Mpho from Phomolong had been using injectable drugs for years. She avoided clinics because of past experiences where staff judged her harshly and refused care. When the Tintswalo Home Based Care outreach team met her, she was withdrawn and fearful of testing. They spent weeks building rapport, visiting her at home, listening without judgement, and inviting her to women’s circles. Over time, she joined weekly aerobics sessions which helped her regain energy and routine. A turning point came when a peer navigator accompanied her to the clinic. Because staff had been sensitised, the reception was different. Mpho tested positive for HIV and was linked immediately to antiretroviral treatment. With support from peers, she adhered to treatment and began sharing her story in dialogues. Her openness inspired others, and she became a visible example of resilience in the Phomolong community.

Women who use drugs like Mpho are doubly marginalised: they face health risks from substance use and social exclusion from stigma. Tintswalo Home Based Care, founded by Elisa Ngomane, has been a pillar of support for the Tembisa community for many years. Tintswalo implemented NACOSA’s Amaqhawekazi Programme, funded by a ViiV Healthcare Positive Action Grant. Focusing on women who use or inject drugs, the programme aims not only to reduce harm and improve access to health services for this vulnerable group, but also to restore dignity, rebuild family relationships, and create opportunities for social and economic participation.

Before the programme, many women reported being turned away at clinics or treated with disrespect. Families often felt ashamed and distanced themselves, while police responses were more punitive than protective. These conditions made it difficult for women to access even the most basic primary health care.

Recognising these barriers, the Amaqhawekazi programme combined peer-led health education and counselling with community sensitisation, partnerships with local structures like the Community Police Forum and activities that built social capital. The programme’s approach was grounded in respect, confidentiality, and the belief that women who use drugs are community members with strengths, not just problems to be managed.

The programme’s activities aim to address both immediate health needs and deeper social drivers of exclusion. Sensitisation sessions and community dialogues were held in clinics and public spaces to raise awareness, while outreach teams conducted door‑to‑door visits and hosted small group meetings where women could speak privately with peer educators. Soccer, netball, aerobics, dance and art workshops provided safe, non‑judgemental spaces where women could reconnect with their bodies, build confidence, and form supportive peer networks. These activities also served as bridges to the wider community: parents, youth groups, and local volunteers were invited to join, which helped normalise participation and reduce stigma.

In Benoni, Rendi’s life was unstable, and she lost contact with her family. She attended a community sports day out of curiosity and joined a netball team. The structure and trust gave her a reason to show up regularly. Encouragement from coaches and volunteers boosted her self‑esteem. She reduced drug use and sought counselling for trauma. Her family noticed the change and began attending outreach events. The presence of parents at sports activities rebuilt trust and opened communication. Rendi’s story shows how sports and mentorship can catalyse health seeking behaviour and family reconciliation.

Similarly, Joice from City Planning was reluctant to discuss her history and relationship with drugs until she attended a community dialogue. In that safe space, she shared how hardship and lack of support contributed to her drug use. Her honesty resonated with others and reduced her isolation. She later joined art workshops where she discovered her talent. Selling some pieces gave her income and confidence. She became a peer educator, helping facilitate discussions about prevention and recovery.

Tintswalo outreach workers went with clients to clinics when needed, provided information about HIV and STI services, and offered on‑site HIV testing during community events. Peer navigators — women from the community trained to support others — played a crucial role in re‑linking antiretroviral defaulters to care and helping clients navigate clinic procedures. Regular meetings with police and the Community Policing Forum helped shift attitudes among law enforcement and community leaders, encouraging protective rather than punitive responses. Engagement with clinic managers and nurses reduced discriminatory practices and streamlined referral processes.

In Umthembeka, Mirah evolved from programme participant to community connector. She had a strong network of friends and relatives and volunteered to help outreach workers find women in need. Her local knowledge was invaluable. By helping others access referrals, she felt renewed purpose and became a trusted peer navigator. Her presence at clinics reduced anxiety for many women, and nurses recognised her as a reliable liaison. Mirah’s story highlights the power of peer leadership.

The Amaqhawekazi programme shows that community‑led, compassionate interventions can change lives. By combining health services, counselling, sports, arts, and partnerships, the programme reduced stigma, increased access to care, and helped women rebuild their lives. With continued support from NACOSA and stronger local partnerships, this model can be sustained and shared with other communities.

Names were changed to protect privacy.

Qhawekazi (not her real name), grew up in Krugersdorp West with a reputation for brilliance and resilience. Born with what she describes as “untouchable, unshakeable gifts,” she excelled academically and carried dreams far larger than her circumstances. Her ambition led her to study medicine at Medunsa, a milestone that promised a new future for her and her family.

But beneath her achievements lay emotional wounds she had never been taught to navigate. When personal instability struck, she found herself overwhelmed by trauma, pressure, and isolation. Without supportive coping mechanisms, she turned to substances initially to quiet the pain. What began as experimentation soon escalated into dependency.

Her life spiralled quickly. She dropped out of university, became homeless, and entered environments where violence, exploitation, and stigma were constant companions. Like many women who use drugs, she avoided health and social services out of fear of judgment.

To survive, she turned to stripping, first to support herself, later to raise her daughter. The emotional burden was immense. Her baby’s father denied the child. Her mother told her she wished she had died instead of her sister. Grief, resentment, and hopelessness consumed her. She began using “Cat” and crystal meth to numb the pain, shutting out reality as she worked long nights and left her daughter in a 24‑hour daycare. Her substance use deepened, and her mental health deteriorated.

For years, she lived in survival mode but in early 2024, she encountered a harm‑reduction outreach team from Tshepo Ya Bana. Unlike the judgment she had grown used to, these peer educators offered compassion, understanding, and safety. They listened. They affirmed her humanity. They invited her into a women‑only safe space where she could breathe without fear. This moment marked the beginning of her recovery.

Through the women-centred support she received, Qhawekazi slowly rebuilt trust in herself and in the world around her. Tshepo Ya Bana implements NACOSA’s Amaqhawekazi Women Who Use Drugs Programme – funded by a ViiV Healthcare Positive Action grant – which provides peer-led outreach, individualised care and psychosocial support services to support access to services and healing.

She joined contemplation groups, attended women‑only workshops, and began addressing the trauma that had shaped her life. With consistent support, she reduced her substance use, reconnected with her daughter, and restored relationships with her family. She found her voice again.

Qhawekazi has shared her journey on Tshepo Ya Bana’s podcast The Fix Beyond The Fix and has written a book to share her story. Her journey embodies the programme’s goals of creating supportive environments, reducing human rights barriers, and strengthening advocacy for women who use drugs. Her transformation demonstrates the impact of safe spaces, peer‑led outreach, psychosocial support, and gender‑responsive harm reduction services. It shows what is possible when women are met with dignity instead of judgment and care instead of punishment.

Her transformation demonstrates the impact of safe spaces, peer‑led outreach, psychosocial support, and gender‑responsive harm reduction services. It shows what is possible when women are met with dignity instead of judgment and care instead of punishment.

Find out more about the issues facing women who use drugs in the Amaqhawekazi Harm Reduction Summit 2026 Communique.

Puleng (not her real name) is a 32-year-old woman from Bequarel who uses drugs and does sex work. She faced double stigma at public clinics, where she was shouted at, made to wait last, and judged. She is living with HIV but defaulted on her antiretroviral treatment and had never had a Pap smear or breast examination. She believed these services were not for women like her. She also shared needles at times and could not always insist on condom use. 

A peer educator from Indibano approached her without judgment during outreach and told her about the Amaqhawekazi (“heriones”) Programme funded by NACOSA through a ViiV Healthcare Positive Action Grant.  Puleng was offered integrated services: HIV care, STI screening, Pap smears, breast examination, family planning, harm reduction, support with experience of gender-based violence and weekly empowerment sessions. She was re-initiated on HIV treatment, given her first Pap smear (which was negative) and breast examination, and taught breast self-examination. Peer educators follow up on her adherence, and she collects her medication at the community safe space instead of queuing at the clinic. 

The most significant change for Puleng has been a shift in her sense of self-worth. She moved from believing she did not deserve healthcare to seeing herself as an iqhawekazi – a hero. “I am a woman first before I am a drug user. I deserve Pap smear, I deserve to check my breasts, I deserve ARVs,” she says.  

Puleng is now back on ARVs and adherent, with fewer opportunistic infections and more energy. She has been screened for cervical and breast cancer and no longer shares needles. She is working towards viral suppression and is hopeful, though still using drugs, that she can be healthy even while she does. She is better at negotiating condom use, knows her rights and knows where to report violence. She has moved from being a beneficiary to an informal peer champion. She brings other women to Indibano and teaches them breast self-examination. 

Women-only safe spaces make sensitive services such as Pap smears and breast examination accessible and integrating HIV, sexual and reproductive health, and harm reduction removes barriers to care. However continued outreach, especially at night, and screening camps are needed because many women remain unscreened. 

Puleng’s journey from a fearful defaulter to an empowered, treatment-adherent peer champion shows that when key populations are treated with dignity in a safe, integrated and peer-led setting, they can take charge of their own health. 

WATCH: Treat Us as People – the lives and experiences of women who use drugs  

This policy brief examines the evidence, implementation challenges and outcomes of NSPs in South Africa. It sets out practical recommendations for a national needle and syringe policy that supports harm reduction, protects the health and rights of people who use drugs, and provides a coordinated, sustainable public health response.

While these cases are shocking, there is another uncomfortable reality to confront: much of the violence experienced by women and girls happens within relationships and families, and the perpetrator is often someone they know. Data collected through NACOSA’s post-violence care programme found that 70% of sexual assault survivors knew the person who assaulted them.

This matters because violence does not begin with femicide. There are a host of warning signs and opportunities to intervene. Women and girls experiencing domestic and sexual violence need access to services that can help them get to safety, understand their rights, access medical and psychosocial care, obtain protection and navigate the justice system.

Yet the organisations providing these services are themselves under increasing pressure.

The National Shelter Movement of South Africa, which supports around 100 shelters nationally, reported this month that approximately 90% of shelters in its network are struggling with funding and other forms of support. And many highly experienced and effective community organisations working in the field of GBVF are facing dwindling resources at a time when it is needed the most.

South Africa has declared GBVF a national disaster and has a National Strategic Plan for GBVF. But it feels as if nothing has changed. A declaration and a national plan should be more than just paper and theory, it must translate into sustained resources for the organisations and community structures that are providing services to survivors every day.

Beyond marches and social media

People are taking to the streets and social media to express their outrage. And because they don’t know what else they can do to bring about change. While public pressure matters, we also need to turn this energy into practical support and sustained accountability.

If you are able to donate, support an organisation working in your community. Ask your employer, business or community organisation to contribute. And continue to put pressure on government and business to provide sustainable funding for the frontline organisations doing this work.

A small donation will not solve South Africa’s GBVF crisis. But collectively, public support can help organisations keep their doors open while we push for the much larger and sustained investment that is needed.

Better data

We also urgently need regular, accurate and publicly accessible data on GBVF. How can we begin to address a problem that we don’t fully understand? We need to know how many cases are being reported, where they are occurring, the ages and genders of survivors and victims, the type of offence, whether the perpetrator was known to the person affected, and how many applications for protection orders are being made and granted; and the reasons why they are not granted. What are the blockages in the justice system? How much of a role does poverty play? Where are systems and support failing victims?

Without reliable data, it is difficult to identify hotspots, understand patterns, direct resources or measure whether interventions are working.

As academic and journalist Nechama Brodie has argued, data allows us to understand GBVF as both a national crisis and a local problem, helping identify the provinces, metros and police stations that require particular attention.

Community-led monitoring at local level can strengthen national datasets and, triangulated with national statistics, can provide a more nuanced picture. This approach has been used to good effect in the HIV response.

The lesson from South Africa’s HIV response is clear: we cannot tackle a major public health and social crisis effectively if we do not understand its scale and patterns.

Attention to targets for GBVF

South Africa has already set targets for its GBVF response through the National Strategic Plan on GBVF. The challenge is ensuring that these targets are properly resourced, monitored and reported on, with reliable data showing whether we are making progress.

The global HIV response adopted clear targets, including UNAIDS’ 95-95-95 fast-track strategy, alongside detailed surveillance, monitoring and investment to track progress towards ending AIDS as a public health threat.

GBVF needs the same level of ambition, focus and coordination. That means being able to see, year by year, whether the response is actually reducing violence and improving safety.

The government has said that the national disaster classification will strengthen coordination and allow resources to be directed towards impactful interventions. Its 2026 plans include strengthening survivor-centred support, shelters, one-stop service centres, mobile and rural outreach and the justice response.

We don’t need another set of promises. We need to properly resource the existing strategy, collect the data required to measure progress and make the results visible. Now we need to see those commitments translated into adequately funded services and transparent reporting.

The nine women whose lives have been lost deserve more than another cycle of outrage, marches and statements.

They deserve action that prevents the next woman from becoming a statistic.

Don’t just march. Support the organisations doing the work.

If you are able to donate, consider supporting an organisation working to protect women and girls and support survivors, here are a few that NACOSA has worked with:

• Valerie House
• Botshabelo Community Care Centre
• Lifeline Vaal Triangle
• Childline
• GRIP
• Areageng
• National Shelter Movement of South Africa – supporting shelters and organisations across the country.

If you or someone you know has experienced gender-based violence

Free post-violence care is available through centres across South Africa and can include medical, emotional and legal support.
Lifeline: 0800 150 150
Childline: 116
GBV Command Centre: 0800 428 428
USSD: 1207867# (“Please Call Me”)
SMS: Text “help” to 31531 for persons with disabilities

“My goal is to turn this small hustle into sustainable community impact”  

Mpho, also known as Gold, is a young man from Mangaung in the Free State who loves working with people and finding ways to create change in his community. He runs a small business selling affordable fruits and vegetables as a way of earning an income while making fresh produce accessible to people in the area. 

His love for entrepreneurship started at the age of 18, when Mpho started selling sweets and water in his community. It was a small business, but it taught him valuable lessons about working hard, serving people and being consistent. It also gave him an early understanding of what it takes to earn a living from your own efforts. 

As Mpho continued looking for ways to grow and support his community, he joined the SEF programme through Men Up Ndoda community organisation as a Community Mobilizer. The programme gave him an opportunity to build his skills and gain more experience working with people through community work. The support he received also helped him see his business in a different way. He now sees it as a source of income and as something that could also benefit people in his community.  

“I chose the fruit and vegetable market because, for me, it is about more than just selling. It is also about feeding families and meeting a need in my community,” Mpho says.  

Looking ahead, Mpho hopes to grow his small business into a larger fruit and vegetable market. He also wants to create opportunities for young people in his community. To take this next step, Mpho is currently seeking funding to help him set up a market shelter and grow his business. 

“My vision is to build something long lasting and create opportunities for young people in my community.” Mpho concludes 

“As a single mother, being able to support my children and run a business that provides me with an income is very important to me“

Buhle Ngidi is a single mother who is working hard to support her family. She is a hairdresser who is running her own salon, which gives her financial independence and helps her provide for her children. 

Buhle tried other ways of earning an income, but they were not successful. She then decided to use her hairdressing skills to start her own business by renting a small wooden shelter where she works and provides hairdressing services to people in Amsterdam, Mpumalanga. At the beginning, she did not have enough money to buy all the equipment and products she needed for her business. But she believed in her dream and, as the person supporting her family, she knew she had to keep trying. 

When she heard about the Social Employment Fund Programme, she reached out to the local implementing organisation, Yakha Ikusasa Manje Health Development Center, where she participated as a community mobiliser and earned monthly stipends, which helped her buy the necessary products and equipment for her hairdressing business.

“The support from SEF has helped me to keep the business functioning and has reduced the financial pressure I experienced as a small business owner and a mother” Buhle says.

Through her work as a community mobiliser, she was able to serve her community while earning an income that helped her invest in her business and improve her livelihood. One of the things Buhle values most about the SEF programme is how it contributed to her business and helped her become less dependent on others for its success. The support from the programme has helped Buhle continue working towards her goal of making the salon sustainable and profitable.

Despite her achievements, she still faces several challenges that inspire her to work even harder toward her goal of building a successful salon. During the rainy season, working becomes challenging because the wooden shelter she rents lacks proper protection from the rain. This limits her ability to offer services and discourages customers from visiting her salon. 

Buhle has a clear dream of owning a hair salon in a sturdy, safe, and welcoming building where her customers feel comfortable. She hopes to grow her salon into a successful and lasting business that will provide a better future for her and her family.  

“My salon lets me earn money while building something of my own. I believe that with the right tools, equipment, and a better workspace, my business can really grow,” she says. 

Book your hair appointment via WhatsApp: 079 078 0067 

The summit comes at a time when people who use drugs, particularly women, continue to experience stigma, discrimination, violence and barriers to accessing health and social services. Women who use drugs can face additional challenges linked to gender inequality, including increased vulnerability to gender-based violence and limited access to safe, confidential and non-judgemental services. HIV prevalence among women who inject drugs and sex workers is estimated to be several times higher than among women in the general population. This reflects the ongoing impact of violence, economic vulnerability and barriers to consistent HIV prevention and treatment services.

The summit will provide a platform to discuss how harm reduction services can better respond to the needs of women who use drugs and other vulnerable populations, including men who have sex with men, transgender people, people in prisons, young people and people with disabilities. Harm reduction is a practical health approach that focuses on lowering the negative health, social, and legal risks associated with behaviors like substance use, without requiring a person to stop. It promotes the non-judgemental and non-coercive provision of services and resources to people who use drugs or engage in high risk activities and the communities in which they live, helping to reduce the potential harm.

“We want to listen to people who use drugs and work together to find practical ways to improve access to safe, evidence-informed and rights-based services,” says Yolaan Andrews, Deputy Grant Manager at NACOSA.

Discussions will focus on five key themes: harm reduction as a public health and human rights imperative; women, gender and harm reduction; young people and harm reduction; integrated service delivery and health systems strengthening; and policy reform, advocacy and accountability.

Participants will consider priorities for strengthening harm reduction within HIV, TB, hepatitis, mental health and other health and social services. The summit will also focus on gender responsive and youth friendly services, disability inclusion, community-led monitoring, policy and legal barriers, and opportunities to strengthen community participation in decision making.

A key outcome of the summit will be the Amaqhawekazi Harm Reduction Summit Communiqué 2026. The stakeholder-driven communiqué will present shared priorities, commitments and recommendations for strengthening and scaling up comprehensive harm reduction services in South Africa. It will also provide a coordinated roadmap for the grassroots action and will highlight opportunities for collaboration between government, civil society, communities and development partners.

“We know that real change requires more than good policy. It also requires services that respond to the realities people face in their everyday lives. This summit is an opportunity to look at what is working, where the gaps remain and what we can do differently to strengthen harm reduction in South Africa.” Says Yolaan Andrews

“A lot of people were selling Kotas, and no one was selling sandwiches; I saw an opportunity to offer something different that would benefit both customers and me.”

Tirolo Boikanyo is a 25-year-old young entrepreneur from Boitekong Extension 2 in Rustenburg who had a dream of owning his own kitchen and selling sandwiches within his community. But Tirolo didn’t just dream, he acted, turning his vision into a growing business and an opportunity to serve his community while creating a sustainable source of income for himself.

Tirolo had no income after finishing high school and he moved from his village to Rustenburg to look for jobs. Things did not work out as plannedso he decided to create his own opportunity and started a small business with his aunt. The business was a tuck shop at first, but Tirolo quickly recognised the potential for big, generously filled sandwiches. He saw a need and decided to fill it by bringing Dagwood sandwiches to his community and started Boikanyo’s Kitchen.

Besides selling his Dagwoods , he also got an opportunity to serve his community, becoming a community mobiliser for the Social Employment Fund programme at Teach-lead Mentor Foundation. During his participation in the programme, he was connected to Pronet, where he was given further entrepreneurship training, and more doors opened for him. The training has helped him gain knowledge and skills to feel more confident in running and growing his business. The Small Enterprise Development Agency (Seda), an agency of the Department of Small Business Development that provides non-financial support to small enterprises and cooperatives was also brought in to talk about funding options that could take his kitchen business to the next level.

“I feel grateful, motivated and inspired by the support I received; the programme has shown me that my small business has a potential and that I could build something bigger if I remain committed and make use of the offered opportunities.” He says.

Tirolo’s biggest goal is to grow his business from working at home to having a bigger space of his own and eventually becoming one of the people who help create employment opportunities in his community. He also sees himself working with bigger companies and catering for major events.

The support he received at home, in his community, and through the SEF programme helped make these ambitions feel possible. What started as a way to earn an income has grown into a journey of creating opportunities. After facing unemployment, he saw a need in his community, created an opportunity for himself, and is now working to grow his business and create opportunities for others.

“I have not forgotten where I come from, and I want my success to inspire others in my community to believe in themselves, identify opportunities and take the first step towards building something of their own.” Concludes Tirelo.

Place your Dagwood order with Boikanyo’s Kitchen on Facebook