It is never pleasant to find litter of any sort in public spaces. Used needles raise many fears and concerns. To reduce the discarded needles, we need a collective effort from all community stakeholders.
The data proves beyond doubt that supplying sterile injecting equipment to people who use drugs has many positive impacts, including:
1.Reducing the spread of HIV and hepatitis C.
2.Improving access to healthcare and increasing the treatment of TB, HIV and HCV.
3.Preventing numerous deaths and hospitalisation due to infective endocarditis, sepsis and related issues.
4.Enables people to reduce drug use, access services and contribute to their communities.
5.Improves the quality of life of people who inject drugs and the communities they live and congregate in.
6.REDUCES the number of needles compared to areas with no services.
The data proves beyond doubt that supplying sterile injecting equipment to people who use drugs has many positive impacts, including:
1.Reducing the spread of HIV and hepatitis C.
2.Improving access to healthcare and increasing the treatment of TB, HIV and HCV.
3.Preventing numerous deaths and hospitalisation due to infective endocarditis, sepsis and related issues.
4.Enables people to reduce drug use, access services and contribute to their communities.
5.Improves the quality of life of people who inject drugs and the communities they live and congregate in.
6.REDUCES the number of needles compared to areas with no services.
Why do people who inject drugs discard needles in public spaces?
Because carrying a used needle puts them at risk of arrest, being targeted and stigmatised, and there are no bins to dispose of used needles.
Solution 1: Stop arresting people in possession of needles and stop harassing people for having needles on them.
Solution 2: Put in sharps bins at convenient places. All over the world, where there are bins, fewer syringes are lying around.
Solution 3: Create supervised consumption spaces where people who use drugs can consume drugs with medical support and can access services including help to resolve their drug dependence.
Why don't people who inject drugs care about keeping spaces clean, why are they aggressive, and why don't they listen?
People who use drugs and are street-dwelling are highly stigmatised, unwanted, targeted and excluded from society and spaces. They are harassed, constantly arrested without cause, beaten by security and sworn at by residents. Why would they treat the spaces they are chased from and abused in with any respect?
Solution: Treat all people within your geographical domain as community members with the right to dignity. Get to know each other.
The needle and syringe programme is attracting drug users to the area.
Service sites are established through a mapping process before they begin. The services are established where the need is. There may be an increase in an area due to increasing numbers of people injecting and because of changing socio-economic conditions. Marginalised and street-dwelling people migrate to areas of economic opportunity and where their peers are. People move to certain areas because they need money and the protection of their peers. Another reason is that the neighbouring areas chase them out of their areas towards other areas.
Solution: Increased services in all areas to stop migration when it does occur. All suburbs should consider the disadvantaged members of their community as legitimate members of the community. The community should try and accommodate their local indigent population.
Don't needle services cause more needles to be discarded in our area?
People use drugs for many reasons. For people living on the street, the benefits usually outweigh the negatives. Without needle services, people will still inject drugs. But now they would have to earn more to buy them, or some people will steal them. They would also have nowhere to throw them away. They would also not get any help with their drug dependence or education about disposing of needles. There would also be no clean-ups.
Research has shown that this results in a reduction of dirty needles in public spaces in most cases.[i] People who receive services are more likely to get the support they need and reduce their anger, mistrust and aggression. As a result, studies have shown up to 8 times fewer needles in public spaces in cities with needle and syringe services than without.[ii]
Solution: Provide a broader coverage of services and include funding for personal sharps packs and peer-led pick-ups. Based on years of evidence in the real world and academic research, harm reduction services protect the community of people who use drugs and the communities they are part of.
But can't one needle from a user lying in a park result in many people getting HIV?
No. there has never been one confirmed case of HIV being transmitted from a used needle lying in the street or outside a healthcare setting. HIV is very unstable and does not last long outside the body.
How can we stop people from defecating in public spaces?
Going to the toilet in a public space is not a choice people would easily make. No toilets are available for someone living on the street, so they have to go to the toilet on the street. If anyone else were excluded from public toilet access, they would also use the street. It is not pleasant for anyone, including the people living on the street.
Solution: Make more public toilets available and use the homeless population to help clean and manage them. The peer management of public facilities and spaces has worked in many other settings.
Needle Services are not going away. Needles services are described in the National Drug Master Plan and are a legal requirement in the response to drug use. The consequences of not having them are significant and will impact all South Africans. There will be increases in people using drugs and homelessness due to economic hardships, unemployment, trauma, and other socio-economic factors. The needle services are not going away, but through collaboration and consultation, solutions can be found.
We can significantly reduce discarded needles and the associated problems.Resolving the community's issues and anti-social behaviour needs people to collaborate and understand the problem. People or organisations are not prepared to support evidence-informed and proven practical solutions, it can be argued, are complicit and part of the problem.
Solutions
- Install sharps bins in public spaces.
- Stop arresting people for possessing used paraphernalia, including needles and syringes.
- Motivate for increased coverage of needle services, mobile services and safe consumption spaces.
- Work with networks of people who use drugs to engage with the local people living on the street and help organise clean-ups.
- Acknowledge that people who inject drugs are dying because of the lack of sterile injecting equipment leading to needle sharing and re-use of non-sterile needles. Re-using needles results in abscesses and sepsis, endocarditis, HIV, HCV and other infections. Their mortality rate is significantly higher than the general population. There has not been a single recorded death in the world due to a needle injury due to a discarded needle from an injecting drug user.
- Recognise that all people who spend a large part of their day in the community are part of the community. If they are engaged and basic needs are met, many issues will resolve naturally.
- Establish a peer group to liaise with and discuss any issues and resolve them collaboratively.
- Work with local networks of people who use drugs and service providers to ensure regular clean-ups. Establish a communications channel for the community to report needles for collection.
- Support the rights of all community members and encourage services for marginalised people, including consumption spaces.
- Support the decriminalisation of people who use drugs.
[i] Oliver KJ, et al (1992) Impact of a needle exchange program on potentially infectious syringes in public places. Journal of Acquired Immune Deficiency Syndromes
[ii] Tookes, H. E., Kral, A. H., Wenger, L. D., Cardenas, G. A., Martinez, A. N., Sherman, R. L., … Metsch, L. R. (2012). A comparison of syringe disposal practices among injection drug users in a city with versus a city without needle and syringe programs. Drug and Alcohol Dependence, 123(1-3), 255–259. http://doi.org/10.1016/j.drugalcdep.2011.12.001
We don't want needles in public spaces. Needles in public spaces