Update on community-based harm reduction services in Durban Jan ’18 – June ’18 SACENDU Date: 24 October 2018

Context Update on Harm reduction services- Data Step-Up Project has been severed a notice by the eThekwini Municipality environmental health department to stopped all needle and syringe services to the PWID community. Services has been stopped since 08 May 2018 Opioid Substitution Therapy Programme(OST) started in April 2017 at our Drop-in Centre in Umbilo Update.

Unique number of clients through their PID- This shows us that since stopping the distribution of sterile injecting equipment clients do not want to access health services, the number of unique contacts at the end of June was more than half of those at the end of April 2018. The number of non unique contacts made bet may and Jun was nearly one fifth of those contacted in Jan - Apr

This graph clearly shows us the decline in contacts by month and gender made on outreach

Unique number of clients through their PID- Reached more clients in Oct 2017 together with more females Decreases around Dec 2017 due to the movement of people- City crackdown on homeless-displacement of people

Unique number of clients through their PID- Reached more clients in Oct 2017 together with more females Decreases around Dec 2017 due to the movement of people- City crackdown on homeless-displacement of people

Needle return rate is much lower in comparison to the needles distributed- Challenges with returning needles: Clients are profiled and searched by law enforcement departments on a random basis Clients are arrested for both sterile and non sterile injecting equipment Once the needle has drugs in it, clients are arrested and charged/sentenced for possession of drugs Clients have their personal possessions stolen, which includes their personal sharps containers (as shown at precious meeting)

Challenges include getting clients into Rx- many prioritize drug use over health care- no stable housing, no support systems, making it very difficult for clients to be adherent on Rx- Clients get arrested and detained. Long waiting period at a health care facility- Since Feb’2018, we have been referring HIV + clients for ART Rx to our sister project based in Morningside, clients are excorted to the clinic by the staff.

Number on OST at start of period (look at those initiated between April to December 2017;excluding LTFU that were not restarted; and if any, exited the program) Number lost to follow-up (LTFU that were not restarted between Jan-Jun 2018) Number exited during period (between Jan-Jun 2018) Number on OST at end of period (all PWIDs currently on OST since the project started in September 2017)

Number on OST at start of period (look at those initiated between April to December 2017;excluding LTFU that were not restarted; and if any, exited the program) Number lost to follow-up (LTFU that were not restarted between Jan-Jun 2018) Number exited during period (between Jan-Jun 2018) Number on OST at end of period (all PWIDs currently on OST since the project started in September 2017)

Recommendations Increase activities to reach more Female PWID within our programme- focus group meeting held and follow up to be planned for Nov’2018. Needle return rate- providing incentives for needle return-Partial exchange- Until programme was stopped. Stakeholder engagement with the eThekwini city- schedule Trade application awaiting approval- Meeting with city manager TB Campaign/Drive within the PWID community. Treatment/care/referral and adherence- HIV within TB/HIV Care through linkage officers- July’18 Documentation of the number of PWID clients seen on outreach in comparison to how many of those accessed services-no NSP Miss-take TB symptoms for withdrawal

Thank you! Kalvanya Padayachee and Zara Von Homeyer   Kalvanya Padayachee and Zara Von Homeyer Kalvanay@tbhivcare.org Zara@tbhivcare.org Supported by: