By the International Network on Health and Hepatitis in Substance Users (INHSU)

Drug use is criminalised in South Africa and people who use drugs in South Africa are subjected to stigmatisation, marginalisation and social exclusion. People who use drugs can face poor treatment from the police and government officials and are routinely targeted by the police. South Africa does not provide any social support for people who use drugs.

Alcohol remains the most dominant substance used in South Africa. Cannabis is the most commonly used illicit drug, followed by methamphetamine, also known as crystal meth or tik. Heroin is also used, and is usually smoked, with a small proportion injecting heroin as the chosen route of administration.

There is no definitive data on the extent of drug use in South Africa. Based on data modelled from a national household survey and expert consensus, there are between 67,000 and 75,000 people who inject drugs in South Africa. The numbers of people who inject drugs in Cape Town, Durban and Pretoria are estimated at 1517, 1245 and 4514, respectively, with 6827 in Johannesburg. Data suggest a high HIV and viral hepatitis burden among people who inject drugs. HIV prevalence among people who inject drugs ranges from 11% in Cape Town to 58% in Pretoria. Hepatitis C prevalence is even higher, ranging from 35% in Durban (before the closure of the needle and syringe service in 2018) to 94% in Pretoria.

Although the South African National Strategic Plan for HIV, TB and STIs 2017 – 2022 includes the provision of harm reduction services for people who inject drugs, there has been resistance to providing harm reduction services. The closing of the needle and syringe programme in Durban in May 2018 for 24 months is an example. Without access to sterile injecting equipment, people who inject drugs had to reuse and share equipment.