A pilot project that aims to enhance existing services that reduce the harms associated with substance use among people who live on the street has been launched in the Cape Town Central City.
The pilot is a result of the TB HIV Care’s Step Up Project teaming up with the Cape Town Central City Improvement District (CCID).
According to Pat Eddy, manager of CCID Social Development: “The challenge that often arises with people who live on the street, some who may be dependent on opioid drugs such as heroin, is they have some difficulty fitting in within a structured environment such as a shelter, as one must adhere to the rules needed to maintain order. As a result, some shelters are reluctant to admit substance users onto their premises.
“The question then becomes: ‘What happens to these individuals who become alienated?’ And that’s precisely what the partnership between the CCID and TB HIV Care aims to address. We hope to reduce harm and change behaviour so that those battling with substance use that affects their wellbeing can improve their lives.”
Key populations project coordinator at TB HIV Care, Rudolph Basson, shares Pat’s sentiments: “People who use drugs and live on the street are likely to have been alienated by other service providers insisting that they cease drug use prior to accessing care.
“The Step Up Project provides people who inject drugs (PWID), with harm reduction, HIV prevention and wellness services, based on the World Health Organisation’s recommendations. This includes the provision of sterile injecting equipment and the safe collection and disposal of used equipment, as well as offering HIV testing and other medical services, including opioid substitution therapy (OST).
“By taking a stance, respectful of individual choice and neutral on the issue of drug use, the harm reduction approach allows for an invaluable initial contact and allows for trusting therapeutic relationships to be established with people who use drugs.”
Essentially, OST involves providing people who are dependent on opioid-type drugs with medication which replaces the illicit drug as part of a structured treatment programme.
Rudolph explains: “Individuals who are dependent on heroin, typically have to use it every few hours to avoid suffering withdrawal symptoms such as nausea, diarrhoea, and significant physical discomfort. The organisation offers methadone, a daily oral medication, as part of its broader programme. Methadone subdues withdrawal, without creating euphoria or what is commonly referred to as a ‘high’.
“OST allows the individual to work on improving their life circumstances, rather than being trapped in a constant routine of sourcing money to purchase drugs and using substances to avoid agonising withdrawal.”
The collaborative pilot, facilitated by the partnership between the CCID and TB HIV Care’s Step Up Project, aims to support existing services. The initiative commenced in February 2018 and will continue for six months. Ten individuals are currently participating and over the next three months, an additional ten individuals are anticipated to enrol. Upon conclusion of the pilot, the CCID and TB HIV Care will evaluate project outcomes and establish the appropriate way forward.
Rudolph elaborates: “The partnership with the CCID has enabled us to expand our services to include life skills training, psychosocial services, art therapy, technical skills development and community engagement. As part of community engagement, participants offer their time as a community service for local businesses and projects and, for some participants, this has already led to securing full-time employment. We are particularly excited about this development, as we believe it could change the way people who use drugs are viewed and mend relationships.”
With regard to fears and scepticism that some members of the public have about the pilot project, Rudolph says: “Most people are in favour of interventions that assist individuals using illicit drugs to turn their lives around.
“Ultimately, the Step Up Project strives to demonstrate the feasibility and effectiveness of providing a holistic package of harm reduction services for PWID in the South African context and we are advocating for domestic funding of these evidence-based activities. By scaling up needle and syringe services, OST, psychosocial support and employment opportunities, we can provide people with effective support for their heroin use, thereby allowing them to reintegrate into their communities and become active participants in the economy, in addition to reducing the risks associated with injecting. This is important from medical and social perspectives, as such activities reduce HIV and hepatitis C virus infection and the associated health care costs. Our services also support social inclusion and reduce crime. This partnership with the CCID that enables us to provide this extended package of services further strengthens our work towards that vision.”
Images by TBHIV Centre