SA FACES SCOURGE OF HEROIN AS WELL AS HIV

Johannesburg

THE United Nations (UN) has recently reported an upsurge in heroin use
among impoverished teenagers and young adults in SA, troublesome news for
those concerned about combating HIV, hepatitis C, and other needle-borne
diseases.

As an injected drug, increased incidence of heroin use among SA's poor
further increases the chances of contracting HIV or hepatitis C, suggesting
prevention strategies which stress informed sexual activities may not
suffice to combat the spread of these diseases in the near future.

The burgeoning heroin problem is mainly due to the expansion of poppy plant
production (from which heroin is ultimately manufactured) following the
fall of the Taliban regime in Afghanistan, which severely restricted such
farming.

The increase in supply has been met with a concordant decrease in price,
making heroin a more accessible and popular drug among those who previously
could neither find nor afford it.

Given that heroin is devastatingly addictive more so than any other illegal
drug its consumption will likely spread and continue an upward trend in
demand, persisting among users even if the drug becomes scarcer and street
prices rise.

In the absence of an adequate rehabilitation infrastructure (including, for
example, government-subsidised methadone clinics and public awareness
program-mes), violence in SA could escalate as users seek to fund their
habit by any means possible, edging the battle against HIV much closer to
the war on drugs.

Organised drug trafficking and distribution will inevitably become
intimately intertwined with disease epidemiology. This is already the case,
for example, in certain parts of the US and UK, where heroin availability
and consumption have soared over the past year in parallel with reported
HIV rates.

The need for an immediate response from SA's government cannot be
overstated. Convenient access to heroin in a population with the highest
number of HIV/AIDS cases in the world could thwart all progress made in
controlling the HIV epidemic and throw the country's health and economy
into shambles.

As the UN report recognises, some appropriate first steps have already been
made, such as heightened scrutiny of foreign shipping containers and the
establishment of the Financial Intelligence Centre to crack down on money
laundering.

The limited success of similar endeavours in other countries, however,
should be sufficient forewarning that more action is needed, especially at
consumer level. Setting up a nationwide heroin/HIV awareness campaign,
maybe modelled on the UN "Ke Moja" ("No thanks I'm fine") project, along
with more funding for community-based drug task forces and treatment
clinics might help curtail this emerging threat before it evolves into a
crisis.

Pre-emptively starting more needle-exchange programmes where used or
"dirty" needles could be exchanged for new or "clean" ones might also be
reasonably implemented at low cost to help to contain the spread of HIV.

The appearance of heroin among SA's poor makes one thing frighteningly
clear: the battle against HIV and AIDS can no longer be waged merely
through condoms and pillow talk. Sadly, the battle may have only just begun.

Lott is a Marshall scholar at Oxford University.