Prohibitionist Drug Policy in South Africa—Reasons and Effects

Abstract

The moral approach that has been used to interpret and implement the Single Convention on Narcotic Drugs exacerbates the health burden faced by people who use drugs. Drawing on our experience in research, programming and policy relating to drug use and health in South Africa, we illustrate the negative consequences prohibition has had for the health of people who use drugs in our country. We argue that South Africa illustrates how approaches that stigmatise people who use drugs are morally justified at the expense of human rights and public health outcomes. We highlight how South Africa is perpetuating prohibitionist approaches on international platforms and question why this has endured. Conflicting health and law enforcement policies, local conservatism and donor conditionality have thwarted harm reduction expansion and evidence-based drug policy development, resulting in notable harms. Persistent morally-based perspectives contribute to stigma and discrimination in healthcare facilities and negatively affect treatment-seeking by people who use drugs. Criminal justice responses have increased TB exposure and entry into correctional centres that do not offer evidence-based drug treatment services. Encouragingly, progressive health and HIV policy affecting people who use drugs has recently been developed, and the recent decriminalisation of cannabis opens a door for policy debate. We recommend that to improve health, the Single Convention on Narcotic Drugs should be challenged to prioritise rights and health and that the personal use of drugs be decriminalised. We also highlight the need for mechanisms to hold health and other actors accountable for ensuring that the health and rights of all people are prioritised and strengthened.