The Western Cape MEC for Health, Prof Nomafrench Mbombo, opened a drop-in centre for people who inject drugs in central Cape Town on Wednesday, the 4th December 2019. The centre, run by NGO TB HIV Care’s Step Up Project, is part of a recent approach to people who use drugs that seeks to reduce the harms associated with disordered substance use instead of demanding abstinence. The Step Up Project has already provided support to over 900 people in the greater Cape Metro.

People who inject drugs are at particular risk for blood-borne infections such as HIV and hepatitis B and C, as well as facing the dangers that come with social marginalisation as a result of the criminalisation of drug use. The Step Up Project aims to reduce these risks by providing a package of wellness services which includes sterile injecting equipment, opioid substitution therapy, HIV testing and screening, and psychosocial services.

The drop-in centre itself is not new. A similar space has been operating in Woodstock for the past two years. However the new location in central Cape Town brings the services closer to the people accessing them, many of whom are living on the streets of Cape Town’s inner city.

The teams have had more than 10 000 contacts with service beneficiaries, which range from providing health education to testing people for HIV and starting them on antiretroviral treatment. Nearly 9000 ‘harm reduction packs’, which contain sterile injecting equipment, have been distributed.

‘That may seem like a lot of needles in the environment, but we need to think of each of them as a potential infection averted.’ Said Prof Harry Hausler, CEO of TB HIV Care, at the launch ‘Our clients are also provided with portable ‘sharps’ containers to store their used needles safely until they can return them to us and we undertake regular outreaches to pick up used needles that have been discarded inappropriately.”

Speaking about the importance of reaching vulnerable populations, which will enable South Africa to reach goal three of the National Strategic Plan for HIV, TB and STIs 2017-2022 ‘leave no one behind’ as well as echoing the 2030 Agenda for Sustainable Development Agenda which “endeavour(s) to reach the furthest behind first.”, MEC Mbombo mentioned the strides the Western Cape has made in reaching marginalised groups such as people who inject drugs, as well as sex workers, men who have sex with men, transgendered people and inmates in correctional centres

Naomi Burke-Shyne, Executive Director of Harm Reduction International NGO dedicated to reducing the negative impacts of drug use and drug policy, commented on how encouraged the international community is by developments in subSaharan Africa, “To see government represented in the room today, supporting this initiative, is inspiring.”

Stigma surrounding HIV remains a ‘serious barrier’ to adherence to care and treatment, according to the Human Sciences Research Council (HSRC). However the Khayelitsha community took steps to end stigma and support the 16 days of activism against violence against women and children this World AIDS Day by inviting Cape Town to participate in the Red Lace Race – a free, five km fun run  held on Saturday, the 30^th November aimed at promoting healthy, positive living, no matter one’s HIV status.

The Red Lace Race (so named because every participant gets a pair of red shoe laces symbolising the AIDS awareness ribbon) has the slogan ‘Masibaleka sonke, masiphile sonke’ – ‘Let’s run together, let’s thrive together’ and is the result of a number of partnerships. Launched last year by non-profit organisation, TB HIV Care, and the Khayelitsha Running Club, the Red Lace Race this year sees the addition of the Khayelitsha Health Forum, the City of Cape Town, and Top Events to the organising committee, along with several other partners – the Government Communication and Information Systems, the Centre for Infectious Disease Research in Africa, Epilepsy SA, Parliament, the Western Cape Association for Persons with Disabilities, and faith based-communities.

Ndibongo Mzanywa, of the Khayelitsha Health Forum, believes the event is important for Khayelitsha “This kind of event can change the style of World AIDS Day events. We are focusing on defeating stigma by making the event about a healthy lifestyle – socialising, networking and physical fitness, rather than just speeches. Anyone can improve their health, whatever their HIV status.”

At the end of October 2019, the HSRC released the full report from their ‘South African National HIV Prevalence, Incidence, Behaviour and Communication Survey, 2017’ which measures several indicators of HIV-related stigma. According to this report, stigma has declined since 2002, but remains ‘a significant challenge’, especially since the HIV prevalence rate was 14% of the South African population and 26,4% of individuals between 25-49 years in 2017.

“Stigma leads to people not getting the help they need. People don’t test, or don’t start or continue treatment because they are concerned about what other people will say.” Says TB HIV Care Programme Executive, David Mametja.

“We need to remember that a supportive community is a healthier community. People who are supported by others and take their treatment consistently soon become virally suppressed, which means they can’t transmit HIV. All of us, churches, sports clubs, stokvels and schools need to get behind the idea that we should be supporting people to take good care of their health. That includes taking their chronic medication, whether it is high blood pressure pills or ARVs.”

On Wednesday, Western Cape Premier Alan Winde, who is also the Chairperson of the Provincial AIDS Council, announced that he would undergo an HIV test and the associated counselling, in the run-up to World AIDS Day.  The aim was to encourage people to take responsibility for their health, and find out their status

TB HIV Care were invited to be a part of the event and were represented by Prof Harry Hausler (CEO), Ellenize Harribi (Professional Nurse Counsellor), Glenn Bradley (Internal Communications Coordinator) and Anelisiwe Piliso (Communications Intern).  Media present included the Cape Argus, and Cape Town TV.

Ellenize set up the testing environment, conducted the pre-test counselling and oversaw the testing process. The test was administered by the Western Cape Minister of Health, Dr Nomafrench Mbombo.

Dr Nomafrench reiterated the purpose and message behind the occasion.

“The message today is not about the outcome, whether you are positive or negative.  The purpose is about getting tested.”

Prof Harry Hausler was interviewed by Cape Town TV and was asked about general HIV statistics and HIV self screening. He had the following to say about the event:

“It’s really great to see the leadership in this province being involved in speaking about HIV and raising awareness about it and leading by example by getting tested for HIV.”

You can view a video on the event here.