About South Africa & context

History and development
South Africa is a nation of diversity, with a wide variety of cultures, languages and religious beliefs. Africans are the majority in the country (79.2%), followed by coloured and white people (8.9% each), Indian/Asian (2.5%), and other groups (0.5%) (StatsSA 2016). The 1977 constitution recognises 11 official languages, but English is South Africa's lingua franca, and the primary language of government, business and commerce. 

South Africa is a newly industrialised country, ranked as an upper-middle income economy by the World Bank. Despite having the seventh highest per capita income in Africa, poverty and inequality are still widespread. In 2010, 54% of the population lived below the national poverty line.

Inequality has strong roots in South Africa’s colonial past and the apartheid regime (1948-1994). It is this racial and economic disparity that frequently defines the limits of what constitutes a ‘vulnerable community’ (Howell and Couzyn 2015).

Drug use
In the last 10 years, the production, distribution and use of illegal drugs in South Africa has steadily increased. The opening of South Africa’s borders after the end of the apartheid regime has radically changed the drug scene. It brought new actors and markets, and increased drug trafficking, and organised crime (Haefele nd, Blackmore 2003).

Nowadays, the country is an established producer and exporter of amphetamine type stimulants and is part of global cocaine trading routes (UNODC 2015). This scenario, together with a context of poverty, lack of education and unemployment, has led many youths to work in drug trafficking.

Following cannabis, amphetamines and cocaine are the most prevalent drugs in the country (UNODC 2014a, 2015). Preferred drugs vary in the different regions. Methamphetamine is popular in the Cape Town region, while the combination of heroin and cannabis is popular in the Gauteng province (and Pretoria), and spread over the lower income population.

This special mixture is locally called whoonga, cocktail or nyope. Heroin is usually smoked in this way, but NSP programmes and drug treatment services have seen an increase in injecting use. Besides heroin, people also inject cocaine, methcathinone, methamphetamine, and over-the-counter medicines (slimming tablets, analgesics, codeine and benzodiazepines). 

Not much specific data is available in South Africa regarding PUD, but small-scale studies have been popping up recently. 

A study in Cape Town (Meade et al. 2015) with 360 methamphetamine users found an average of 7.06 years of use, and high levels of drug dependency (90% according to ICD-10 standards). Only 10% of these users had received drug treatment previously, although 90% said they wanted it.

Another recent study estimated a number of 65,000 PWID in South Africa (Scheibe et al., 2016). The study was made with 450 PWIDs in five South African cities (Centurion, Pretoria and Johannesburg, Durban and Cape Town). Half of the PWIDs had already experienced an overdose, and over 75% of men and about half the women had been in prison.

HIV and TB
South Africa has the largest HIV epidemic in the world (PFIP, 2012) and, at the same time, it hosts the world’s largest HIV treatment programme, with more than 3 million people receiving antiretroviral treatment at the end of 2014 (UNAIDS, 2016). Currently, PWID prevalence for HIV (14%) is lower than for the general population (18%), but the increase in injection use and the lack of support for this population raises serious concerns (Sheibe et at. 2016).

South Africa has the third highest TB burden. It is estimated that 80% of the South African population is infected with the TB bacillus, even though not all develop the disease. PUD, smokers, PLHIV and people who are malnourished, are among the groups with higher vulnerability to progress from TB infection to TB disease (SANAC 2016). TB incidence in South Africa has increased by 400% over the past 15 years, making South Africa the country with the highest incidence of TB in the world.

Harm reduction in South Africa
In South Africa, there is the Department of Social Development, through the Central Drug Authority, which is responsible for drug policies and drug treatment. Drug response focus on 3 areas: demand, supply and harm reduction.

Despite constitution and legislation around drug policies being progressive in South Africa, practice does not follow the same pace due to the disconnect between the written documents and policy implementation. Despite a legislation supporting harm reduction, there have been upheavals against harm reduction projects in communities, and the programmes still lack support from governmental actors. International support for harm reduction, however, is promoting rapid changes.

Currently, there are 3 NSP projects in 3 key cities (Cape Town, Durban and Pretoria), all supported by Mainline and other international donors. With the advocacy role of our partners, a new NSP project will start in Port Elisabeth 2017, while current NSPs will be up scaled and/or will develop new activities. Advocacy with government and other partners also brought new pilots for OST treatment in the 3 cities.

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