 South Africa is known and documented as one of the most unequal places and Cape Town itself where we are now You just have to fly in on the aeroplane and you can see how unequal it is You drive from the airport you go past some of the biggest informal settlements in Africa and then you can drive all the way down to the sea and see the Dollar billionaires homes down on the seaboard and then people want to get angry and say well Why are there so many homeless people? It's like well, I'm during a part eight You weren't allowed to have an education, you know, you weren't allowed to be in certain areas You were chased you were segregated. That's obviously gonna still have an impact That's gonna have an impact for a good and this of course is a great driver of dependent drug use because people are looking for Meaning and hope in their life when you're in that much pain Everyone's a great analgesic for a lot of people is sitting with people who've got really good reasons to keep using drugs Inequalities very much in terms of criminalization in terms of our eyes in terms of the criminal justice is a view by justice And then in terms of healthcare Governments should place the public health aspect of the drug control more prominently in the agenda Without these services Drugs are still being used So why can't we just save life? I welcome you to 2023 Africa policy week this particular event has got a history It is known for sparking change We need to find solutions which are suitable to our context to our people which are driven by motivation from the community Rather than imposed you are part of an event that changes lives through changing policy It's proven it in the past and we will prove it again drug policies must be grounded in public in a public health approach based on scientific evidence and Respect for human rights and always putting people first drug prohibition Has failed to achieve its goals of a drug free world While having detrimental impact on our societies It is causing far more harm than good We must stop the practice of arresting people just because they use drugs Governments of our region should consider a variety of reform in drug policy approaches Including decriminalization and legalization. We feel that science can and should Play a role not only in strengthening health and human rights approaches to drugs But also in helping communities to achieve social justice I am proud to be part of this incredible collective of people charging forward with big ideas To decolonize drug policy to dismantle the colonial punitive systems that still govern our lives To remove punitive approaches to health which also still govern our lives and to work together to shift power to the global majority So the apartheid is over but South Africa is still the most socially unequal country in the world as far as I know The dream of a rainbow nation and a shared economy is just lying in shatters, you know, it's all over the place It just hasn't been achieved The thing that is most noticeable about the South African drug scene Is you've got privileged drug users who never get caught They use in very confined spaces But you've got masses and masses of people using drugs who are living in very economically deprived circumstances And they don't have any resources There were no home reduction services up until we started them People who inject drugs have by far the highest incidence of HIV in the country out of any key population And up to 93% prevalence of hepatitis C in some communities And only about 1% of people who should get home reduction services actually get them What I am seeing which is really good is a general acceptance that arresting people isn't working We also heavily incarcerate the country as well and recidivism is huge So we're really getting increased recognition that it's not helpful just to put people in jail We're getting increased recognition that home reduction services are essential So we work with people who inject drugs primarily We do behavioural change intervention which is our peer educator set for other people It's almost like a community leader but it's peer educators who come through substance use themselves They then interact with the clients to say look, since we are a home reduction programme We don't say you must stop using drugs But we do say use it in such a way that it doesn't cause any further harm Then we also do HIV testing and then in the event we client two test positive We link them to care so that they can be on antiretrovirals We offer them an opiate substitute treatment programme which is methadone We go out in the communities and we have sick places that we go to Sick time frames that we go to see clients and we provide them with lean needles and syringes Oh, it's a very, very good programme because they don't just give us needles They give us the swabs, they give us the cotton wool They give us a chance not to maybe get viral disease by using somebody else's own needles We have our current peers coming through the programme as clients who were using heroin themselves And now they have nine to five jobs They are working, living by themselves, having a flat, renting, paying their rent Our community linkage officer will go out into the community and she will sit with the community And she will discuss like she'll ask you how are you doing today, what has been going on in your life How can I assist you and then they will say I need to go on the methadone programme Or I would like to get more clean needles and then Natalie will She's a community linkage officer, she will then refer them to the TBHV case centre I love working with my community, I love my community to butts And a couple of years back, the way I look and the way I am at this point now I can, actually I can't believe it myself, the way I look now, it is as far for I actually, so to speak, look like the living dead Walking on, almost like just waiting for me to kick the bucket But the woman support group gave me that safe space, that comfort And they guide me to become the person that I am today So I am so lucky, I'm happy that I took that step Because if I didn't take that step, I would have been six feet under Because of my experience, my grievances of my mother that I lost So that's how I started using drugs and I wanted actually to drug myself to death But that wasn't in my destiny, so destiny had another purpose for my life I'm still applying home reduction to myself, I'm still using But I am a functional substance user, which can function in a working environment We as people would not understand how to treat people with drugs We need to stop stigmatising and discriminating, we need to support people and not punish Sometimes I have the feeling that we make such a fuss about drugs Because it's so much easier to blame drugs than to address real issues Like inequality and poverty and exclusion and suffering related to trauma and all this stuff You're 100% correct, so one of the things that I say to people is I play this thought experiment with them, I said I want you to imagine your community But really imagine it, now just take the drugs out of it What have you solved? And if people are really thinking about it, they suddenly go, not very much If we want to reduce the number of people who suffer from drug use issues If we are really dependent and don't want to be dependent and that kind of thing You've got to address the structural issues and the economic issues We ask the wrong question all the time, you know, when you see somebody sitting on the side of the road And they're injecting through an already septic abscess People go, oh that person must be sick or what kind of evil is that, or they're criminal or whatever But that's the wrong question, the question we need to be asking is What is it that makes this the best short term solution for this person? Because that's what they mean, all of us, we optimise our lives for comfort And if you are homeless, hungry, infections You're going to want a really strong analgesic, and that's what heroin is It's an emotional and a physical analgesic So if you want to ease people's pain, you can either give them heroin Or you can give them hope and housing and food Mertiel, can you just give us a short overview of what happened with cannabis After the decision of the Supreme Court in 2018, right? Yes, so in 2018 the Constitutional Court of South Africa declared that the prohibition Of the use and cultivation of cannabis within private spaces was unconstitutional They did not legalise trade, we were left in this really grey area Lots of people started to open up private clubs because it was the privacy judgement We've had about 400 clubs open up around South Africa And it's really just the role of the dice, whether the cops arrive or not So a cannabis private club is a collective of like-minded members You would have a consumption area plus a shop People would need to join the club and the owner of the club or whoever is running the club It can be run as a non-profit or it can be run as a for-profit Needs to keep records of their members and then you would keep very specific records of your stock I think that the private club model really really is the great equaliser Because it's not that pot shop with fancy Norwegian wood shop fitting Let the trade happen in the clubs You should be able to run that establishment in an exercise book In a shack, in an informal settlement Where do you see positive developments in Africa you can report? I've seen Sierra Leone taking steps, they have actually approached civil society To guide them in terms of their commitments in the area of drugs And what can be improved in terms of the law Civil society has given them a written opinion on that We have also seen even though laborious law is not really a decriminalisation But we've seen a significant reduction because they were sending people for common use For 15 months, even more, two years And now for them to reduce the drastically to three months I believe that as time goes on Probably there might be amendments and people will begin to actually look at that Gambia is also in the verge of doing that Gambia has actually started a conversation, they actually have a bill We were invited to make inputs to that and we have suggested a few areas they should look at We've seen an addition of some countries doing harm reduction Incorporating harm reduction, for instance We've seen Benin, Côte d'Ivoire, we've seen Mali We have seen Mozambique, we have seen Mauritius And many other countries that are actually going in the direction of harm reduction Also we have seen countries that have also sort of opened the conversation on cannabis regulation Malawi, Zimbabwe, Rwanda Five years back you wouldn't see an African country talking about cannabis illegalisation or regulation Not at all And so for us to begin to see these things happening That means that governments are really resonating with the conversation They have acknowledged the fact that those draconian laws have actually not made an impact And they need to begin to shift away from those draconian laws How do you feel is there a meaningful dialogue between civil society and decision makers in Ghana? I think over time we have been able to build a strong relationship with government And most of the time when government wants to propose something They want to see civil society part of that discussion on the table I think it's a very meaningful relationship which is good Now we are beginning to see some commitment looking at the drug issue more from the public health perspective And so of course getting the endorsement of the president to support harm reduction So Ghana will be starting with OST and then gradually will move towards the NSP To provide services for persons who inject drugs What about the criminalisation of drug users? Do you think there will be any change? So you could go to prison for more than five years for just mere possession for personal use Now with a new law what it has sought to do is it has scrapped the custodial sentencing And has introduced fines Yes of course it's a progress but we still feel as civil society that the fines are a little bit hefty About $160 I don't think they can pay that So that conversation is still ongoing with the Minister of Interior as well as the Court's control commission To see if we can do some amendments with the current law to at least reduce the fines I'm really happy that Ghana has been able to pass the bill for plantation of cannabis And also for medicinal and industrial purposes But I'm also hoping that we could legalise the recreational use What would you like to achieve in Zimbabwe? What policy changes you would like to achieve? Currently the drug policies we are having in Zimbabwe are outdated They were established during the colonial era We need decriminalisation of people who use inject drugs As well we also need an environment where we can access services So that we reduce the high rate of mortality in our country What motivated you to start activism in this field? I've heard how I've been stigmatised, I've been discriminated as an unactive drug user at that time And how I've been harassed by police People are how perceiving the people using drugs is different They see them as a criminal They see them as people who don't have the right to live While these are human rights According to the different international human rights declarations Even from our constitution perspective Even of the right to live, even of the right to education Even have the right to access treatment So these people have been marginalised in a way that they cannot access the different services That's how it moved me on to become an activist How would you describe or summarize the drug situation, the drug scene in Uganda? The drug situation in Uganda is at increase If the government has not provided targeted services for people who use drugs In five to three years to come Then Uganda we are going to be having very big problems Because as a country it has positioned itself on criminalisation Public health approach But our dream is to make sure that everyone has the right to access treatment Without going through a judicial kind of process That's our dream, not being handcuffed, paraded before the court And then the court decides It's like when you have a son and a daughter and is addicted And then you want this person to get off drug Then you have to go to police and report to yourself My son or daughter they are using drugs And I want them to get treatment or to go to the rehab Then the police will arrange a day with the judge Then the judge looks into you, that's how the law was But I think we made our case and the issues are going to be included It's our prayer to see that everyone who needs services Walks direct to the hospital or to the treatment centre Yes, the treatment he deserves and gets better Have you achieved any success in your advocacy work in Kaya? Yes, we have a little, so much so in creating awareness Because we have worked with members of parliament for a long time The government has recognised people who use drugs as stakeholders Healthcare is very comprehensive and it's going on But we have a long way to go when it comes to law enforcement When it comes to the criminal justice system The motto of our drug authority is actually a drug free world So they do it through policing And we have seen children being expelled from school We have seen our university students being discontinued It is not fair because getting into drug use really isn't a mistake The mistake is what we do after this person gets into drug use I take it like all of us can use drugs Some get addicted, some do not, some are functional, some are not So for the ones who get addicted, they need treatment But I think people should also know that not all drug users are addicted And not all are non-functional They are those that are very functional And they are productive members of society It is something that we need to look at as a society Because again, if we want to offer treatment What are we doing about the joblessness among the youth? What are we doing among the understanding of the society About the causes of addiction So if we want to come up with a comprehensive solution We must also think of creating jobs for young people Expanding the healthcare system And being comprehensive in a way that the family support system is also functional