AIDS2018: Humans in the age of HIV-It’s the living that can hurt you

By Nomatter Ndebele

There are an estimated 75000 people living in South Africa who inject drugs. According to local NGO, Jab Smart, 1653 of these users, are located within Sub-region F in Johannesburg. Sub-region F covers the Johannesburg CBD, Braamfontein, Rossetenville, Mayfair, Hillbrow and Yeoville. 42-yeard-old, Marthinus Barnard, is just one of them.

It is a bitterly cold morning in Vrededorp, Johannesburg. Marthinus walks ahead of us with a limp that came back a few days ago, after stealing a municipal bin for his friend. We move silently and steadily along, until he turns around with a cheeky smile, opens his arms and announces “welcome to my office”.

His office is one of Johannesburg’s oldest cemeteries, the Brixton Cemetery which is adjacent to Vrededorp. We weave in and out of tombstones, trying to find a spot to settle. Eventually we come to an area that has many horizontal tombstones. Here, the trees part just enough to allow the struggling  sunlight to illuminate a piece of a broken tombstone that reads “Moeder” (A formal Afrikaans reference to Mother).

“My mother told me, dead people can’t do anything, it’s the living that can hurt you,” says Marthinus.

He settles on an abandoned piece of a tombstone and turns his striking blue eyes to mine, ask me anything,” he invites.

Marthinus, who goes by  “Thinus” has spent more than half his life on drugs. He has come a long way since he first smoked marijuana, with a group of school friends in an attempt to beat his depression.  In these twenty years, this once handsome blue eyed boy has lost all his front teeth, his skin is patchy, he is covered in grime as washing himself is no longer a priority. His wrists are decorated with thin lines acquired from self-harm, and his arms are covered in tattoo’s, some from boyhood and others from prison stints.

Thinus spends five to six hours in his “office” every day. In this space, he has had countless “hits” and a track record of 400 clients during the time he was a sex worker. Thinus no longer engages in sex work, he does odd jobs where he can to make enough money to support his habit. Fortunately or unfortunately, Thinus quips.

A bag of heroin costs anything between R18 and R40. (around $1.20 to $3)

A bag of heroin in Vrededorp typically contains about 3% heroine, and is mixed with rat poison, ant poison and antiretrovirals.  The crook of Thinus’ left arm is decorated with a red rash, that’s the “Rattex” (rat poison) he says matter-of-factly. The high from this heroin lasts three to four hours, before Thinus needs his next fix. He goes through six or seven bags every day.

Key populations?

The term key populations draws a blank from Thinus. Despite knowing all there is to know about the history of Vrededorp. It seems this is one term he doesn’t know about.

Although he no longer engages in sex work, Thinus is still an in injecting drug user, and is at high risk of contracting HIV. He admits having been ignorant about HIV in the early days. “I always used to tell people that there was no such thing, that if you just cleaned the needles nicely, you wouldn’t catch it, what a mistake that was,” he says while letting out a belly laugh.

A month ago Thinus learnt that he had tested positive for HIV. He knows for a fact that he contracted the virus through the sharing of needles. “There is only one guy I share needles with, and he is also HIV positive, I’m sure I got it from him.”

A local NGO and mobile clinic called Jab Smart, has started operating in Mayfair which is a few blocks away from Vrederdorp. Jab smart is currently the only organization that provides harm reduction packs (HRP) to People who inject drugs (PWID). The harm reduction packs consist of new needles, alcohol swabs and condoms. These packs are made available to people who inject drugs at least once a week. People simply have to remember when the mobile clinic is coming to the neighborhood, so they can access a HRP.

At the mobile clinic people are encouraged to take HIV tests. This is part of Jab mart’s comprehensive care package. Where they encounter users who are HIV positive, they refer them to a clinic or a doctor to try and get them on treatment as soon as possible. It was through this service that Thinus discovered that he was living with HIV.

Jab Smart is currently the only service assisting injecting drug users  in the area. The programme seeks to ensure that if users cannot quit the habit, they at least continue in a safe manner or that they try to lessen their intake of drugs. The same programme independently provides OST (Opiod substitution therapy) to eligible candidates. OST therapy provides people who inject drugs with monitored dosages of Methadone – which provides relief to the severe drug withdrawal symptoms which could otherwise drive people to again use drugs.

A mobile population

Despite the fact that this service is just a stone’s throw away from Vrededorp (about 7 kilometres), it is an impossible feat for the average drug user to access it.  “We can’t go there every day, it’s easier for us to make up the money to get a hit than to get together the money to travel to Yeoville,” says Thinus.

While Thinus’ problem is that he is  somewhat  immobile, most users face the problem of being too mobile.

Anthony Manion, project manager of Jab Smart, says that the fact that most drug users are mobile provides the programme with great challenges when it comes to monitoring  and supporting users. “Because people move all over the city, sometimes with all their belongings in tow, it is difficult to trace users.” Despite this challenge, Jab smart has managed to retain many of their first time users who receive HRPs.

In the month from May to June Jab smart saw a total of 1 653 new users. In the same month, they had 5 944 people who returned to use the service.  They managed to test 1 086 users for HIV, of which 504 tested positive, but only 112 of them were successfully referred to a clinic or a doctor.

Despite the fact that Thinus was referred to a clinic through this programme, he has not yet gone. “I still feel healthy, but also my life is already fucked up, what is there left to do,” he says.

Thinus has been through Rehabilitation twice and relapsed each time. Despite having had the opportunity to be in a private rehabilitation facility, Thinus was unable to stay away from the drugs. He blames this on the fact that despite getting clean, he came back to the very same environment that fostered his habit for so many years. “If there is nothing to occupy your mind or something for you to do, you’ll go back, there just isn’t enough support for us when we come out from rehab.”

He isn’t lying. The lack of resources and support for people who inject drugs in Vrededorp, is glaringly obvious. The flats are all dark, most have cracked windows and are decorated with crude graffiti. The streets are deserted and there is no life, other than on a few corners where groups of boys loiter around. The community has one soup kitchen, which also operates as a crèche, for smaller children. Other than that, you’d be hard pressed to find a library or a community resource center. Leaving is hardly an option for anyone in Vrededorp.

Apart from Jab Smart, there isn’t any other programme that offers such comprehensive care to users. Even at state hospitals, where people have been specifically trained to work with people who inject drugs, not enough is done to assist this vulnerable key population group. “Often nurses will turn away drug users asking them to return when they are clean”, says Mourbadin. “In most instances, people are turned away from facilities, either because of the way they look, or how they smell.”

The threat of being mistreated or turned away from healthcare facilities has thus become a major deterrent to people looking for care services. This has caused many people who might otherwise have accessed life-saving care, to fall by the wayside. There simply seems to be no way back for people like Thinus.

Six years ago Thinus and his friends were travelling from Krugersdorp to Johannesburg. One moment Thinus was chasing a glass of Vodka with a cocktail of crystal meth, Mandrax and marijuana, the next moment he opened his eyes and a doctor was standing over him in the Intensive Care Unit, telling him that he had flat lined for a minute and 20 seconds. Thinus was clinically dead. “ Doing drugs is never enough, the only way you can win is by dying,”says Thinus.

This article is part of a Spotlight special series on people who form part of so-called key populations.