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When enough is enough

Harm reduction and a rights-based approach supports public health and gets lives back on track

Berenice’s journey into heroin use was a desperate attempt to silence the pain and sadness stemming from a traumatic past. “I was raped twice and faced a difficult family life,” shares the 37-year-old mother of three from Mitchell’s Plain.   

Heroin became both a friend and an enemy, offering temporary confidence while simultaneously robbing her of a fulfilling life. “It numbed all my pain and the sadness I was feeling,” she says. The streets became her reality, trapped in abusive relationships and the constant struggle for survival. On the darkest nights, Berenice would crawl and hide, fearing for her safety. “It was really tough, I couldn’t be the mother I wanted to be and my kids were suffering because of it.” 

Despite multiple attempts at rehabilitation, the root causes of Berenice’s struggles – trauma, violence and poverty – remained unaddressed. “I attended rehab programmes and went back home and everything would be fine but I would relapse over and over again because we never dealt with the trauma.”   

“I kept on trying because I knew the miracle was going to happen. I told myself: it’s either the miracle happens or drugs are going to kill me. But I didn’t want to die like that. I kept that hope alive in myself, even though there were many times I didn’t see a way out.”  

The way out for Berenice was a harm reduction programme for people who use drugs. It is a holistic approach that recognises that people and communities need support at all levels for things to change. “We are not judged, they understand that it’s a process and know it’s a struggle. There’s always someone willing to listen and talk to when you need them.” 

“What I like about the programme is that they never pressured us to get clean immediately.” Instead, Berenice was offered opioid substitution therapy, also known as methadone. “When you’re on your methadone, you wean yourself off, and eventually, you become clean.” 

What makes Berenice’s story even more remarkable is her commitment to giving back. Now a peer field worker, she works with the homeless and others struggling with dependency. “I wanted to give back, and I know I came from there, so I know there’s some way I could help somebody, even if it’s just one person.”  

Her role involves connecting with the homeless community, offering support, and guiding individuals toward shelters and harm reduction support. Berenice believes in the importance of respecting the rights and dignity of every individual, regardless of their circumstances.  

Berenice’s story shows how trauma from human rights violations can almost destroy a person’s life, but also how a rights-based approach, that is complemented by progressive policy and changes in society, can turn lives around. Harm reduction strategies reduce the harm associated with drug use to people and the community. NACOSA’s People Who Use Drugs programme works through TB HIV Care in Cape Town, an implementing organisation offering harm reduction services and support, education, human rights advocates to document abuses and provide access to legal services, and a community-based approach that puts people first. The programme, funded by the Global Fund, also plays a critical public health role by reducing the transmission of HIV and TB and another infection that affects this community, hepatitis. Operating in four urban centres across the country, NACOSA’s programme advocates for the expansion of harm reduction services and changes in policy and society to give hope to more people like Berenice. 

Berenice’s story has a happy ending. She has been reunited with her children and is in a healthy relationship: “I’m happy today. I’m clean, I’m young, giving back to the people who are struggling with addiction and the homeless community. It’s amazing, man, and I just want to tell the peers out there who are struggling, ‘you know when it’s enough.’”