In November 2023 there was a significant backlash about the provision of harm reduction services, specifically needles and syringes, in Wynberg East, Cape Town. Here are links to some of the media and conversations. 

The following are podcasts from the last few weeks...
https://omny.fm/shows/capetalk/sa-drug-policy-week
https://soundcloud.com/powerfm987/powerperspective

Watch this amazing video from Bhekisisa on how methadone can transform lives. Methadone services are offered alongside the needle and syringe services. It is often the need for sterile and new needles that brings people who inject drugs into contact with treatment services.

On the 21st of February 2018, an article was published in Durban's Daily News. The article contains a number of claims that are not true or misleading. This is TB HIV Care's response:

We are a non-profit organisation that aims to prevent, find and treat TB and HIV and other major diseases. TB HIV Care’s work includes programmes that prevent HIV through voluntary medical male circumcision, that offer HIV testing services in public health facilities and in communities, and that provide treatment support for people living with TB and HIV.
 
We have also always been committed to providing healthcare to marginalised members of society who might not otherwise have access to care. As part of this work, we distribute needles and syringes to people who inject drugs as part of a package of services through our Step Up Project. This is done to mitigate their risks of blood-borne diseases such as HIV and hepatitis C. The Step Up Project adheres to strict protocols and waste management practices to minimise the risks of anyone being exposed to used needles. This is a carefully considered response based on science, research data and compassion in the face of the HIV and hepatitis C epidemics that affect all South Africans.
 
In the incident on the 22nd January, a freak storm wave washed inappropriately discarded needles onto Durban’s North beach. Within 40 minutes the municipality response team – trained by and using equipment supplied by TB HIV Care’s Step Up Project – had responded. Shortly afterwards they were joined by members of the NGO response team and within two hours the risk was removed. We have continued to perform twice weekly sweeps of the area to ensure that there are no further incidents.
 
We distribute sterile injecting equipment to our service users in a responsible manner and take every measure to ensure that these needles and syringes are returned to us or are safely disposed of. When needles and syringes are given out to service users, we provide health education including the importance of returning the needles, and safe ways to dispose of needles. We strongly encourage, and incentivise, service users to return the needles to us. We also provide our service users with portable ‘sharps’ containers, from which used needles cannot be extracted once inserted. Used needles are kept in these containers until they can be returned to us to be disposed of safely and in line with medical waste disposal guidelines. In addition to the above, we conduct regular cleaning operations in public areas where we know people inject drugs to remove any needles that may have been discarded inappropriately.
 
These services are just part of the package of care the Step Up Project provides and that have been recommended by the World Health Organisation and the United Nations Office on Drugs and Crime as a way of reducing harms associated with drug use. Eighty other countries around the world operate similar needle and syringe programmes because of their effectiveness in reducing the transmission of disease. The services provided are recommended by South Africa’s National Strategic Plan for HIV, TB and STIs 2017-2022 and the Department of Health has confirmed that the provision, collection and disposal of sterile injecting equipment as part of HIV and viral hepatitis prevention services targeting people who inject drugs is in line with national policies and legislation.
 
The Step Up Project’s package of care for people who inject drugs in Durban also includes HIV counseling and testing, screening for TB and sexually-transmitted infections, basic wound care, social support and opioid substitution therapy (OST). OST is one way for people who use heroin to cope with withdrawal should they decide to stop taking the drug. It is a highly effective way for people who use drugs to build some stability in their lives so that they can approach issues like finding employment or reintegrating with their families.
 
Two of the greatest barriers to the safe return of used needles are the fear of being found carrying needles by law enforcement agencies and arrested, and the lack of specialised ‘sharps’ bins in public areas where needles could be disposed of safely.
 
We believe that a collaborative, compassionate approach between all parties would help us create an environment in which there is less risk of needles being discarded inappropriately, and where everyone feels safer.  We look forward to working with the City and all its people to find creative, inclusive solutions for a safer city.

Response to Daily News articles, ‘Syringe disposal in the spotlight’ and ‘City investigates dumping company’

TB HIV Care shares the City of eThekwini’s interest in creating a safe, healthy and inclusive city.
 
We are a non-profit organisation that aims to prevent, find and treat TB and HIV and other major diseases. TB HIV Care’s work includes programmes that prevent HIV through voluntary medical male circumcision, that offer HIV testing services in public health facilities and in communities, and that provide treatment support for people living with TB and HIV.
 
We have also always been committed to providing healthcare to marginalised members of society who might not otherwise have access to care. As part of this work, we distribute needles and syringes to people who inject drugs as part of a package of services through our Step Up Project. This is done to mitigate their risks of blood-borne diseases such as HIV and hepatitis C. The Step Up Project adheres to strict protocols and waste management practices to minimise the risks of anyone being exposed to used needles. This is a carefully considered response based on science, research data and compassion in the face of the HIV and hepatitis C epidemics that affect all South Africans.
 
In the incident on the 22nd January, a freak storm wave washed inappropriately discarded needles onto Durban’s North beach. Within 40 minutes the municipality response team – trained by and using equipment supplied by TB HIV Care’s Step Up Project – had responded. Shortly afterwards they were joined by members of the NGO response team and within two hours the risk was removed. We have continued to perform twice weekly sweeps of the area to ensure that there are no further incidents.
 
We distribute sterile injecting equipment to our service users in a responsible manner and take every measure to ensure that these needles and syringes are returned to us or are safely disposed of. When needles and syringes are given out to service users, we provide health education including the importance of returning the needles, and safe ways to dispose of needles. We strongly encourage, and incentivise, service users to return the needles to us. We also provide our service users with portable ‘sharps’ containers, from which used needles cannot be extracted once inserted. Used needles are kept in these containers until they can be returned to us to be disposed of safely and in line with medical waste disposal guidelines. In addition to the above, we conduct regular cleaning operations in public areas where we know people inject drugs to remove any needles that may have been discarded inappropriately.
 
These services are just part of the package of care the Step Up Project provides and that have been recommended by the World Health Organisation and the United Nations Office on Drugs and Crime as a way of reducing harms associated with drug use. Eighty other countries around the world operate similar needle and syringe programmes because of their effectiveness in reducing the transmission of disease. The services provided are recommended by South Africa’s National Strategic Plan for HIV, TB and STIs 2017-2022 and the Department of Health has confirmed that the provision, collection and disposal of sterile injecting equipment as part of HIV and viral hepatitis prevention services targeting people who inject drugs is in line with national policies and legislation.
The Step Up Project’s package of care for people who inject drugs in Durban also includes HIV counselling and testing, screening for TB and sexually-transmitted infections, basic wound care, social support and opioid substitution therapy (OST). OST is one way for people who use heroin to cope with withdrawal should they decide to stop taking the drug. It is a highly effective way for people who use drugs to build some stability in their lives so that they can approach issues like finding employment or reintegrating with their families.
Two of the greatest barriers to the safe return of used needles are the fear of being found carrying needles by law enforcement agencies and arrested, and the lack of specialised ‘sharps’ bins in public areas where needles could be disposed of safely.
We believe that a collaborative, compassionate approach between all parties would help us create an environment in which there is less risk of needles being discarded inappropriately, and where everyone feels safer.  We look forward to working with the City and all its people to find creative, inclusive solutions for a safer city.

• Prof Harry Hausler, CEO of TB HIV Care, is an HIV clinician and preventive medicine specialist with 25 years of international public health experience in implementing and evaluating tuberculosis, HIV and comprehensive health programmes.