Facing off a dual burden of high disease risk and low service access
CAPE TOWN, 08 OCTOBER 2025: South African and international leaders in public health will gather on Friday, 10 October 2025 at the University of Cape Town to convene an in-person scientific seminar: Agents of change and women who use drugs. Women who use drugs (WWUD) in South Africa face compounded health and social vulnerabilities that leave them disproportionately excluded from essential health services. Compared to men, women experience heightened stigma, intimate partner violence, reproductive health challenges, and structural barriers such as childcare responsibilities and lack of women-centred care.1,2 Scientific discussions among academics will focus on how women can be supported through access to harm reduction programming and drug policy reform.
Seminar: Agents of change and women who use drugs
· Date : 10 October 2025
· Time : 13:30 – 15:30 (SAST)
· Venue : Neurosciences Institute Auditorium, UCT/Groote Schuur Hospital, Cape Town
Recent evidence highlights both the scale of drug use and the urgent need for tailored harm reduction. National estimates suggest there are approximately 82 500 people who inject drugs (PWID) in South Africa, with women comprising between 16% and 27% of this population.3 Led by TB HIV Care, a 2023 bio-behavioural survey across four South African sites documented extremely high HIV prevalence among PWID: 72.1% in Tshwane, 49.3% in eThekwini, 45.4% in Mashishing, and 30.3% in Mbombela. Hepatitis C (HCV) prevalence was similarly alarming, reaching 89% in Tshwane and over 75% in multiple sites.3
“The evidence consistently shows that harm reduction works,” says Dr Andrew Scheibe, medical doctor and technical advisor with TB HIV Care in Cape Town, INHSU board member, and fellow co-convener of the upcoming INHSU 2025 conference. “Harm reduction reduces infections, prevents overdose, and connects people to healthcare, yet access across Africa remains the exception rather than the rule.”
Sex-based disparities are stark. While HIV prevalence among PWID overall has ranged from 14% to over 70%, women consistently show higher prevalence rates than men. One multi-city study found 18% HIV prevalence among female PWID, compared to 13% among males.4 More recent research in Durban confirmed that women face greater barriers to accessing sexual and reproductive health, harm reduction, and HIV services, often due to fear of arrest, intimate partner control, and lack of programming designed for women.5
“Everyone in our communities deserve health, dignity, and care,” says Mfezi Mcingana, Programme Director: Key Populations at TB HIV Care. “People who use drugs are part of our communities and supporting their access to healthcare, not punishment, builds a safer, healthier society for all”, Mcingana concludes.
Despite the magnitude of risk, women remain underrepresented in harm reduction programmes. In opioid agonist therapy (OAT), fewer than 10% of participants are women.6 Needle and syringe programmes (NSPs) and OAT are limited in coverage, mostly urban-based, and not designed with women’s needs in mind. The absence of services aimed at women perpetuates cycles of preventable morbidity, mortality, and infectious disease transmission.
“While the scale of the challenge is undeniable, pioneering efforts by a few African governments show what harm reduction leadership can look like,” says Angela McBride, Executive Director of the South African Network of People Who Use Drugs (SANPUD), INHSU board member, and co-convener of INHSU 2025. “Harm reduction means putting health and human rights before punishment, shifting away from criminalisation and towards evidence-based, rights-affirming policies.”
To address this gap, investment in women-centred harm reduction is essential. Priorities include scaling up OAT and NSPs with women-specific entry points, integrating sexual and reproductive health services into harm reduction sites, providing childcare support, and ensuring protection from intimate partner violence. Without these interventions, WWUD in South Africa will continue to be excluded from public health progress and national HIV/HCV response goals.
References:
- Shirley-Beavan, S., Roig, A., Burke-Shyne, N., Daniels, C. and Csak, R. (2020). Women and barriers to harm reduction services: a literature review. Harm Reduction Journal, 17(74). Available here.
- Harm Reduction International & South African Network of People Who Use Drugs (SANPUD) (2020). Barriers to harm reduction for women who use drugs in South Africa. London: Harm Reduction International. Available here.
- SANPUD (2023). South African bio-behavioural survey and population size estimation among people who inject drugs. Johannesburg: South African Network of People Who Use Drugs. Available here.
- Scheibe, A., Young, K., Moses, L., Basson, R., Versfeld, A., Spearman, C.W. and Sonderup, M.W. (2016). HIV prevalence and risk among people who inject drugs in South Africa. International Journal of Drug Policy, 30, pp.107–113. Available here.
- Milford, C., Cavanagh, T., Bosman, S., Chetty, T. and Rambally, G. (2024). Access to and acceptability of sexual and reproductive health, harm reduction and other essential health services among people who inject drugs in Durban, South Africa. Harm Reduction Journal, 21(123). Available here.
- INHSU (2021). Gender and opioid substitution therapy access in Tshwane, South Africa. International Network on Health and Hepatitis in Substance Users. Available here.
