The Bellhaven Harm Reduction Centre was officially founded in June 2020, however, its roots lie in the success of the first low threshold opioid substitution therapy (OST) programme in Durban, and in initial ideations to create an “African Centre for Hope”. In April 2017, the Durban University of Technology’s Urban Futures Centre (UFC), together with TB HIV Care opened South Africa’s first low threshold opioid substitution therapy (OST) programme in Durban. This was located in Umbilo in Durban. This programme provided a very important evidence-based service to low-income people who use drugs. But it was also an advocacy platform, providing evidence of the efficacy and efficiency of such a programme in a local South African context. The South African Network of People Who Use Drugs, under the leadership of Shaun Shelly, played a critical role in developing the protocols for this programme and in creating platforms for drug policy change. When this programme ended in 2019, a platform was formed to advocate for an all-inclusive community-based harm reduction centre in Durban. This was a dream shared by the non-government sector and by progressive government officials. The idea was to create what was called the Africa Centre for Hope. Durban became a key city for the implementation of a comprehensive harm reduction centre – imagined initially as an African Centre for Hope – given its influence politically and the success of the demonstration project. This remained a dream until Covid-19, which presented an unexpected opportunity for this dream to become a reality. This reality is today called the Bellhaven Harm Reduction Centre.
This all began in March 2020 when the then eThekwini Deputy Mayor, Belinda Scott, facilitated the creation of lockdown safe spaces for the homeless, to protect them from contracting the deadly COVID-19 virus, and to prevent them from spreading it to others. Recognising that a large percentage of the homeless population have a substance use disorder, mostly related to heroin use, it was determined that a withdrawal management programme be run from the lockdown safe spaces. A short-term opioid-substitution programme was set up by a private medical team, led by Prof. Monique Marks (DUT), Michael Wilson (Advance Access & Delivery) and with Shaun Shelly (SANPUD) who played an advisory role. Throughout this programme, which ran for the 10-week period of COVID-19 lockdown level 5 and 4, AA&D and TB HIV Care were responsible for identifying clients within the homeless safe spaces who were in need of short-term methadone intervention. They were also responsible for testing for TB and HIV during this period, and for providing chronic medications to those on the programme. SANPUD played two critical roles. Firstly, SANPUD provided advice on how to run the withdrawal management programme, in line with best international practices while locally relevant. Secondly, they provided the fiscal vehicle for donor funds to support the programme.
The eThekwini Municipality received praise for having one of the most comprehensive and compassionate responses to the homeless during the hard lockdown, which included having the foresight to implement a successful withdrawal programme. When South Africa entered lockdown level 3, and the homeless people were given the freedom to leave, the Municipality looked more deeply at the link between drug use and homelessness, and recognised that continuous access to the harm reduction services and interventions offered in the hard lockdown had the potential to decrease homelessness drastically. This spurred the Municipality to make the radical decision to spearhead the expansion of the programme from a temporary response to a crisis, into a permanent harm reduction centre in the inner city.
In June 2020, the Deputy Mayor Scott worked with the Homeless Task Team, and selected what was previously the Bellhaven Memorial Centre, at 217 First Avenue, to become the long-sought harm reduction centre. SANPUD became a key actor in generating funds, and in raising funds for the programme, and was also responsible for co-managing Bellhaven on a daily basis, particularly through activating networks of people who use drugs. The Bellhaven Harm Reduction Centre was formally launched by the Deputy Minister of Social Development together with SANPUD on the 28th of October 2020.
– The fundamental human rights of all people, especially the most vulnerable in our society, must be upheld
– The harms associated with drug policy and drug use can and should be minimised
– Stigma and prohibition of all kinds must be eradicated
– People who use drugs should be able to access globally recognized evidence based services
– All people, regardless of social and economic status, deserve the highest quality health and psycho-social services
– All drugs should be decriminalised to enhance health and other help seeking behaviour
– Individuals who use drugs can and should determine their own life goals
– The role of professionals is to accompany people who use drugs on their journey to self-realisation, rather than imposing pre-determined outcomes as ‘experts’.
Aims and Objectives:
1. To provide a comprehensive set of harm reduction services to low-income and homeless people who use drugs. This is integrated with the screening and linkage to services for those infected with TB and HIV, so as to ensure adherence to treatment.
2. To advocate for the expansion of harm reduction service provision throughout the country, by showcasing the positive outcomes of the centre and its cost effectiveness.
3. To provide a safe space for women and young people affected by problematic drug use to meet and to support one another.
4. To create a platform for training medical and mental health professionals who are interested in harm reduction and drug use disorders. This includes developing continual professional development courses that are recognised by the relevant professional bodies.
5. To run engagement sessions with law enforcement agencies to ensure their ongoing support for the Centre and for harm reduction more generally.
6. To document the personal narratives