ID: HR19-281

Presenting author: Shaun Shelly

Presenting author biography:

Shaun Shelly is dedicated to advocating for the rights of people who use drugs. He brings clinical, academic, programmatic, research and lived experience together into a 360 degree-view of the complex issues that inform our understandin and response to the use of certain drugs, and the people that use them.

The Community Oriented Substance Use Programme: A public well-being response to the use of drugs in Tshwane, South Africa

Shaun Shelly, Jannie Hugo, Andrew Scheibe, Tessa Marcus

Issue:
The responses to drug use in South Africa targets the individual by criminalising, pathologizing, or moralizing their use of drugs. This leads to the perceived need to remove the individual from the community for the purposes of incarceration, treatment or rehabilitation. This increases stigma and social exclusion, resulting in on-going and more harmful drug use.

Setting:
Over the past decade, the City of Tshwane has experienced a rapid increase in the use of heroin and stimulants. There are increasing numbers of injecting drug users among whom the prevalence of HCV and HIV is as high as 93% and 43% respectively.

Program:
With funding from the City of Tshwane, the UP Department of Family Medicine developed a citywide response to drug use. Drawing the experience of implementing a community oriented primary care (COPC) approach to health service delivery, the Community Orientated Substance Use Programmme (COPC) adds to and integrates with health and wellbeing services to provide a continuum of community based harm reduction services for people who use drugs. By being collaborative and inclusive, COSUP maximizes and expands existing infrastructure and services, enabling the sharing of knowledge and evidence-making through research and learning. Importantly, COSUP changes the environment, not just the individual.

Outcomes:
Between June 2016 and 2018, COSUP established 17 community sites, screened 300000 people for substance use, enrolled 2957 people, started the country’s first publicly funded OST maintenance and syringe programmes, initiated > 600 people on OST, and employed more than 20 service users as peers. The peers form an essential part of the multidisciplinary teams. Challenges include stigma towards clients and peers, a reluctance to accept harm reduction as an overall philosophy and continued criminalisation of people who use certain drugs. However, the COSUP shows that it is possible to implement low threshold services within the community.