TB & HIV implementing partner awarded Elton John AIDS Foundation grant.
CAPE TOWN, 7 NOVEMBER 2025: In June, a three-year grant from the Elton John AIDS Foundation launched a national initiative led by TB HIV Care (THC) to unite public health and legal experts, civil society, policymakers, and people with lived experience. The goal: to develop evidence-based legal and policy models on harm reduction tailored to South Africa’s context. South Africa faces a dual crisis at the intersection of public health and criminal justice. Peer-reviewed estimates suggest that approximately 67,000 people inject drugs in South Africa, with women accounting for about one-fifth to one-quarter of this population (1). The 2023 police data shows that drug-related offences still account for more than a quarter of all arrests nationwide (2). These figures underscore a system overwhelmed by criminalisation rather than supported by health-based care.
Underpinned by THCs harm reduction capacity building agenda for the PWUD sector, this nationwide initiative aligns with the National Drug Master Plan (NDMP) 2019-2024 and the draft Prevention and Treatment for Substance Use Disorders Policy. It aims to strengthen the PWUD sector and advance a coordinated national strategy promoting public health-based alternatives to punishment. The criminalisation of minor drug possession fuels congestion in South Africa’s justice system, with thousands arrested each year for drugs intended for personal use. This diverts vital police and judicial resources from serious crimes and entrenches cycles of poverty, incarceration, and stigma. Despite its stated rehabilitative intent, policy remains punitive, casting people as both patients and criminals. The result is an overburdened court and prison system and a public health crisis worsened by stigma and reduced access to care. Evidence shows that punitive drug laws fail to curb use or harm; instead, they deepen them.
“It is encouraging that our country’s policies relating to health issues and drugs is being increasingly informed by local evidence and practice that focuses on the health and well-being of all people, aligning with best practice and global norms,” says Dr Andrew Scheibe, Technical Advisor at TB HIV Care.
Global evidence shows that decriminalisation, when coupled with robust health systems and harm reduction services, delivers measurable results. In Portugal, reforms introduced in 2001 led to a 93% reduction in new HIV infections among people who use drugs and a sharp decline in overdose deaths (3). Similarly, Ghana’s 2020 Narcotics Control Commission Act shifted the national focus from punishment to treatment, resulting in higher uptake of health services and reduced rates of reoffending (4).
“Whereas other countries’ reforms have often been top-down, South Africa’s opportunity is rooted in grassroots understanding,” said Mfezi Mcingana, Programme Director, Key Populations at TB HIV Care. “This initiative bridges lived experience with policy reform, ensuring that those most affected are also those leading the call for change,” Mcingana said.
People who inject drugs (PWID), for example, experience some of the country’s highest rates of HIV, hepatitis C, and tuberculosis, driven by stigma, unsafe injecting conditions, and barriers to healthcare. The need is urgent: only seven of South Africa’s 52 districts currently provide comprehensive harm reduction services, leaving most communities without access to essential, life-saving care (5). HIV prevalence among PWID reaches 72.1% in Tshwane, 49.3% in eThekwini, and 45.4% in Mashishing, with national studies showing incidence rates as high as 19% in Gauteng.
Viral hepatitis C affects up to 90.5% of PWID in Mbombela, and tuberculosis rates in eThekwini stand at 7.2% (6). More than half avoid healthcare due to stigma, and fewer than half of those living with HIV know their status. Despite overwhelming evidence that harm reduction saves lives, just 1% of PWID in eThekwini and Mashishing have access to opioid agonist therapy (OAT), underscoring the urgent need for a public health–driven, rather than punitive, response.
Momentum for reform is growing. The Cannabis for Private Purposes Act, 2024 marked a watershed moment, legalising private adult use and cultivation and expunging past convictions. This reform signalled that personal drug use need not be criminalised, setting a precedent for broader decriminalisation rooted in dignity, inclusion, and public health. This TB HIV Care-led initiative strengthens South Africa’s growing shift toward treating drug use as a health, not criminal, issue. Building on successful harm reduction projects in Cape Town, Gauteng, and KwaZulu-Natal, where access to dignified, community-based care has improved health outcomes, the initiative will expand evidence-based interventions and empower people who use drugs to lead reform from the ground up.
This grant comes at a pivotal moment for South Africa. The burden of substance use is escalating, while the health system struggles under the weight of overlapping epidemics of TB, HIV, and mental illness. At the same time, the shortcomings of punitive drug policies have become impossible to ignore, demanding a shift toward evidence-based, health-centred approaches that prioritise care over punishment.
“These realities call for urgent structural change,” said Professor Harry Hausler, CEO of TB HIV Care. “This grant allows us to align with local and global evidence that treating substance use as a health issue, not a crime, saves lives and strengthens communities,” Hausler concluded.
The initiative aligns with a spectrum of scientific discussions and presentations which flourished at the 13th International Conference on Health and Hepatitis in Substance Users (INHSU 2025), which took place, for the first time on South African soil in Cape Town from 14–17 October 2025. The conference illuminated global and African innovation in harm reduction, integrated care, and policy reform, offering a platform to highlight South Africa’s leadership in the field.
Adopting a rights-based approach in South Africa would mean recognising drug dependence as a health condition rather than a moral failing. It would require shifting the state’s response from punishment to prevention and care, anchored in the Constitution’s commitment to human dignity, equality, and access to healthcare.
References:
- HIV prevalence and risk among people who inject drugs in five South African cities (Scheibe et al., Int J Drug Policy 2016). Access here.
- South African Police Service (SAPS) (2024) Annual Crime Report 2023/24. Pretoria: SAPS. Access here.
- Transform Drug Policy Foundation (2021) Drug decriminalisation in Portugal: setting the record straight (case study summarising trends in new HIV diagnoses among PWID and drug-related deaths since 2001). Access here.
- Ghana (Parliament) (2020) Narcotics Control Commission Act, 2020 (Act 1019). Access here.
- Artenie, A. et al. (2024) HIV incidence and factors associated with HIV risk among people who inject drugs engaged with harm-reduction programmes in four provinces in South Africa: a retrospective cohort study. Access here.
- Press Release: High HIV And Hepatitis Infections Thwart 95-95-95 Goals
Issued by:
- Aziel Gangerdine
- TB HIV Care, Spokesperson
- E-mail: aziel@tbhivcare.org
- Cell: +27 (0) 66 545 6053
ENDS.
TB HIV Care
TB HIV Care is a registered non-profit company (NPC) that puts integrated care at the heart of responding to TB, HIV, and other major diseases. We work to prevent, find and treat TB and HIV in South Africa as well as targeting our interventions to address the needs of populations most at risk, including communities in the Eastern Cape and Western Cape, adolescent girls and young women in KwaZulu-Natal, inmates in correctional centres, sex workers and people who inject drugs.
