Vernon and Zama, who lives with HIV, receive care and support at Durban's TB/HIV Care Center for injecting drug users in South Africa.

Like many people who inject drugs in Durban, Vernon Van Wyngaard, 49, is homeless. He makes money either by begging at intersections or through gardening. Zama Nene, 27, also is homeless. She has been injecting drugs since 2011, but last year was diagnosed with HIV, a result of sharing needles. She is matter-of-fact about her life: “I didn't know about the needle sharing thing, but they say that’s why I have AIDS.”

Nationwide, only around 1,500 people receive opioid replacement therapy – a treatment to help wean injecting drug users off heroin by substituting with methadone. But methadone is not recognized in South Africa as an essential medicine and so costs around 30 times more than elsewhere.

For Zama, coming to the center provides a measure of relief from an overwhelmingly hostile environment. She is constantly exposed to the threat and reality of sexual violence made worse by the stigma that comes from drug use and homelessness. She says: “Living on the streets is difficult. The guys using ‘whoonga’ [a street drug that has become widespread in the townships of Durban over the last decade] are the worst – the scariest.”

The Global Fund / Vincent Becker