Misconceptions about HIV infection and injection drug use could shut down the only project working to curb it.
About fifty used needles and syringes on a beach. That’s what’s caused the City of eThekwini to threaten to close down an HIV prevention programme for drug users.
The needles and syringes had been buried in the sand. But on a mid Sunday morning towards the end of January, a freak wave swept the shore and exposed them.
Soon thereafter, the City of eThekwini accused the TB/HIV Care Association organisation of causing a spill of medical waste on its coast and environmental health practitioners rushed to inspect its offices.
The government officials were investigating how the organisation goes about handing out clean needles to drug users, says the association’s spokesperson Alison Best. “The City was worried that we are handing out needles to people willy nilly.”
TB/HIV Care provides health services to injecting drug users in Durban. Its Step Up project supplies them with harm reduction packs which contain clean needles, sterile water and other equipment they need to reduce the health risks linked to reusing needles.
People in South Africa who inject drugs are 40% more likely to contract HIV than the general population a small, five-city study in International Journal of Drug Policy in 2016 found.
Needle exchange programmes, where drug users are provided with sterilised needles so they don’t share needles, have been shown to cut HIV prevalence rates by almost half in just three years among British drug users who inject, according to a 1995 AIDS study.
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But Best says the City may be pointing fingers to the wrong people. “It’s not the drug users or people trying to help drug users that are to blame,” she says.
“Our position is the City needs more safe places for drug users to throw away used needles.”
Monique Marks is a senior technical advisor at TB/HIV Care. She says “cutting the programme will only exacerbate the problem”.
“They’re shooting themselves in the foot.”
Marks admits the needles are the same generic type included in its harm reduction pack. But there is no way of knowing exactly where the needles came from, she says. “The needles could be from any pharmacy or hospital. We don’t know where users get their needles.”
The massive swells – estimated to have reached 5 meters – swept a seven-year-old girl out to sea where she drowned and wreaked havoc for beach-goers. But the freak waves have also exposed the lengths drug users must go to avoid harassment by the police.
Marks explains: “People are being harassed by the police when they try to dispose of their needles safely. Some users dig deep holes in the sand to be as safe as possible. They’re not being irresponsible – they collect the needles and then bring them back to us all at once to reduce their chances of being harrassed. This big wave could have washed up the hidden needles.”
No one really knows how many injecting drug users South Africa has. The national number – around 67 000 – is based on an extrapolation of the latest household survey. “But wherever we [TB/HIV care] have done needle exchange programmes, the number of people that show up is always higher than expected,” says TB/HIV Care’s Andrew Scheibe.
What we do know, says Scheibe, is that Durban is likely to have more injecting drug users than other metros because it has a harbour. “The ports have caused an underground heroin trafficking trade, and it is likely that people involved in it may start injecting too.”
Since it started in 2015, the Step Up project has provided clean needles and syringes to over 1300 drug users in Durban, and provided more than 1000 users with HIV counselling and testing, the organisation’s data shows.
People who make use of Step Up’s services are closely monitored, Marks says. “There’s a record of every client, how many needles they take, and where they live.”
Best explains: “This is not an ad hoc service offered without consideration of the risks. It is a carefully considered response based on science, research data and compassion in the face of the HIV epidemic affecting all South Africans.”
Marks says the “moral panic” created by the city’s counsellors and politicians is based on ignorance. “We [at the TB/HIV Care Association] have the same vision as the City. We want a safe, healthy and caring society. But we need help from the government. Drug users can’t do this alone.”
TB/HIV Care discourages their drug users from hiding needles, says Best. “Hiding needles until they can be safely thrown away is one way drug users try to reduce their risk of being arrested, and harm to others.”
The organisation has hosted workshops on the harm reduction programmes for police, but but users are still forced to hide needles to minimise their risk of being arrested, says Best.
The association conducts bi-weekly clean-ups to collect used injecting equipment in 74 locations around eThekwini.
Users are encouraged to return the needles to the association, which then disposes of the medical waste safely. They are given portable containers called ‘sharps’. Once a needle is put into these containers, it cannot be removed.
But Marks says these efforts are undermined because users do not feel safe bringing needles back to the association. “There is nowhere else in the city for users to safely dispose of used needles.”
TB/HIV Care has agreements with the provincial and national health departments to provide harm reduction services. Needle and syringe programmes will form part of the country’s National Drug Master Plan for 2018 to 2022, according to policy, advocacy and human rights manager at the TB/HIV Care Association, Shaun Shelly.
But the future of Durban’s harm reduction programme now hangs in the balance.
Mthunzi Gumede, spokesperson for Durban’s mayor Zandile Gumede, says the city is looking into the matter and seeking legal advice.
In an attempt to stop the shutdown, the organisation has called a meeting with the Durban City Council in early April.
Deptuty mayor Fawzia Peer, who heads the mayoral committee for security and emergency services, has also approached the TB/HIV Care Association to take part in consultations about its needle and syringe programme, Best says.
Durban’s beachfront drama has highlighted the failure of South Africa’s war on drugs, Shelly says. He argues the country’s drug policies are based on apartheid-era forms of social control: “Criminalisation of drugs in this country has nothing to do with what’s best for people.”
Shelly says he is cautious, but optimistic, that the new drug plan will succeed to move away from the goal of a “drug-free South Africa” towards ideals of harm reduction and prevention of HIV and Hepatitis-C infections among drug users.
The city’s threats to shut down the needle and syringe programme shows how harshly people who use drugs are stigmatised, he says. “Drug users can’t get the health care they need without being exposed to the authorities.”