In South Africa, needle exchange programme for drug users feels effects of Trump’s aid cuts

A homeless drug addict sleeps on the ground, on the outskirts of Pretoria, South Africa, on March 5, 2025
| Photo Credit: 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 addictions. 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 Donald Trump administration’s decision to kill 83% of U.S. Agency for International Development programs worldwide.

In South Africa, which has more people living with HIV, treatment for people has been hit hard. Users who share needles are at risk of such diseases.

The team in Pretoria have built relationships with the drug users, encouraging them to accept an opioid-substitution therapy, and offering treatment if they have illnesses such as HIV.

Last year, a University of Pretoria report estimated that 84,000 people inject drugs in South Africa, and in Pretoria, there was an HIV prevalence of 38%. South Africa’s overall HIV prevalence is over 12%, according to data.

The report said the country’s drug market for cocaine, heroin, and methamphetamine is worth about $3.5 billion, and is growing.

While the Community Oriented Substance Use Programme in Pretoria is fully funded by the municipality and the university, it has been indirectly affected by the shock to the global aid system.

At least one local health clinic that provides services in Pretoria has closed, forcing patients to turn to often crowded, poorly funded government-run facilities.

Now, harm reduction programmes will face stiff competition for sharply shrinking resources.

The 30-year-old Dipolelo Lekota said she was struggling to quit drugs. She said she can access HIV medication and clean needles through the visiting project to avoid infecting others.

Likwa Ncube leads the project in parts of Pretoria. He acknowledged that drug withdrawal can be painful, as people accept methadone instead. The challenge is helping them through it. He said the programme had been unfairly accused of enabling or encouraging drug use because it provides needles.