Such initiatives are relatively new in Africa and have met some resistance. 

“I think the main challenge is… some leaders think that harm reduction might encourage drug use,” said Cynthia Semá Baltazar, a researcher at the Mozambican government’s National Health Institute. “[I]t’s in our society. I think historically the main strategy addressing drug use in our society has been punishment. But it’s important that we shift from a criminal justice to a public health approach.” 

In 2018 the charity Medecins sans Frontieres opened Mozambique’s first harm reduction programme in Malfalala. MSF had to work closely with the community, including religious leaders, elders and even the drug dealers themselves, in order to create enough buy-in to safely open their doors.

The programme has already saved lives. 24-year-old Rukeya, rail-thin after years of heroin use, began using drugs at the age of 17, after her mother was diagnosed with cancer and her brother was sent to prison. Rukeya watched her mother die in front of her eyes while her brother listened on the phone.   

“I am powerful now, but it was difficult because he was my support,” she said, her hoarse voice cracking as she began to cry. “He was my everything. And then when I lost my mother, I felt like no one liked me. So, I started to use drugs. And I started to sleep on the street.”