In South Africa, a needle exchange program for drug users feels the
effects of Trump's aid cuts
[April 04, 2025]
By MOGOMOTSI MAGOME
PRETORIA, South Africa (AP) — A secluded corner surrounded by litter and
makeshift structures on the outskirts of South Africa’s capital is home
to dozens of people with drug addiction. They inject themselves and each
other with heroin-laden mixtures, some of them sharing needles.
A group of health workers has been making weekly visits to this and a
dozen other places across Pretoria. In the project backed by the
University of Pretoria and the Tshwane municipality, they offer the
chance to exchange needles for new, sterile ones.
Needle exchange is not a new idea globally, but such efforts have been
jolted by the Trump administration’s decision to kill 83% of U.S. Agency
for International Development programs around the world.
In South Africa, which has more people living with HIV than any other
country, treatment for people with HIV has been hit hard. Users who
share needles are especially at risk of such diseases.
The team in Pretoria includes doctors and social workers who have built
relationships with the drug users, encouraging them to accept an
opioid-substitution therapy, and offering treatment if they have
illnesses like HIV.
The need for such help is increasing. Last year, a University of
Pretoria report estimated that 84,000 people inject drugs in South
Africa, and in Pretoria there was HIV prevalence of 38%. South Africa's
overall HIV prevalence is over 12%, according to government data.
The report said the country's drug market for cocaine, heroin and
methamphetamine is worth about $3.5 billion, and growing.
U.S. aid cuts bring uncertainty
While the Community Oriented Substance Use Program in Pretoria is fully
funded by the municipality and the university, it is indirectly affected
by the shock to the global aid system. Some nonprofits that the program
partners with have closed.
And at least one local health clinic that was providing services in
Pretoria has closed, forcing patients to turn to often crowded, poorly
funded government-run facilities.
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A homeless drug addict holds a syringe after injecting himself, on
the outskirts of Pretoria, South Africa, Wednesday, March 5, 2025.
(AP Photo/Themba Hadebe)
 Now, harm reduction programs like
the Pretoria one for drug users will face stiff competition for
sharply shrinking resources.
Regrets and hope
As doctors did consultations, Phumulani Mahlangu expressed regret
for his situation. The 30-year-old said he is addicted to a heroin
mixture locally known as nyaope. He is homeless and has three
children in his hometown nearly 200 kilometers (124 miles) away.
“In 2013, I experienced with nyaope with friends. I never felt such
relaxation before," he said as he prepared a syringe. “I started
spending my own money on it and that's how I got here.” He takes
part in the needle exchange.
Dipolelo Lekota is one of the few female drug users at the site. The
30-year-old said she was struggling to quit drugs so she could take
care of her child, who is with relatives.
She said she can access HIV medication and clean needles through the
visiting project to avoid infecting others.
Withdrawal pains
Likwa Ncube leads the project in parts of Pretoria. He acknowledged
that drug withdrawal can be painful as people accept methadone
instead.
“It’s not an easy thing to deal with," he said. The challenge is
helping them through it.
Ncube said the program, like similar ones elsewhere in the world,
had been unfairly accused of enabling or encouraging drug use
because it provides needles.
“It can be viewed as if you are enabling somebody to use, but we can
have the same argument with condoms," he said. “When we distribute
condoms, are we saying we are encouraging people to have sex?"
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