The stigma experienced by people who use drugs either personally or by their peers are powerful disincentives for individuals to access healthcare in South Africa.
Stigma in the healthcare system also reinforces low self-worth, which in turn inhibits health-seeking.
Local data has highlighted that without appropriate and acceptable services, people living with HIV who use substances experience challenges in adhering to antiretroviral treatment, and, due to anxiety and depression, are less likely to report psychological distress.
In a chapter published as part of the International Development Policy authors Dr Scheibe, Shaun Shelly and Dr Anna Versfeld, argue that “South Africa illustrates how approaches that stigmatise people who use drugs are morally justified at the expense of human rights and public health outcomes”.
Conflicting health and law enforcement policies, local conservatism and donor conditionality have thwarted harm reduction expansion and evidence-based drug policy development, resulting in notable harms. Persistent morally-based perspectives contribute to stigma and discrimination in healthcare facilities and negatively affect treatment-seeking by people who use drugs.
The research found that “healthcare providers in South Africa tend to come from the communities they serve and are often representative of dominant moral positions around drug use. They are neither sensitised nor equipped to manage the realities and needs of people who use drugs”.
This has meant that stigma and discrimination towards people who use drugs is widely accepted in healthcare facilities. This includes denial of care, conditional access to care, shaming, lack of confidentiality and privacy and being made to wait disproportionately long periods for services.
The authors also found that “there are currently no effective accountability mechanisms within healthcare facilities to manage rights abuses, nor is there easy access to legal recourse for people who use drugs whose rights have been violated”.
Encouragingly, progressive health and HIV policy affecting people who use drugs has recently been developed.
In their paper the authors recommend “that to improve health, the Single Convention on Narcotic Drugs should be challenged to prioritise rights and health and that the personal use of drugs be decriminalised. We also highlight the need for mechanisms to hold health and other actors accountable for ensuring that the health and rights of all people are prioritised and strengthened.”
The South African National Aids Council has recently overtly supported a call for the decriminalisation of drug use.