Over the last two decades South Africa has undergone a massive transformation. We have moved from being one of the most oppressive countries in the world ruled by the infamous apartheid regime, to having one of the world’s most progressive constitutions, recognising the human rights of all our people. Unfortunately we have lagged behind in the area of drug policy. Drug use is often featured in our headlines, and “substance abuse” is seen as one of the major causes of broken communities and increasing levels of crime and gangsterism. South African drug policy is guided by the National Drug Master Plan.

There is an undue emphasis on supply reduction and policing strategies to address demand reduction by targeting end users. These policies have resulted in significant harms to our communities in general and drug users specifically. Large portions of our most vulnerable populations are criminalised by their drug use and the stigma and discrimination entrenched by these policies limits access to health and other services. Despite the obvious harms and rights violations caused by our policies and associated drug-control measures, with the exception of the cannabis lobby, there was no credible civil society voice or initiatives motivating for progressive drug policy.

There have been no organised, sustained or collaborative efforts to advocate for the health and human rights of drug users. The popular narrative that drugs were the cause of the breakdown of communities, and by extension drug users should be criminalised, remained largely unchallenged in the mainstream. Internationally the imperative to limit the spread of HIV/AIDS has motivated services for drug users, and particularly injecting drug users. However, in South Africa people who inject drugs (PWID) where considered to be an insignificant minority and despite a commitment to Step Up Overview The Step Up Project, run by TB/HIV Care Association (THCA) and OUT Wellbeing, with support from CDC, PEPFAR and Mainline, aims to provide a package of mobile outreach HIV prevention and linkage to care services to PWID in selected areas of Cape Town, Durban and Pretoria.

This package of services is recommended by PEPFAR, WHO, UNODC and UNAIDS. It includes: HIV Counselling and testing; referrals and successful linkages to antiretroviral treatment; needle and syringe programmes, condom programs and IEC materials; screening and referral for the management of TB and STIs and where possible viral hepatitis and peer based outreach services. One of the major barriers has been the policy framework, hence the need for policy & advocacy initiatives. Page 6 of 52 achieve the goals of the Political Declaration on HIV, including the 90-90-90 target, there were no sustainable services for PWID.

With funding from PEPFAR/CDC, in 2014 TB/HIV Care Association launched the Step Up Project aimed at delivering the WHO/UNODC/UNAIDS recommended “comprehensive” package of HIV prevention services for PWID. The funding provided was limited to programme delivery and excluded funding for policy and advocacy work. The project has utilised a variety of consultative processes and continues to do so. Academic, experts, civil society and members of drug using communities have been, and continue to be included, in this process.

A number of intervention gaps have been identified. Some of the key gaps identified by the process were:

  • The high level of stigma, exclusion and human rights abuses that have significant effect on the rights and well-being of drug users in South Africa.
  • The contradictory policy legal frameworks that hinder the implementation of evidence based interventions for drug users.
  • Lack of evidence based harm reduction within the policy framework.
  • The lack of advocacy efforts around drug user rights and the development of effective drug policy.
  • The lack of drug user representative groups who could take part in advocacy efforts and policy debate. Mainline provided initial funding for human rights and advocacy work.

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