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In the 1980s and 1990s, most South Africans using heroin were white and male, concentrated largely in Hillbrow.

There, Nigerian dealers supplied the illicit drug, which was not commonly available outside Joburg.

The low number of users meant heroin likely entered the country in small shipments, transported by mules on planes.

But that changed in the early 2000s, with use growing rapidly about five years ago.

“Today, heroin is widely sold and used in all major South African cities, many of its large and small towns and even in rural areas,” writes Simone Haysom, a senior analyst at the Global Initiative Against Transnational Organised Crime.

As heroin use increased in South Africa the type of user has shifted.

“Injectors were once primarily white, but now black users have transitioned from smoking to injecting, and black South Africans make up the majority of people who inject drugs.”

Haysom is the author of a hard-hitting report, Hiding in Plain Sight, Heroin’s Stealthy Takeover of South Africa, which suggests the trade in South Africa is larger, more lucrative and more deeply embedded than previously thought.

The research was released this week by ENACT, an EU-supported project that monitors and develops responses to transnational organised crime in Africa at the Institute for Security Studies. In 2018, it published The Heroin Coast: a Political Economy Along Africa’s Eastern Seaboard, on the transit route across a portion of the east coast of Africa and South Africa, for transhipment to primarily Europe and North America.

“While that report was welcomed by many who observe and respond to the criminal underworld in the region, we encountered scepticism among some observers,” writes Haysom.

“Could something so serious really have gone unnoticed and was SA’s heroin problem really that bad?

“Answering these questions is not straightforward, in part, because we lack the kind of data about drug use and drug trafficking volumes that would allow us to make more accurate calculations about their prevalence and impact.

“But we believe we can make a fairly strong case that SA’s heroin use situation is more serious than most people realise and is taking a heavy toll on tens, if not hundreds of thousands of people across the country.”

This includes those who use heroin, support family members who do, or live in neighbourhoods badly affected by competition in the drug trade.

The route that crosses South Africa has created a multibillion-rand regional heroin economy, with “severe social and political repercussions”.

The upsurge in use and availability is a result of South Africa’s position on the so-called “southern route”, one of three major heroin routes out of Afghanistan.

That the southern route has become more significant since 2000 has occurred principally because of an increase in opium production in Afghanistan, increased enforcement on the other routes and persistent “impunity” for traffickers operating in East Africa.

“Heroin is not the only lucrative drug that drives these markets, but our interviews suggest it has become a substantial feature of local drug markets,” writes Haysom, whose research team interviewed those close to the heroin economy: dealers, users, health professionals, outreach health workers, law enforcement officials and gang members.

“In fact, to a significant degree, heroin is a key commodity underpinning the criminal economy in SA and has facilitated the expansion of the criminal economy by pulling in new players as traffickers, dealers and users.”

Widespread heroin use has created social marginalisation and a public health crisis, and embedded Tanzanian criminal networks in the country which “have been pivotal in developing local heroin markets”.

In Cape Town, Nelson Mandela Bay, Joburg and Tshwane, Tanzanians largely control heroin supply.

“In suburbs where South African gangs control retail drug markets, Tanzanians act as wholesalers and supply heroin to gangs for them to distribute and sell. In other suburbs - usually inner-city neighbourhoods home to African immigrant communities - Tanzanians control distribution, although they may employ locals or other nationalities as dealers.

“In all the major metros there is a more-or-less strictly enforced division between the drugs sold by Tanzanian networks (heroin) and by Nigerian networks (cocaine, crack, meth).”

Haysom writes that with the expansion of problematic heroin use, the growth, scale and increased organisation of Tanzanian criminal networks have gone largely unnoticed over the past five years. “The major figures in these networks are not known to us.”

This situation has been developing for half a decade. “The corruption of neighbouring states complicit in this trafficking has been building for even longer. The Central Drug Authority does not seem to have galvanised the necessary political will or resources to address the heroin economy

“It is shocking these phenomena have not received greater attention from the state and are not subject to a comprehensive state strategy. This speaks to inadequacies in criminal intelligence, which does not appear to have monitored drug markets or the broader criminal underworld with enough vigilance in recent years.”

Data on use is limited and does not provide a complete picture of people’s habits or dynamics of the trade. A 2015 figure of 75000 people injecting and 110000 who smoke heroin is believed to have grown significantly.

South Africa, warn the researchers, is at risk of following drug patterns in sub-Saharan Africa, which is expected to have 20 million users of hard drugs by 2040.

Heroin and drug combinations which include heroin are traded and used under a variety of names in South Africa, including nyaope, sugars and unga. “Heroin users are also concentrated in marginalised communities or spaces that do not attract media and political attention. As such, the issue has been ignored as much as misunderstood.”

In South Africa, large populations of homeless people use heroin and congregate in inner-city streets, along railway tracks, under bridges and in disused buildings.

“Less well-known is the large number of people with a dependence on heroin living in major townships and in towns, especially those along the N7 (which follows a major heroin route into the country), such as Witbank, Middleburg and Pietermaritzburg.

“In Cape Town, an important vector for nation-wide drug use, heroin has eclipsed many other drugs in dealers’ repertoires and rivals, if not outsells, tik (crystal meth).”

The growth of the heroin market has several social, economic and political implications.

“A comprehensive policy response to South Africa’s heroin economy should encompass not just law enforcement and public health responses but broader measures, “including political approaches to dealing with the corruption that accompanies drug trafficking and more creative development interventions to address the drivers of community vulnerability”.

‘Someone gave me an opportunity, I took it’: ex-user

It wasn’t trauma or peer pressure that pushed Connie van Staden to start using heroin.

“I just loved what it did for me,” says the 43-year-old frankly, recalling how he started injecting heroin when he was 15 years old.

“I come from a middle-class home and started using substances at a very young age. I got into the club scene in a big way.

“After years of using heroin, at one stage I wanted to get clean, but I just couldn’t put heroin down I used to inject, smoke, schnaaf, I did everything.”

By 2007, in his late twenties, his heroin dependence resulted in him becoming homeless.

“I was tired of hurting my family so I ran away. I was tired of seeing the disappointment in their faces, of trying but not coming right, then I’d fall back the whole time, then phones would go missing, then furniture would go missing and money.

“I was just sick and tired of them telling me what a big disappointment I was.”

He lived on the streets of Tshwane for a decade, supporting his drug habit by begging, stealing, shoplifting and engaging in opportunistic sex.

“Eventually, I ran into a harm reduction project that showed me no matter if I use, they will give me clean syringes. They just showed me they loved me no matter what I do. I thought if a complete stranger can show me love like this, maybe I deserve better. Someone gave me an opportunity, I took it.”

By 2016, he stopped using heroin and is now the regional human rights and advocacy officer for the Harmless Project at OUT-LGBT Well-Being, which offers, among others needle and syringe distribution, collection and disposal and HIV counselling and testing.

Van Staden is the founder and chairperson of Drug Users Gauteng, a network offering support to drug users.

Helping his peers is “phenomenal”, but there’s pain too.

“I’ve just returned from a debriefing session. In the past week, I lost six of my people, three overdosed and three others died of HIV-related illnesses.”

He has seen how heroin use has exploded in Pretoria. “It has grown exponentially. What I see today on the ground level, it’s scary. The data says that for every five people who are smoking heroin, three will start injecting within the first two months of starting. It’s an economic decision.

“If you smoke eight to 10 bags just to function through the day, what happens because heroin is now so freely available and money is scarcer, more people are transitioning to injecting. The high is better, it’s immediate and you have to use a whole lot less in the beginning.

“Of course, your tolerance goes up quickly to where you have to inject four bags at a time six times a day just to function. You’re not high. It’s just to keep the sick away.”

Van Staden says it breaks his heart that so many heroin users need help, but “we can’t get to everyone.

“I constantly tell people how our country, in five to 10 years, we are going to need young people to start families, work, pay taxes, grow the infrastructure of our country. Those young people, who are 18 to 35, are all sleeping under bridges, pushing dustbins.

“We have a hepatitis prevalence rate of over 95%, an HIV prevalence rate of over 27%, a co-infection of over 37%. We are looking at a health crisis in our face that is going to tear our country into pieces.

“There’s a lot of people who really want to make a positive change in their lives but they are not given the opportunity to do so.

“A lot of people don’t understand what a person who is addicted to an opiate goes through. So there’s a lot of ignorance, a lot of fear-mongering.

“And the people who want to help sometimes want to help in their specific way, so it’s either faith-based, or abstinence-based, and it comes from a good place, but it’s not always the right way to help.”