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TB HIV Care: marginalised populations have needs, too

TB HIV Care is a non-profit organisation that places care at the heart of responding to TB, HIV and other major diseases. They work to prevent, find and treat TB and HIV in South Africa, addressing the needs of marginalised, at-risk populations, like inmates, sex workers and drug users.

Preventing TB and HIV transmission

Ultimately, only prevention will bring an end to the global TB and HIV epidemics. TB HIV employs several prevention strategies, including: 

  1. Distributing condoms and explaining the importance of correct and consistent condom use. 
  2. Voluntary Medical Male Circumcision – a procedure that reduces a man’s chance of contracting HIV from a female partner by up to 60%.
  3. Pre-exposure Prophylaxis (PrEP) – a new, safe HIV prevention method for HIV-negative people.
  4. Informing, educating and counselling the public around the implications of their behaviour and options. 

Locating TB and HIV patients

The first step in providing care for people with TB or HIV is finding them. TB HIV Care has a highly successful programme that tests and screens people where they are, whether at a clinic, taxi rank, workplace, farm, high school or university. All mobile testing and screening takes place in customised caravans, mobile units and gazebos to ensure each client’s comfort and privacy.

Treating TB and HIV patients

Once a person has tested positive for either TB or HIV, they must receive the appropriate treatment as soon as possible. TB HIV Care is dedicated to linking clients to care and supporting them in adhering to treatment. Treatment is a particularly important method of prevention, as an HIV-positive individual who is adhering to treatment is virally suppressed and has almost no chance of passing the virus on. 

HIV transmission via needle

Injecting drug users are some of the most vulnerable population groups when it comes to blood-borne viruses, and often struggle to access HIV prevention services or appropriate treatment, care and support. 

There is a severe lack of research on young people and drug use that is centred around harm reduction and human rights, compared to abstinence-based studies. By taking a stance that is respectful of individual choice and neutral on the issue of drug use, a harm reduction approach allows for important initial contact with drug users and increases the likelihood of trusting, therapeutic relationships being established. 

The problem with stigmatising drug users

A stigma can be understood as an indelible mark or stain, and generally applies to an attribute or status that makes an individual unacceptable in other peoples’ eyes. A stigma is different from the disapproval of certain behaviours because it is not necessarily linked to the actions of an individual, but rather to what is assumed about “someone like that.”

People with a history of drug problems, as discussed in more detail below, are heavily stigmatised and are seen as both blameworthy and to be feared. As a result, they are subject to exclusion and discrimination in many areas. 

The dialogue – “once a junkie always a junkie” – is harmful because it tells drug users that there is no reason to acknowledge their problems or seek treatment. Employers will continue to resist giving them jobs, landlords will remain reluctant to give them tenancies and communities will resist the establishment of treatment centres. As a result, drug problems will remain entrenched rather than overcome.

But, while society needs to set norms for behaviour and people need to take responsibility for their actions, the stigmatisation of people who have developed drug problems goes beyond this. 

Such stigma results in those with drug problems conforming to the stereotype that they are thieving, dirty and dangerous, and embracing the label for life – impeding the very recovery that society wishes to promote.

Understanding drug addiction to reduce the stigma

This month, we were privileged with an opportunity to speak to a recovering drug addict, who helped us to understand drug addiction from an addict’s point of view. 

What drug did you end up addicted to? For how long did you take the drug?

I went through all of them and ended up on Heroin. Once you’ve used heroin, there are no questions about “what next,” all other drugs lose their appeal once heroin sinks its teeth into you. You practically sell your soul for the drug – it robbed me of 20 years of my life and I’m still battling the consequences.

How were you introduced to the drug?

I was a kid that many thought was most likely to succeed in life. I was clever and I got good grades. Then, I was introduced to my first party drug while at university. A close friend of mine and someone I really respected gave me ecstasy while out with friends. I was hesitant as I’d always had a negative view of drugs, but he convinced me that the drug wasn’t addictive. Which is correct – the drug isn’t addictive, but the feeling is. My experience with ecstasy made drugs seem harmless because I felt totally in control of my drug use.

I wanted to see what else was out there and progressed to other drugs, but I always kept one rule for myself: the needle was off limits. I particularly loved taking acid during my trance party phase, this was a really fun time in my life. But this all changed one night when heroin forever took all the fun away from me. 

While spending time with a friend from work and his friend, his friend brought out a bag of heroin. This was the first time I had ever seen the drug. He offered some to me and I was tempted to know what it felt like. Both of the people sitting next to me seemed put together – they managed to hold down a job and I trusted them. So, I thought, “why not?” They smoked it and all I did was inhale the second-hand smoke. Looking back, I was a bit too smart with experimenting with heroin. It was the perfect first experience – not too intense, which is what puts most people off. 

Why did you continue to use the drug?

Once you have a good experience with heroin, all other drugs seem to bow down to it. The psychological effect of heroin is impossible to explain. I had discovered something that was able to make me feel infinitely better in an instant, and I was expected to carry on living without it? There was no way.

Then, I tried spiking (injecting) for the first time. It was unreal. There’s a scene in the movie, Trainspotting, where the character falls through the carpet after taking a hit. This is a perfect interpretation of spiking. The sensation is immediate and intense. I evolved from having a terrible phobia of needles to believing, “if it doesn’t fit into a needle, I’m not taking it.”

What were the circumstances in your life that caused so much stress?

I would prefer not to go into detail about the circumstances, but I grew up in an extremely strict household with an abusive parent.

Were you hurt by those who judged you without knowing your story?

Yes, especially when I was judged by the people I so badly wanted to be good for – my family. Drug addiction paints you in such a bad light, but there’s so much misconception. Non-users don’t understand that addicts are slaves to their drug. They think that we choose to hurt those we care about the most and wake up each morning wondering how to cause destruction. I know that I’ve made mistakes, but that shouldn’t make me a mistake. 

What ultimately helped you get and stay clean?

There was no single epiphany – my first epiphany occurred years before I stopped using. It happened 4 years into my addiction, after a couple of months of using the needle. But there was no one to help me and I didn’t have access to professional support. 

I have been forced into rehab by my family on multiple occasions, but I was never going to get clean until I was frustrated enough to make that decision for myself. However, my family’s efforts were never wasted – each one brought me closer to finally deciding to get clean once and for all. Relapse is a part of recovery. 

What advice would you give to those struggling with addiction?

If someone is in a situation where they need advice for overcoming addiction, it’s likely already too late for advice. But I will say this: it’s never too late to stop. 

To their family and support systems, I ask that you don’t give up on the addict. Support is one of the most valuable parts of recovery.

To some, drugs are an act of evil against society, but to others, they are a means of escape. So, why do so many people frown on those who need our help?

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