Strategic Plan did include people who use drugs as a key population in need of tailored interventions, even through few people at that time considered interventions for people who use drugs a priority. The lack of data confirming links between HIV and drug use, specifically injecting drug use and HIV, and workable population size estimates, were cited as reasons to not provide appropriate HIV services for people who use drugs.

Two years later I led a team of community researchers to conduct a multi-site prevalence and risk survey among people who inject drugs (PWID) in five cities across the country. Despite our tiny budget and methodological limitations, we successfully recruited 450 PWID. Participants represented major racial groups, and included 20% women – debunking the myth that injecting drug use in South Africa was restricted to white men. I clearly remember several stories I heard during this project about the lives of people who took part in the study. Stories included episodes of rummaging in dustbins in search of needles, renting needles, or being chased out of pharmacies when trying to buy needles. One participant explained how he would share his gear with his girlfriend and friends and how he had tried to stop injecting several times. I remember how he tried to verbalise how difficult it was to find money to pay for opioid substitution therapy (OST). (His situation did not change and he committed suicide a few months after the study was completed.) We found that women were at higher risk for HIV than men. Over half of the women had been involved in the sex industry, and a third of them reported symptoms of a sexually transmitted infection the previous year. Women also reported higher levels of needle and syringe sharing than men. I think the main finding of our study was to show the the need for evidence-based HIV prevention and treatment services for PWID in South Africa.

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