Nkosinathi Zuma, Project Manager at Anova Health Institute, gives more insight on what the program is about, what it has achieved so far and the program's future plans.

What is Anova Health Institute role in this program?

Anova provides specialized healthcare services for PWIDs in the Johannesburg Health District and Sedibeng District. Anova collaborates with community-based organizations (CBOs), non-government (NGOs), government and municipal departments to facilitate direct delivery of healthcare, other social services and advocacy for PWIDs.

The JabSmart program is implemented within the framework of the National Strategic Plan (NSP) for HIV, TB and STIs: 2017 – 2022. The program is supported by the National Department of Health (NDoH) and the South African National Aids Council (SANAC). This program is funded by the Global Fund (GF) to fight HIV-AIDS, Tuberculosis, Hepatitis, and STI. The principal recipient of the grant from the GF is The Networking HIV and AIDS Community of South Africa (NACOSA), while Anova Health Institute is the implementing agency.

What are the objectives of the JabSmart program?

• Prevent new infections of HIV and TB amongst people who inject and use drugs.
• Reduce human rights, social and structural barriers to HIV, Hepatitis and TB prevention, care and impact among PWID.
• Strengthen the advocacy and national commitment for PWID programming in South Africa.
• Provide psychosocial interventions to PWID’s.
• Provide opioid substitution therapy (OST) to persons who inject drugs.
• Improve the 90- 90- 90 health outcomes for PWID by using combination prevention approaches.
• Empower and support woman who use drugs through group therapy.

Who benefits from this program?

• People who inject drugs are the main beneficiaries of this program.
• Families of PWIDs benefit from the program through family reunification and psychosocial support provided by our team of social workers, social auxiliary workers, and psychosocial counselor.
• Peer educators, who are former injectors, are employed by the program. They have access to Opioid Substitution (OST) Therapy and other clinical services provided by a medical doctor and professional nurses at the Yeoville Clinic. They also have access to psychosocial support. 

What are some of the challenges you face with this program and how do you overcome them?

• Acceptance of needles and syringes program remains a challenge in communities as it is perceived as promoting drug use. We are currently engaged on community dialogues and sensitization trainings to share information about the importance of distributing needles and syringes to PWIDs. For instance, the distribution of needles and syringes reduces the following: the likelihood of users of heroin and other drugs sharing the syringes and using them more than once; transmission of HIV, hepatitis B and C; skin trauma; and other blood-borne viruses.
• Confiscation of needles and syringes by the police remains a challenge in some communities. For instance, some PWIDs have been arrested by the police for being in possession of needles and syringes.
• Stigma and discrimination towards the PWID population is very high. They are commonly labeled as troublesome people who commit crimes in communities, and as a result at times they are normally victims of community mob justice. Some health facilities do not want to provide healthcare services to PWIDs which causes a huge barrier to client’s access to treatment, including ART.

To overcome these challenges, we do community dialogues and sensitization trainings to inform the communities about the PWID population. In these trainings we provide information about the importance of distributing the needles and syringes to the PWID population. We respect the concerns raised by the communities about the dangers of needles discarded by PWIDs in public spaces. We ensure PWIDs are aware of the importance of disposing off needles safely through inter alia:

1. We educate our clients about appropriate disposal of used needles.
2. We provide black sharp container during outreach to every client receiving harm reduction packs.
3. Project staff do daily needle pickups during their outreach.
4. During daily outreach, clients return used needles and get fresh needles.
5. We also implement community clean up initiative involving stakeholders such as community gatekeepers, the general public, and the PWID clients in picking up inappropriately disposed needles.

We also do one-on-one engagement with the police to share information about the PWID program and how the program benefits the PWID communities.

What are some of your proudest moments that the program has been involved in?

• Some of our clients have been reintegrated back into their families.
• After raising awareness on drug injection, some families are assisting relatives injecting drugs and living with HIV to adhere to OST and ART treatment.
• The program provides great empowerment to the PWID communities as it provides high-quality services to a neglected population. The following are the services provided: HIV testing services, mobile van ART initiations, linkage of HIV positive PWID to care, dignity packs for women, male and female condoms, screening for TB, STI, Hepatitis B and C, Opioid substitution therapy (OST), mental health support, peer education, advocacy for human rights violations, and building referral linkages and networking for the PWID community.
• The program has recruited about 30 peer educators who were unemployed and had less chance of finding employment anywhere.
• We have managed to establish and drive a women-focused component of the program encompassing weekly female contemplated groups that deal with issues affecting female PWIDs. This has given this group of women a platform for group discussions on their life challenges and how to overcome these challenges. This also gives them access for psychosocial support from our well-trained team of Social workers, Psychosocial Counsellor, and Social Auxiliary Workers. The program provides these females with dignity packs (sanitary pads, toothpaste, toothbrushes, bath soap, face masks) and COVID-19 packs (sanitizer, face masks, soap).

What has the PWID program achieved since it started?

Since the start of the program in April 2019 we are providing services to about 12913 PWIDs. 4161 clients have received HIV testing services and about 500 clients have been initiated on Antiretroviral therapy (ART). 219 clients have been successfully put on OST. OST improves the physical and psychological health and wellbeing of PWIDs, specifically heroin users. It minimises withdrawal symptoms, reduces craving, and blocks the euphoric effects of other opioids.

Sedibeng OST clinic has been approved by NACOSA and the Global Fund starting with a target of 100 patients enrolled on OST between May 2021 – March 2022) and aiming at 85% retention rate.

What are the future plans for the program?

There is still a need for more funding for PWID programs for the implementers to introduce more activities that will assist the PWID communities. For example, there is a high demand for OTS treatment, however, the program is unable to rapidly scale up OST as methadone is expensive, and we have a limited budget for this therapy.