In a secluded corner on the outskirts of South Africa’s capital, Pretoria, a community of people struggling with drug addiction resides amidst litter and makeshift shelters. These individuals are often seen injecting themselves and others with heroin-laden mixtures, sometimes sharing needles.
Assisting this community is a dedicated group of health professionals who make weekly visits to a dozen places around Pretoria. Supported by the University of Pretoria and the Tshwane municipality, this initiative provides a needle exchange service, enabling addicts to swap used needles for sterile ones.
Although needle exchange programs are established worldwide, they face challenges due to significant funding cuts, notably when the Trump administration reduced 83% of the U.S. Agency for International Development’s (USAID) global programs.
South Africa, with the world’s highest number of people living with HIV, has felt the impact of such cuts profoundly. Needle-sharing poses a significant risk for spreading diseases like HIV, making these programs crucial.
In Pretoria, the team composed of doctors and social workers has built relationships with drug users, motivating them towards opioid-substitution therapy, and offering treatment for illnesses such as HIV.
The need for such assistance is growing. A 2022 report from the University of Pretoria estimated that approximately 84,000 people inject drugs in South Africa, and HIV prevalence among users in Pretoria stands at 38%, while the national prevalence is over 12%, according to government data.
The report revealed that the market for drugs such as cocaine, heroin, and methamphetamine in the country is valued at about $3.5 billion, and is on the rise.
Despite being fully funded by the municipality and the university, the Community Oriented Substance Use Program in Pretoria indirectly suffers from the global aid system’s upheaval. Closure of nonprofit partners has hindered the program, and at least one local health clinic providing services in the area has shut down, pushing patients to overcrowded, underfunded government facilities.
Such harm reduction initiatives now face fierce competition for dwindling resources.
Among those affected is Phumulani Mahlangu, a 30-year-old who expressed remorse over his circumstances while attending consultations. Addicted to a heroin mixture called nyaope, he is homeless, with three children in his hometown 200 kilometers away.
“I began using nyaope with friends in 2013 and had never felt such relaxation before,” he mentioned. “I spent all my money on it, leading me to this point.”
Dipolelo Lekota, one of the few women in the community, also finds herself battling addiction. At 30 years old, she is striving to quit drugs to care for her child, who is currently with relatives. She benefits from the project by accessing HIV medication and clean needles, preventing the spread of infection to others.
Withdrawal can be daunting, acknowledged Likwa Ncube, who leads the project in parts of Pretoria. Transitioning to methadone from other substances involves severe discomfort, presenting steep challenges.
Ncube addressed misconceptions about the program, which some critics argue perpetuates drug use by distributing needles. “Providing condoms doesn’t equate to encouraging sexual activity,” he said, drawing a parallel. “We can apply the same reasoning to needle distribution.”