Harm Reduction: Common sense or nonsense

Tara Gerardy and Mr Fergus Ashburner joined Benito Vergotine in studio on Tuesday 27 September to discuss Harm Reduction.

Listen to the conversation here: Harm Reduction addressing drug usage in Western Cape

On the 17th of September, 100 health care workers, social workers and people from the
general community attended a social responsiveness event hosted by the Division of
Addiction Psychiatry at the University of Cape Town as part of their Social Responsibility
activities, held at Valkenberg Hospital in Cape Town, which highlighted the need for South
Africa to adopt an evidence-based approach to managing the harms related to drug use,
because traditional approaches have failed.
Dr Andrew Schiebe, TB HIV Care, Technical Advisor, started the conversation with the
reminder that “harm reduction is an approach that is aligned to medical ethics, protects
human rights and is a patient-centred approach that can be used to reduce the harms
related to drug use”.
Drug use, including of heroin (also known as nyaope or whoonga) and methamphetamine
(known as Tik or crystal meth), is increasing in South Africa. This is despite huge
investments in the punitive, law enforcement-based approaches known as the ‘war on drugs.
There is global and local evidence showing the negative health impacts of the war on drugs.
This is in addition to the high levels of incarceration for people who use drugs, which
generally has negative impact on their health, their drug use, their engagement in criminal
activities and their future prospects. Other ineffective strategies are those that solely rely on
abstinence, or are purely prohibitionist in focus. About 90% of people with a heroin use
disorder who go through a detoxification programme in South Africa will reuse heroin within
a year. Harm reduction is an alternative to these ineffective, and often harmful approaches.
Shaun Shelly, coordinator for the South African Network of People Who Use Drugs
(SANPUD) challenged the delegates on the “need to advocate for the decriminalisation of
drug use as it is a cause of many of the health and social problems that are currently
experienced and are related to drug use”.
Harm reduction has been implemented in South Africa for several years, and the evidence of
its effectiveness is increasing.
Dr Sibeko the head of the Division of Addictions at the Department of Psychiatry at the
University of Cape Town saw the hosting of the engagement session around harm reduction
as reflecting the support for interventions that work, and do good, not harm for people who
use drugs and the wider community. “By involving TB HIV Care, an organisation at the
vanguard of South African harm reduction, and people who use drugs, links between health
service providers, civil society and people were highlighted in this event”.
The programme included a range of speakers working in the field of harm reduction,
including technical advisors, policy experts and programme managers working at TB HIV
Care, psychiatrists working at Groote Schuur and Stikland Hospitals, health worker trainers
and people who use drugs. The programme provided insights into the increasing harms of
drug use and the need for harm reduction.
“Harm reduction works. This is because it aligns with ethical principles and meets people
where they are at. I hope that this is something that all health providers will embrace. I
believe that stigma and discrimination towards people who use drugs can be changed, and
that South Africa can scale-up these important services. We can no longer ignore the need
to offer effective and compassionate services to people who use drugs. We need to act.
Portugal decriminalised drug use and are benefiting as a result. Kenya is scaling up their
harm reduction services, and we should follow suit.”
Andrew Scheibe, TB HIV Care, Technical Advisor
Notes on Harm Reduction
Harm Reduction International defines harm reduction as “policies, programmes and
practices that aim to minimise negative health, social and legal impacts associated with drug
use, drug policies and drug laws. Harm reduction is grounded in justice and human rights – it
focuses on positive change and on working with people without judgement, coercion,
discrimination, or requiring that they stop using drugs as a precondition of support.”