Page 89 - HIVMED_v21_i1.indb

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 3 Editorial

Introduction to the Southern African HIV Clinicians

Society harm reduction guidelines

Lawyers have done much damage in South Africa. Apartheid was enforced, minutely and
Author:
Edwin Cameron 1 brutishly, through the law. Its central weapon, viciously wielded, was the criminal law.

Affiliation: That legacy looms large over our still-new, still-nascent constitutional democracy. It is particularly
1Judicial Inspectorate painful in the case of people who use drugs.
of Correctional Services,
Pretoria, South Africa
For more than 50 years, the criminal law has waged war on people who use drugs. The
Corresponding author: consequences have been deadly. Criminalising people who use drugs is not only vicious, as
Edwin Cameron, apartheid’s laws were. It is stupid, and ineffective. It does nothing to diminish the use of drugs.
[email protected]
How to cite this article: Prisons rarely advance rehabilitation, and indeed prison is no place where someone dependent on
Cameron E. Introduction to drugs could hope to resolve their dependence or find ‘rehabilitation’.
the Southern African HIV
Clinicians Society harm
reduction guidelines. S Afr J Globally, leaders and institutions, including the United Nations, have conceded this. They now
HIV Med. 2020;21(1), a1179. acknowledge that criminalising people who use drugs is not an appropriate solution and that
https://doi.org/10.4102/ treating them as criminals inflicts significant harm on society.
sajhivmed.v21i1.1179
In South Africa, the debate has been muted. Current policies rely on a criminal justice response to
Copyright:
© 2020. The Author. drug use. So far, this has attracted little public criticism, although former President Motlanthe has
Licensee: AOSIS. This work recently added his considerable stature to the call to decriminalise drug use: he has spoken out
is licensed under the strongly against prohibition, repression, harsh penalties and prison for drug-related offences. 1
Creative Commons
Attribution License.
It is notable and timely that in June 2019 the Southern African HIV Clinicians Society (SAHCS)
published a position paper supporting decriminalisation of drug use.

Like sex, the pursuit of mind-altering substances is part of being human. This seemingly radical
2
statement is in fact an inoffensive truism. And hence, as with sex, the ‘just say no’ message is
futilely misplaced in reducing transmission of human immunodeficiency virus (HIV) between
people who use drugs.

Furthermore, research has established that people who use drugs are not a homogeneous group,
and the drug experience is mediated by not only the pharmacology of the drug but also individual
vulnerabilities and mindsets, in addition to the context in which the drugs are used. 3

The majority of people who use drugs will not suffer harmful consequences. However, misguided
application of the criminal law inflicts harm, disastrously. People who are marginalised, excluded
and stigmatised are far more likely to suffer harm from their drug use, as well as become addicted
to drugs. 4

Recent years have seen an increase in the use of drugs in South Africa, as well as in the numbers
of people dependent on heroin. The use of drugs like Nyaope, Whoonga and Unga is increasing,
as is the injecting of heroin and stimulant drugs. 5

This calls, imperatively, for harm reduction services, including providing sterile injecting
equipment. But they are absent. This invites an increase in blood-borne infections. The prevalence
of HIV amongst people who inject drugs is 21%, and the rate of hepatitis C is 55%.

Read online: The Joint United Nations Programme on HIV/AIDS (UNAIDS) warns, if South Africa does not
Read online:
Scan this QR take action now, it will never reach the 2020 fast track targets for HIV reduction that we missed. 6
Scan this QR
code with your
code with your
smart phone or
smart phone or
mobile device
mobile device Here, history grimly repeats itself. The barriers people with and at risk of HIV and acquired
to read online.
to read online.
immunodeficiency syndrome (AIDS) faced are strikingly similar to those people using drugs
http://www.sajhivmed.org.za 81 Open Access