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In a secluded area on the outskirts of South Africa’s capital, Pretoria, dozens of people battling drug addiction inject themselves with heroin-laden mixtures, some sharing needles despite the risks.
A team of health workers has been making weekly visits to this and a dozen other sites, offering clean needles in exchange for used ones. The initiative, backed by the University of Pretoria and the Tshwane municipality, aims to curb the spread of HIV and other infections among drug users.
While needle exchange programs have been widely adopted in other parts of the world, such efforts have been disrupted by the Trump administration’s decision to slash 83% of U.S. Agency for International Development (USAID) programs globally.
South Africa’s HIV Crisis and the Growing Drug Market
South Africa has the highest number of people living with HIV worldwide, and drug users who share needles face an even higher risk of infection.
A University of Pretoria report estimated that 84,000 people inject drugs in South Africa, with HIV prevalence among them at 38% in Pretoria alone—far above the national average of 12%.
The same report found that the country’s market for cocaine, heroin, and methamphetamine is worth about $3.5 billion and continues to grow.
Funding Cuts and Rising Challenges
The Community Oriented Substance Use Program in Pretoria remains operational thanks to municipal and university funding. However, partner nonprofits have shut down due to global aid cuts, and at least one local health clinic has closed, forcing drug users to seek help at overcrowded government-run facilities.
Now, harm reduction programs like the needle exchange project face increased competition for shrinking resources.
Debate Over Harm Reduction
Likwa Ncube, who leads the Needle Exchange project, acknowledges the painful withdrawal process for addicts transitioning to opioid-substitution therapy with methadone.
Critics argue that providing clean needles enables drug use, but Ncube likens it to distributing condoms for safe sex.
“When we distribute condoms, are we encouraging people to have sex?” he asks.
