This June, we mark the Support. Don’t Punish Global Day of Action, a worldwide call to action that promotes drug policies grounded in health and human rights. The campaign highlights the urgent need to shift from punitive approaches to compassionate, evidence-based strategies that support – rather than punish – people who use drugs.
Ensuring that people who use drugs can access quality, stigma-free health services is a cornerstone of the Elton John AIDS Foundation’s strategy. We know that stigma, criminalisation, and a lack of investment fuel cases of HIV among this community, who are 14 times more likely to acquire HIV compared to the general population.
That’s why, in addition to extending our long-standing support for the global Support. Don’t Punish campaign this year, we’re proud to announce two new partnerships in South Africa – with TB HIV Care and the South African Network of People Who Use Drugs (SANPUD). Amid growing funding challenges, these partnerships offer a timely opportunity to strengthen community-led responses and protect the future of life-saving services.
TB HIV Care: Building Power and Policy Change for People Who Use Drugs
South Africa is home to an estimated 82,000 people who inject drugs, with recent data from 4 locations showing high HIV prevalence of between 30% and 70% among this community. Access and take up of HIV treatment among people who use drugs is limited and harm reduction services like needle and syringe programmes and opioid agonist therapy – interventions which can help prevent the transmission of HIV – are dependent on donor resources. As the country navigates a changing funding landscape, it is more vital than ever to invest in solutions that address obstacles to care and are designed for people who use drugs.
To address this, the Foundation is partnering with TB HIV Care to support the creation of a national People Who Use Drugs Sector. This initiative will give people who use drugs a formal seat at the decision-making table – empowering them to advocate for harm reduction, shape the policies that affect them, and raise public and political awareness of their health needs.
Outreach worker from TB HIV Care’s Step Up project, which provides a holistic package of services to people who use and inject drugs.
Our partnership will also lay the groundwork for long-term systemic change. Current laws that criminalize drug use act as a major barrier to care and fuel stigma and discrimination. With funding from the Elton John AIDS Foundation, TB HIV Care will develop a roadmap with achievable plans for the decriminalization of drug use in South Africa – a crucial step in ensuring more people can access essential HIV and health services without fear.
“This partnership is groundbreaking. It will support the development of leaders from the community of people who use drugs, foster meaningful engagement in policy processes and contribute towards the sustainability of the HIV response for people who use drugs in South Africa and beyond,” said Mfezi Mcingana, TB HIV Care’s Programme Director: Key Populations.
SANPUD: Expanding Compassionate, Gender-Responsive Care for Women
In South Africa, around 1 in 5 people who inject drugs are women – who face unique, and often overlooked, health challenges. Pregnant women who use drugs in particular face significant barriers to accessing perinatal and neonatal care, with stigma and discrimination worsening health outcomes.
To respond, the Foundation is supporting SANPUD to scale up a first-of-its-kind healthcare training toolkit tailored to the South African context, building on previous efforts funded by the Foundation. The toolkit is designed to increase healthcare professionals’ knowledge around drug use and approaches to reducing its harms, reduce stigma in healthcare settings, and improve quality of care. By giving healthcare providers the tools to offer compassionate, evidence-based support, this initiative helps ensure women who use drugs can stay healthy, adherent to HIV treatment, and receive the maternal care they deserve. In doing so, we’re not only prioritizing the health and well-being of mothers but also paving the way for healthier futures for their children – including through the prevention of mother-to-child transmission of HIV.
Lehandra, an 19 year mother from McGregor, a rural farming community in the Western Cape, and her baby boy Luhan. Lehandra was a participant during the project pilot phase, which saw SANPUD roll out training for health care workers in the Langeberg Region.
“The Pregnancy and Substance Use Toolkit is a critical resource for healthcare workers, addressing systemic gaps in harm reduction and maternal care for women who use drugs. By integrating trauma-informed, non-stigmatizing approaches, it strengthens South Africa’s HIV and TB response, ensuring women access lifesaving services without fear of judgment,” said Kalvanya Padayachee, People Who Use Drugs Program Specialist at Networking HIV and AIDS Community of Southern Africa (NACOSA), a partner of the program. “This initiative aligns with NACOSA’s Global Fund mission to advance health equity and dignity for people who use drugs and with our commitment to dignity-centred care, fostering trust and improving access to essential services for some of the most marginalized women in our communities, because when we meet women with compassion and not judgment, we transform lives.”
In this new phase of work, SANPUD will advocate for the National Department of Health to endorse the toolkit and training curriculum. Embedding this approach at a national level will be a critical step toward ensuring that women who use drugs can access compassionate and stigma-free care – keeping them and their newborns safe. By leading with empowerment, respect and support, rather than judgment, this initiative can help reshape public perceptions, influence policy change, and strengthen South Africa’s healthcare system to better serve one of its most marginalized communities.
“The journey of motherhood is often celebrated as a beautiful and empowering experience. However, for women who use drugs, that experience is too often taken away from us due to the stigma and we face both from society and within the healthcare system,” shared CR, a mother who uses drugs in the Western Cape. “This pregnancy toolkit, along with education that dispels myths around drug use and pregnancy, is vital to restoring our dignity. It ensures that expecting mothers who use drugs are treated with respect and given the opportunity to embrace and enjoy their pregnancy journey.”
A Compassionate Path Forward
Together, these two bold initiatives demonstrate that even in the face of devastating challenges for key populations and HIV prevention programming, communities are innovating and finding sustainable ways to expand essential services to protect the rights and health of people who use drugs.
The message is clear: compassion and care – not punishment and exclusion – will bring us closer to an AIDS-free future. The Elton John AIDS Foundation is the second biggest philanthropic funder of people who use drugs globally. Learn more about our work.
