Pretoria's heroes

It’s early October, Mainlines Simon and Mac have joined the outreach team in Pretoria over two days. The need for harm reduction services in Pretoria is enormous, more than 7.000 people in Pretoria are homeless and many of them use drugs.

Pretoria has become known as the heroin capital of the country and its widespread use is very visible in the streets. With growing numbers across ethnic communities who are starting to inject, it is easy to spot people openly using in public spaces. Groups of people who use drugs live under bridges, next to railways, and in improvised shacks on the street.

'The condition of people is serious. Many have lived on the street for years. People are malnourished, they have tooth decay, their feet are ruined, they have abscesses and open sores. People shoot in the neck or anywhere else where they can still find a vein’, explains Simon.

'Coming from the Netherlands, where we had an open drug scene like this in the past, you know it doesn't have to be this way' says Mac. 'People are being chased by the police, the few things they have may be purposefully burned, often by the police. People rotate in and out of jail. Lives of people who use drugs really are worth nothing here'.

South Africa drug policy week took place in Cape Town that same week. 'Yes, it is a political choice to allow people to suffer this way. If a small portion of law enforcement budgets were redirected to social housing, proper health care and job creation, people would not have to live under these conditions', thinks Mac.

Slow change is visible, with South Africa running Needle and Syringe Programmes in five major cities since three years and the introduction of methadone in 2017. But there are an estimated 75.000 people in South Africa who inject drugs. With an HIV prevalence between 20% and 48% depending on the city. 

The prevalence of hepatitis C is largely unknown and people have no access to treatment. Overdose is often fatal and Naloxone is not widely available. 

Simon: 'In 9 out of 10 cases, the ambulance does not even come when an overdose is called in. In desperation, people might only call the ambulance and report on a friend not breathing.

Once the ambulance arrives they are more inclined to help. A friend might leave a needle next to the body to ensure the medics don't waste time. The person himself waits at a safe distance to avoid arrest’.

'The outreach workers at OUT in Pretoria deserve all of our respect. They still live the street life, but come to work every day. Regardless of their landlord throwing stones at them while they are sleeping, because "he doesn't like junkies". Regardless of troubles to travel to work. Of being in withdrawal. Of needing to take care of your sick girlfriend. Of missing your methadone dose because the pharmacy forgot to put your order in.

This team is out there on the streets every day. They hand out needles. They treat peoples wounds. They connect you to care wherever they can. They show compassion. These are the hero's of the streets of Pretoria.'

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