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Page 7 of 34 Guideline

1.2.7 The relevance of harm reduction TABLE 6: The use of non-stigmatising language to enhance patient outcomes. †
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Principles Recommended wording to use Wording to avoid
It will take a long time to affect a significant reduction in the • Separate the person from People who use drugs A user
number of drugs used, and the harms caused because this the behaviour A person who uses [alcohol] Addict
requires structural reform, which is explored later. The • Do not use pejorative People who are dependent on Alcoholic
drugs
Junky
terms as a noun
historical focus on abstinence and law enforcement has been • Avoid words with a moral People who inject drugs Injector
or negative connotation
ineffective and resulted in significant harm. Harm reduction • Do not use language that They no longer use … Clean
vilifies or separates people
is an effective public health intervention. It keeps people They have chosen to abstain Dirty
from [heroin]
alive and reduces drug-related morbidity. For individuals, They stopped using cocaine
They resolved their dependent
harm reduction aligns with the tenets of medical ethics in heroin use
that it is beneficent and patient centred. It takes a longer-term Substance/drug use Substance abuse
view and helps people meet their goals in a stepwise manner. †, Additional information and responses around drug use and substance use disorders
and treatment can be found at: https://www.changingthenarrative.news/.
Specific harm reduction interventions relevant to people
who use drugs are covered in the section ‘Evidence-based The International Network of People Who Use Drugs (INPUD)
interventions’. recognises that language cannot be regulated, and that context
can transform a term that is used to oppress into one through
Key points which emancipation is pursued … Ordinarily, however, language
that may denigrate, is best avoided. 40
• People use drugs for many reasons, in an array of
circumstances and contexts and this cannot be modified Discrimination, which is the enactment of stigma, also
rapidly.
• Not all drug use is harmful. needs to be addressed and the rights of all people secured.
Many governments in the region have signed the
• Addressing drug use in isolation will seldom result in a International Covenant on Economic, Social and Cultural
sustained resolution, unless the underlying motivators Rights, which outlines the range of rights that are relevant
40
are addressed.
• People use drugs in different ways; drugs are mostly to people who use drugs in health settings. Some of the
smoked in South Africa, but injecting is becoming more relevant rights are: the right to self-determination (Article
prevalent. 1); the right to non-discrimination based on race, colour,
• Drug-related risks and effects depend on the drug, sex, language, religion, political or other opinion, national
(mind-)set and setting. or social origin, property, birth or other status (Article 2);
• The use of opioids and amphetamine-type stimulants in and the right to enjoy the highest attainable standard of
the region is increasing. physical and mental health (Article 12). People who use
• In the context of criminalisation, many people who use drugs experience frequent violation of these rights, which
drugs enter and exit the criminal justice system, placing increases the harms of drug use – including confiscation
them at risk for HIV and other infectious diseases. of sterile injecting equipment and medication that forms
• The burden of HIV, viral hepatitis and TB amongst people part of substance use disorder treatment or other health
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who use drugs in the region is high. conditions.
Key points
1.3 Stigma, discrimination and human rights
• People who use drugs frequently experience stigma,
Stigma is a process of exclusion; it occurs when a person – or discrimination and human rights violations, which
group of people – are tainted or disgraced. When people perceive negatively affect their health and well-being.
themselves as being stigmatized, they may also come to hold • The use of appropriate language is an important
the same negative perceptions about themselves, leading to an component of providing support services.
internalization of stigma and acceptance of a ‘spoiled identity’. 37
2. Evidence-based interventions
Stigma, misinformation and the lack of evidence-based harm
reduction approaches are major contributing factors to the 2.1 A guiding framework
vulnerabilities people who use drugs face. Stigma is often not These guidelines are built upon the framework set out
prioritised by healthcare professionals, yet has a profound in the WHO Consolidated Guidelines on HIV Prevention,
effect on the relationships between clinicians and their patients. 38
Diagnosis, Treatment and Care for Key Populations, including
19
health sector interventions (Table 7) and critical enablers
The use of non-stigmatising language can enhance (Table 8).
relationships with patients and clinical outcomes. Table 6
outlines alternative supportive language to use.
2.2 Assessing a person’s needs
‘Stigma in health facilities undermines diagnosis, treatment, The screening for substance use and offer of assistance for
and successful health outcomes. Addressing stigma is potentially harmful substance use can take place in a range
fundamental to delivering quality healthcare and achieving of clinical scenarios (see Appendix 2). The integration of
optimal health.’ 39 screening for substance use and mental health conditions,

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