How government is hindering its own drug policies

Clients line up for assistance at the TB HIV Care mobile clinic in Wynberg, 15 October 2024. Photos: David Harrison.

• In November 2023, Metro health services in Cape Town requested the suspension of a mobile clinic after residents complained it was giving out needles to drug users. The program was halted for four months.
• Heroin users in Wynberg told GroundUp that after the program was closed, they increasingly resorted to sharing needles. This would have increased the risk of HIV transmission.
• Users also developed abscesses on their arms as they used old blunt needles.
• The program was reinstated after the Western Cape Premier told local officials that sterile needle and syringe services are in line with the province’s strategy on preventing HIV.

In recent years, HIV has spread rapidly among people who inject drugs, because users sometimes share needles when they don’t have access to new ones. The government has repeatedly proposed a simple and evidence-based solution to this problem: provide users with clean needles, and thereby eliminate the need for them to share.

Studies from around the world consistently find that the number of new HIV cases falls when this is done. Yet despite the government’s formal commitments, local officials from around the country have often shut these programs down.

In November 2023 the City of Cape Town requested the suspension of one such project in the Wynberg area. It was run by TB HIV Care, a health services organisation operating a mobile clinic in the area.

Mobile clinics are vans which park where people who inject drugs are known to congregate. Nurses provide a range of services, including HIV testing, general medical consultations and sterile needles and syringes. Staff also help people who want to stop using heroin to get on a treatment program that the organisation runs.

TB HIV Care’s mobile clinics operate in several South African cities under the Step Up programme.

Following community backlash in Wynberg over needle services, municipal officials requested that the mobile clinic be suspended in that area.

In 2018, the eThekwini municipality also closed TB HIV Care’s program for two years, despite agreements that the organisation had with the Kwazulu-Natal government.

In Wynberg the shutdown lasted four months before Western Cape Premier Alan Winde intervened. He informed local officials that sterile needle programs are an explicit part of the provincial government’s strategy for reducing HIV transmission, and need to be supported.

GroundUp spoke to several heroin users in Wynberg, most of whom are homeless, about the impact of the temporary closure.

Abu Talib, who is in his thirties and originally from Hanover Park, said the suspension of the program affected people “badly”, because they were increasingly “using each other’s needles”. This was repeated by other users in the area, some saying that they increasingly resorted to taking used needles “off the floor”. (Talib says he chose to buy needles from the pharmacy).

TB HIV Care CEO Professor Harry Hausler said, “It’s almost certain that the [suspension of the program] would have increased HIV and hepatitis C transmission, so from a health perspective it was the wrong decision to make”.

A second health consequence was the uptick in skin infections. Lee-Earl Veldsman, who has been homeless for seven years, said that the temporary closure of the program “affected me because I had to reuse old needles”. These were single-use needles, which became increasingly blunt. Injecting with them “damages your skin and veins”, said Veldsman. “It’s damn sore.”

When TB HIV Care returned to the area, its health workers noticed that an unusually large number of beneficiaries had abscesses on their arms. Nobahle Madolo, a professional nurse who works at the mobile clinic in Wynberg, said that if such abscesses go untreated people “can end up with an arm amputation”.

Lee-Earl Veldsman at the TB HIV Care mobile clinic site in Wynberg.

Backlash

In recent years, some Wynberg residents grew increasingly frustrated with needles littering their environment and open drug use. They blamed the mobile clinic.

Ward 63 Councillor Carmen Siebritz (DA) told GroundUp that she and her constituents wanted to terminate the needle exchange service because of “the adverse effects it has on anyone and everyone either residing in the area or moving through it”.

Siebritz did not elaborate on what these adverse effects were, though she stated that the sharing of needles was not being curbed by TB HIV Care, and raised several concerns about drug use in the area.

“Users are seen sitting on sidewalks, in front of people’s homes, in front of businesses and in fact just about anywhere, injecting themselves and openly sharing their needles,” said Siebritz. “The net result also [is] that these needles are left behind in the streets, leaving non-users at risk.”

Things came to a head at a Local Drug Action Committee meeting in November chaired by Patricia van der Ross, mayco member for community services and health.

Mfezi Mcingana, a program director at TB HIV Care who was present at the meetings, said, “It was explained that there has been some complaint from the community about needles lying around, and based on [these concerns], we should pause providing services in Wynberg.”

Curiously, the resolution was not simply that TB HIV Care should halt the needle service, but that they “should not actually go to the area”, according to Mcingana.

Hausler says that shortly after this he corresponded with officials from the metro and City health services, who had jointly “sent a request to suspend the service for three months”.

Van der Ross confirmed to GroundUp that following community complaints, “TB/HIV Care was asked to suspend the needle exchange programme.”

She said this was “in a bid to manage the situation, and find common ground”. She denied that they requested the closure of the entire program.

“The concern was the needle exchange programme, and the request was for that to be suspended,” she said.

GroundUp has seen a letter which local officials sent to TB HIV Care and it appears to request the suspension of the entire mobile clinic.

The letter, signed by City and metro health services officials on 22 November, proposes that TB HIV Care “temporarily pause the programme and shift the support for the PWID [people who inject drugs] to Mowbray or another site managed by TB HIV Care where the programme appears to operate well”.

It does not single out the needle services specifically, nor does it say that the organisation should continue with the rest of its health programming in Wynberg.

After the suspension began, a “Wynberg working group” was established, which included the City and metro health departments, ward councillors and TB HIV Care.

Hausler says that by February, three months after the suspension began, the working group agreed that the mobile clinic would resume operations in Wynberg but that they should not provide needles.

In response, Hausler raised the issue at the provincial council on AIDS and TB, chaired by Alan Winde (Hausler was co-chair at the time).

In late-March, Winde sent a letter to Mayor Geordin Hill-Lewis requesting that local officials support the provincial implementation plan for preventing HIV, TB and STIs. He stated that this included needle-syringe exchange services.

Winde’s spokesperson, Regan Thaw, told GroundUp, “The Premier did not believe the programme should be discontinued given the important work it does in preventing the spread of HIV-AIDS, which is backed by research.”

By April, the full service was re-established, though as a compromise the mobile clinic has now been operating from western Wynberg, just outside Siebritz’s ward.

Emile Abrahams shows a bucket full of used needles discarded by clients at the mobile clinic in Wynberg. It’s one of more than 40 buckets the organisation collects from sites around the city every week.

Litter bugs

Asked about the littering of syringes, Hausler said, “I think it’s completely natural for community members to feel uncomfortable if they see needles in their environment.”

“What we’ve done throughout our programming is that we provide our beneficiaries with portable sharps containers … You can dump your needles in there and then once you lock it you can’t open it again.”

People can keep these containers in their pockets, says Hausler, and provide them back to the mobile clinic when they fetch their new needles.

GroundUp visited the current mobile clinic in western Wynberg, which operates from a parking lot. Most beneficiaries appeared to have sharps containers or bags full of used needles when they arrived. They would then discard these in specialised yellow bins provided by TB HIV Care, before they were given a fresh pack.

GroundUp did nonetheless spot littered needles close to the mobile clinic, which could pose a hazard to residents. Of course, people are not going to stop using drugs or littering if the program disappears.

Hausler says that the organisation does regular cleanup drives at all its sites and that “if people see needles distributed somewhere, they can call our hotline and our team will go out specifically to that area and pick them up.” The number is 079 589 8834.

Beyond cleanup operations and sharps containers, there are also institutional issues which need to be resolved in order to prevent littering of needles, according to staff at TB HIV Care.

Loraine Moses, who oversees quality standards at the organisation, says that its staff constantly encourage its beneficiaries to keep their used needles in sharps containers, and return them to the mobile clinic. However she says they’re less likely to do this when the authorities arrest or harass users for having needles in their possession.

Police often search people who use drugs, says Moses, and if they “find needles they will be arrested”. As a result, users frequently drop used needles on the floor when they see police nearby.

A police spokesperson previously told GroundUp that “possession of needles is not a criminal offence. Therefore, we cannot arrest a person [for] possession of needles, and neither can we confiscate needles”.

However, such incidents appear to be fairly common. Rozelle Prouse, who records the testimonies of drug users at the Wynberg mobile clinic, said that people often reported that authorities confiscated their injection equipment or locked them up for carrying needles.

“That’s the main reason the clients get arrested,” she said.

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