Curb Aids and HIV by decriminalising drugs, say experts

• Mary O'Hara
• The Observer, Sunday 19 April 2009
• Article history

Aids and HIV worldwide. Photograph: Cat Davison/Pete Guest

The use of illicit drugs must be decriminalised if efforts to halt the spread of Aids are to succeed, one of the world's leading independent authorities on the disease has warned.

In an unprecedented attack on global drugs policy, Michele Kazatchkine, head of the influential Global Fund to Fight Aids, Tuberculosis and Malaria, has told the Observer that, without a radical overhaul of laws that lead to hundreds of thousands of drug users being imprisoned or denied access to safe treatment, the millions of pounds spent on fighting HIV and Aids will be wasted.

Kazatchkine will use his keynote speech at the 20th International Harm Reduction Association conference tomorrow in Bangkok to expose the failures of policies which treat addiction as a crime. He will accuse governments of using what he calls "repressive" measures that deny addicts human rights rather than putting public health needs first.

He will argue that governments should fully commit to the widespread provision of harm reduction strategies aimed at intravenous drug users, such as free needle exchanges and providing substitutes to illicit drugs, such as methadone.

"A repressive way of dealing with drug users is a way of facilitating the spread of the [HIV/Aids] epidemic," Kazatchkine said. "If you know you will be arrested, you will not go for treatment. I say drug use cannot be criminalised. I'm talking about criminalising trafficking but not users. From a scientific perspective, I cannot understand the repressive policy perspective."

He condemns policymakers who argue that, because drug users frequently turn to crime to fund their habit, it justifies making it a criminal justice issue. Harm reduction both helps the addict and wider society and reduces the need to commit crime, he said.

"The one population where [Aids] mortality has been untouched - and in fact has worsened - has been IV [intravenous] drug users. It's amazing, because what we call harm reduction, such as exchanging needles, has been scientifically proven as the most effective.

"This is why I will most probably start my speech in Bangkok by mentioning the contrast between major progress achieved in decreasing mortality from Aids in the poorest countries of the world versus the total lack of progress for what is the main route of transmission in most parts of the world outside Africa."

Kazatchkine suggested that politicians feared that the public would label them soft on drugs. A doctor and respected Aids expert with 20 years in the field, he has in his two years at the helm of the Global Fund overseen some of the most dramatic improvements in treatment and prevention of HIV globally.

Since it was established in 2001, the fund has received $21bn in contributions from the world's wealthiest nations and used it to play a significant part in reducing rates of new HIV infections. It has also contributed to the distribution of much needed life-preserving anti-retroviral drugs to millions of people already diagnosed.

Alex Stevens, a senior research fellow specialising in drugs and criminalisation at the University of Kent, said tomorrow's speech would highlight many of the troubling consequences of criminal justice approaches to drugs policy.

"In many countries, serious human rights infringements are committed in the name of fighting drugs," he said. "These include the use of the death penalty for drug offences, compulsory treatment regimes that include methods (such as physical beatings) that are akin to torture, and, for example in the USA, depriving convicted drug law offenders of the right to vote."

Stevens said that, while the UK was ahead of many other countries on harm reduction, its tendency to criminalise drug users could undermine its efforts.

What is needed, Kazatchkine will argue tomorrow, is a total rethink of drugs policies. "What I'm saying is that government's function is to protect their citizens. This is why harm reduction should be supported by all governments everywhere."

Portugal's drug decriminalization 'bizarrely underappreciated': Greenwald

Rachel Oswald Published: Monday April 6, 2009
http://rawstory.com/news/2008/Portugals_drug_decriminalization_bizarrely_underappreciated_Greenwald_0406.html

Champions of harsh drug criminalization laws as the best solution to curbing drug use will be chagrined to find that Portugal’s eight year history of decriminalization has led to lower drug usage rates.

According to a new report entitled, “Drug Decriminalization in Portugal: Lessons for Creating Fair and Successful Drug Policies,” while drug use across the European Union has risen steadily since 2000, Portugal, which has the most liberal drug laws of any country, has actually seen its prevalence rates decrease in various age groups since it decriminalized all drugs in 2001. Prevalence rates measure how many people have consumed drugs over the course of their lifetime.

“I think it’s bizarrely underappreciated what’s been done in Portugal,” said Salon writer Glenn Greenwald, who authored the report. Greenwald, who speaks fluent Portuguese, traveled to Portugal in 2008 to study the affects of drug decriminalization in the country.

Because drugs were not legalized outright in Portugal, violations of laws prohibiting drug possession for personal usage are now merely treated as administrative offenses and carry with them no criminal charges. Drug trafficking, however, continues to be prosecuted as a criminal offense in the country.

Compared to the low to moderate levels of drug use in Portugal since decriminalization went into effect, the majority of EU states have drug use rates that are double and triple that of Portugal today, according to the report.

Greenwald, who presented his findings at a Friday event at the Cato Institute, which sponsored the writing of the report, noted that the United Kingdom and Estonia, EU nations with some of the harshest criminalization laws, also have the highest cocaine usage rates in the EU.

“None of the fears promulgated by opponents of Portuguese decriminalization has come to fruition, whereas many of the benefits predicted by drug policymakers from instituting a decriminalization regime have been realized," writes Greenwald in the report. "While drug addiction, usage, and associated pathologies continue to skyrocket in many EU states, those problems—in virtually every relevant category—have been either contained or measurably improved within Portugal since 2001.”

Greenwald said the strongest evidence in Portugal that supports drug decriminalization is the declining usage of drugs in the crucial 15-19 age group.

In every single drug category, with the exception of the new drugs that have come into popular usage since 2001, like ketamine and GHB, teen drug use has declined. The biggest drug category declines were seen in marijuana, which saw teen drug use slip from just over 10 percent in 2001 to 6 percent in 2006.

“Drug policymakers are ecstatic about this,” Greenwald said.

Since decriminalization took effect in Portugal, deaths as a result of drug usage have declined significantly. Opiate-related deaths experienced the biggest drop, falling from about 275 deaths in 2000 to about 125 in 2006, according to information provided in the report from the Portugal National Institute of Legal Medicine.

The Portugal report, which also tracked drug usage rates outside of the European Union (the region of the world that has gone the farthest in decriminalizing drug usage), found that “by and large usage rates for each category of drugs continue to be lower in the EU than in non-EU states with a far more criminalized approach to drug usage.”

Tim Lynch, director of the Cato Institute’s Project on Criminal Justice, said, “For a very long time all of the academics, who studied drug policy, had to acknowledge one reality -- that the drug policy of the United States is the drug policy of the world.”

That premise, however, is now changing.

As evidence of this, Lynch pointed to a number of news bulletins calling for drug reform in recent months: “Canadian government tries anew to decriminalize marijuana”, “Argentine president calls for decriminalization of drug use”, “Mass. voters OK decriminalization of marijuana”, ” Obama administration to stop raids on medical marijuana dispensers” and most recently, ” Webb, Specter introduce bill to overhaul America’s criminal justice system.”

Advocates of drug decriminalization in the United States, should focus not on ideological or moral arguments in making their case, but rather, empirical evidence that shows decriminalization reduces drug usage, said Greenwald.

Greenwald said supporters of decriminalization in the U.S. have an “ideal moment” to talk about it as the political mood regarding decriminalization is now shifting in favor of reform.

According to Greenwald, much of the discussion on why drugs should not be decriminalized (the primary argument being that it will lead to higher drug usage and higher assorted drug-related problems) has been speculative. He said it was up to drug reformers to refocus the drug debate away from moral and civil liberties arguments “so that it ends up being an entirely empirical and pragmatic issue.”

Because there has been little debate on empirical grounds, which are verifiable and provable, on why drugs should stay criminalized, the “extremely unexamined” assumption that decriminalization would result in a massive increase of drug usage has become widespread and generally accepted, Greenwald said.

But with the decriminalization of drugs in Portugal, drug reformers can now point to empirical evidence that demonstrates that decriminalization has positive affects.

As Greenwald writes in the report, “By freeing its citizens from the fear of prosecution and imprisonment for drug usage, Portugal has dramatically improved its ability to encourage drug addicts to avail themselves of treatment. The resources that were previously devoted to prosecuting and imprisoning drug addicts are now available to provide treatment programs to addicts.”

“Those developments, along with Portugal’s shift to a harm-reduction approach, have dramatically improved drug-related social ills, including drug-caused mortalities and drug-related disease transmission,” the report continues. “Ideally, treatment programs would be strictly voluntary, but Portugal’s program is certainly preferable to criminalization.”

Peter Reuter, a professor of criminology at the University of Maryland, who supports the continued criminalization of drugs, provided a skeptical critique of Greenwald’s report at Friday’s event, though he did admit that “I think it is fair to say that decriminalization in Portugal…has indeed achieved its central goals.”

While non-violent drug users are no longer dealt with as criminals in Portugal, Reuter speculated that because Portuguese police no longer have to put as much effort into making a criminal arrest against drug users, they are now more likely to issue many more administrative citations for drug use, which he said served to increase, rather than decrease, the intrusion of government into the lives of private citizens.

He added, that the higher rates of drug users seeking government treatment was more likely due to the aging of Western Europe’s heroin-using population. According to Reuter, the large bulk of the population of heroin dependents first began using in the 1970’s, 80’s and 90’s and so would be much older today and more likely to seek out medical help.

“Much of what is recorded here, I think, is consistent with what I see happening in many other Western countries,” said Reuter of the number of drug users in Portugal seeking treatment.

Some cause for celebration

After years of struggle, we've finally achieved real reform. Last night the state Senate approved major reforms to the Rockefeller Drug Laws. New York will no longer use prison as a first approach to deal with drug dependency and abuse.

You have the chance to thank senators for doing the right thing by sending a message now: http://dpa.convio.net/site/R?i=Fn09A4QhAsFBXpJ6HVRw1Q..

Debating yesterday on the Senate floor was fierce, but Sen. Schneiderman did a powerful job leading the debates for the Democrats, resolutely bringing the conversation back to the science, evidence and justice that back up the case for reform.

The legislation is not a complete repeal of the laws, but these changes will make a real difference in people's lives. The reforms eliminate most mandatory minimum sentences and set aside more than $70 million for treatment and re-entry services.

You can say thanks to Sen. Schneiderman and the others who voted for reform by sending them a message: http://dpa.convio.net/site/R?i=JxeGi1d6jtlqIbe3Co28aQ..

Thank you again for your dedication and hard work.

Sincerely,

gabriel sayegh
Director, State Organizing and Policy Project
Drug Policy Alliance Network

'I get my heroin on the NHS'

By Tom Geoghegan BBC News Online

Get caught with heroin and you face seven years in prison. But not Erin O'Mara, one of 440 addicts in the UK to get a regular fix from an NHS prescription - an arrangement she says has turned her life around.

Erin O'Mara is a bright, bubbly magazine editor - hardly the stereotype of someone who injects heroin four times a day.

But her habit, now in its 20th year, does not line the pockets of a drug dealer. The 34-year-old gets her fix from her local chemist in west London. This "perfect prescription", as she calls it, began two years ago and rescued her from a life of prostitution, drug dealing and serious illness.

The downward spiral began with Erin's first taste of heroin aged 15 while in her native Australia, and has included 10 unsuccessful methadone programmes along the way.

To finance her habit, she began working as a masseuse, which led to escort work and then street prostitution. That stopped when she discovered she was HIV positive.

But the prescription has transformed her life. As founder of Black Poppy, a magazine by and for drug users, she addresses drug conferences and is being consulted about pilot projects.

Sitting in her office, she says: "My prescription has meant I have money now, and choices I can make in my life - simple things like what I want for dinner. I can do things I haven't done for years and can think five years ahead. Before I was just thinking about my next 'hit'."

ERIN'S DAILY PRESCRIPTION 4 x 100mg diamorphine (solid) 4 x sterilised water 4 x sterilised needles 4 x swabs pharmaceutically prepared advice leaflet enclosed

Each shot supplied by her chemist is just enough to enable Erin to function properly and prevent the onset of withdrawal. She only feels the buzz if she relaxes.

The NHS allows only licensed doctors to prescribe diamorphine, the medical name for heroin, to addicts if they have failed to respond to methadone treatment. At present just 0.5% of those in treatment are prescribed heroin, but new pilot projects are expected to increase that number.

Supporters of this policy, such as the independent research group DrugScope, say controlled distribution by the state can drastically reduce crime.

They also argue that clean heroin like diamorphine is not in itself dangerous, just incredibly addictive. And a pharmaceutical prescription excludes all the risks associated with unsafe injecting and enables the user to gradually be weaned off the drug.

Topped up doses

Erin believes this approach can save lives. But prescribing heroin is not always the answer, as she herself knows from the first programme she took part in in 1998.

HEROIN & THE NHS Prescriptions peaked in 1960s The UK is one of the few countries to allow it Any doctor can prescribe it for medical conditions, but need Home Office licence to treat addiction Home Office says every £1 spent on drug treatment saves £3 in less crime Source: Drugscope Prescribed heroin 'safe'

"The whole set-up was really oppressive and heavy-handed, but the doses were too low so people were using other drugs and too scared to admit it. No-one was happy and no-one was doing well on it. The carrot and stick approach doesn't work because you can't punish users enough to make them stop".

One patient, a 45-year-old woman, threw herself off a tower block two days after being penalised by having her prescription withdrawn, Erin says.

And with strict attendance requirements and supervised injections, it prevented users from getting full-time employment.

Erin claims she was forced off the course after 18 months when she tried to start a support group. She then founded Black Poppy to give a voice to drug users, and address issues missed by treatment programmes.

Why did I have to wait until I'd finished selling my young body to men?

After leaving the prescription programme, Erin was put on methadone injections, which she topped up with crack. This period was one of her lowest and her veins began to collapse.

When she heard about a vacancy on a pioneering prescription course at the Maudsley Hospital in south London, she cornered the doctor in charge at a drugs conference.

"I remember my sense of complete and total desperation. I felt I could not go on any longer, that if they didn't help me, I didn't know where I would be. I felt that this was my last hope, that I'd tried everything. And I begged."

Her powers of persuasion paid off and she joined what turned out to be a more flexible programme. She was able, for instance, to spend a few months at her mother's in Colchester and pick up her prescription from a local chemist, so long as she visited the doctor every fortnight.

Her immune system strengthened, and two years on she is on a reduced dosage and aims to come off heroin completely.

HEROIN IN THE UK 200,000 heroin users 88,000 in treatment , of which 40,000 on methadone Heroin is an opiate which depresses the nervous system It can combat physical and emotional pain Users can feel warm, relaxed and detached Purity of street heroin varies, with a risk of fatal overdosing Unsafe injecting means risk of HIV, hepatitis, abscesses and ulcers Source: DrugScope, NTA

As she looks to the future, there is a trace of anger about the years spent on and off treatment programmes.

"Why did I have to wait until I'd finished selling my young body to men, until I'd got sick and deeply depressed, until I'd used every vein in my body from my neck to my feet, until I'd contracted both HIV and Hep C?"

But she is optimistic that the government has begun to move in the right direction and listen to what drug users want.

Cocktail of heroin and tik scary - experts

March 26 2009 at 12:48PM

Related Articles Dangers of mothers' new little helper The 'epicentre' of HIV and tik Where do tik addicts come from? New drug mix in the Cape

By Bronwynne Jooste

The number of heroin users in Cape Town is growing steadily and the drug is is also being used with tik in a dangerous new cocktail, according to rehabilitation centres in the city.

The centres said that although tik was seldom used on its own, the use of it with heroin as a secondary drug was scary.

The Western Cape branch of the South African National Council on Alcoholism and Drug Dependence (Sanca) said it had noted a rise in the use of heroin.

'These are two of the most addictive drugs'

Grant Jardine, of the Cape Town Drug Counselling Centre, agreed that their figures showed a steady climb.

"It wasn't as dramatic as tik, which shot up suddenly. But it is the one drug that has increased each year."

Tertius Cronjé, of Sanca, said the number of users they saw with heroin-addiction problems had tripled in the past three years.

He said people were mostly using the cheaper, less pure form of the drug.

In line with research from the South African Medical Research Council, Cronjé said most users smoked the drug.

According to the council, the Western Cape is the only province in the country where the majority of users took the drug in this way. In other areas, most users injected the drug.

Cronjé said this could be attributed to the fear of contracting HIV and Aids.

Research showed that the recovery rate for heroin users was dismal. But, he said, the most alarming new development was the use of heroin in conjunction with tik.

He said the combination held devastating effects for the user.

"These are two of the most addictive drugs. Using them in tandem is as bad as addiction gets. It's very difficult to come off; you can't really win here."

It was made worse by the fact that heroin carried a major risk of overdosing, while tik held severely damaging psychological effects.

Jurgens Smit, the director of Western Cape-based Faces and Voices of Recovery South Africa, said the combination of the two drugs was "a disaster".

"We first saw this surfacing around two years ago. But it has been spreading, especially across the Cape Flats."

Smit said early intervention was needed to clamp down on the spiralling drug problem.

"We need to start intervention programmes early, targeting children as young as six years old. Society is responsible for offering young people healthy alternatives," he said.

Drug policy for methamphetamine use urgently needed

During 2004 there have been media reports of a dramatic
increase in the use of methamphetamine (MA), locally known
as ‘tik’, in the Western Cape. These reports have been
supported by findings from the South African Community
Epidemiology Network on Drug Use (SACENDU) Project.1
SACENDU is an alcohol and other drug (AOD) sentinel
surveillance system operational in Cape Town, Durban, Port
Elizabeth (PE), Mpumalanga, and Gauteng (Johannesburg/
Pretoria). The system monitors trends in AOD use and
associated consequences on a 6-monthly basis from multiple
sources, including over 50 specialist treatment centres.
SACENDU findings reveal that the proportion of clients at
specialist substance abuse treatment centres reporting MA as
their primary and/or secondary drug of abuse increased
significantly between the first half of 2002 and the first half of
2004, from 4 patients seen at 23 centres to 241 patients seen at
25 centres (Table I). The sharp increase in the number of
clients seeking treatment for MA-related problems is
unprecedented in the country. Data from other sites suggest
that while MA use is increasing elsewhere the extent of use is
greatest in Cape Town.2 In addition, in Cape Town MA has
rapidly become the third most commonly reported primary
illicit substance of abuse (after methaqualone and cannabis),
where previously it was rarely reported as a problem drug.3
Not only does the rapidly growing popularity of MA point to
the urgent need to address this problem in the Western Cape,
but the demographic profile of clients in treatment for MArelated
problems also highlights this urgency. MA is the drug
of choice for young people; the average age of patients who
reported MA as their primary substance of abuse in the first
half of 2004 was 20 years, with 60% of patients being younger
than 20 years of age. This is cause for concern given that
adolescents are particularly vulnerable to the neurotoxic effects
of MA.
More specifically, MA’s potent and toxic action on the
sympathetic and central nervous systems makes a strong case
for the urgency with which MA use should be addressed,
especially in the Western Cape. Positron emission tomography
(PET) imaging and postmortem studies in humans provide
evidence of MA’s neurotoxicity, with regular users showing a
loss of dopamine nerve terminals in the caudate and putamen,
reduced glucose metabolism in the thalamus, caudate and
putamen, and increased glucose metabolism in the parietal
cortex.4 These structural brain changes are associated with
long-term impairment in cognitive processing, memory and
emotion.5 Other MA-related chronic health problems include
cardiovascular and pulmonary complaints such as myocardial
infarction, arrhythmias, cerebral oedema, hyperpyrexia, chronic
pulmonary congestion, seizures and strokes; psychiatric
consequences such as paranoia, acute and chronic MA-induced
psychosis, hallucinations, depression, anxiety and
uncontrollable anger; dermatological problems; malnutrition
and weight loss; and the risk of overdose and death.5 In
addition, the behaviours associated with MA use, which
include high-risk sexual behaviours, place MA users at
increased risk for HIV and other infectious disease
transmission.6
Based on a review of the international literature and advice
from colleagues in other countries, it is clear that there are a
variety of potentially useful interventions that should be
considered in dealing with this new public health threat.
Raising awareness and providing accurate information to the
public and policy makers on MA and introducing specific,
science-based prevention programmes that target individual,
family and community risk and protective factors for substance
use appear to be the most promising prevention strategies.
In terms of treatment, consideration should be given to: (i)
ensuring that there is adequate access to affordable and
effective treatment in general; (ii) establishing MA treatment
protocols in public hospitals and specialised care facilities; (iii)
training health and social service providers to identify, assess
and manage MA-induced psychosis, anxiety, withdrawal and
Drug policy for methamphetamine use urgently needed
Table I. Patients in specialist substance abuse treatment centres in Cape Town with methamphetamine as primary or secondary substance of
abuse (2002 - 2004)
2002a 2002b 2003a 2003b 2004a
N % N % N % N % N %
Primary 4 0.3 13 0.8 38 2.3 38 2.3 241 10.7
Secondary 7 0.4 19 1.2 43 2.6 83 5.0 188 8.3
Overall* 11 0.7 32 2.1 81 4.8 121 7.3 429 19.0
Total no. of
patients 1 608 1 551 1 686 1 659 2 255
* Patients who have methamphetamine as primary or secondary substance of abuse.
a = data collected between January and June; b = data collected between July and December.
SCIENTIFIC LETTER
overdose; (iv) specifically equipping primary health care
providers and emergency room personnel to provide brief
screening and interventions; and (v) introducing science-based
models of substance abuse treatment into community settings,
especially cognitive-behavioural approaches.
Interdiction strategies should include: (i) monitoring the
distribution and use of precursor chemicals used in the
manufacture of MA; (ii) investigating companies that distribute
precursor chemicals (e.g. pseudoephedrine, ephedrine,
anhydrous ammonia and red phosphorous) or equipment used
in clandestine methamphetamine laboratories; (iii) expanding
community policing strategies to engage the public in MA
issues; and (iv) continuing to put pressure on drug-related
organised crime (especially focusing on drug-related crimes
such as perlemoen (abalone) smuggling and high-intensity
drug dealing/trafficking areas).
Provincial responses during 2004 have focused almost
exclusively on social service and policing interventions. Given
the likely future burden of MA on the health sector, a greater
public health response to this threat is urgently required.
C D H Parry
B Myers
A Plüddemann
Alcohol and Drug Abuse Research Group
Medical Research Council
Tygerberg
1. Parry CDH, Bhana A, Plüddemann A, et al. The South African Community Epidemiology
Network on Drug Use (SACENDU): Description, findings (1997 - 1999), and policy
implications. Addiction 2002; 97: 969-976.
2. Plüddemann AP, Parry CDH, Bhana A, Harker N, Potgieter H, Gerber W. Monitoring alcohol
and drug abuse trends in South Africa (July 1996 - December 2003): Phase 15. SACENDU
Research Brief 2004; 7(1): 1-12.
3. Myers B, Parry CDH, Plüddemann A. Indicators of substance abuse treatment demand in
Cape Town. Findings from the SACENDU Project 1998 - 2002. Curationis 2004; 5: 27-31.
4. McCann UD, Ricaurte GA. Amphetamine neurotoxicity: accomplishments and remaining
challenges. Neurosci Biobehav Rev 2004; 27: 821-826.
5. Brecht ML, O'Brien A, von Mayrhauser C, Anglin MD. Methamphetamine use behaviours
and gender differences. Addict Behav 2004; 29: 89-106.
6. Semple SJ, Patterson TL, Grant I. The context of sexual risk behaviour among heterosexual
methamphetamine users. Addict Behav 2004; 29: 807-810.

"Towards 2010: Safety is not just for those who can buy it"

No mention of harm reduction...

"Towards 2010: Safety is not just for those who can buy it"

The affluent are obsessed with crime, but it is the poor that fight daily for survival, writes Irvin Kinnes. Only when we realise that all lives are equal can the safety of World Cup visitors be assured

May 16, 2007 Edition 1

How safe is Cape Town? Do we think that our preparations for 2010 will increase safety or will they only provide safety for certain sections of our population? Can Cape Town truly proclaim itself an inclusive, world-class city when it comes to safety?

There is a common illusion that Cape Town is a world-class city - not only because it attracts the lion's share of the tourists who visit South Africa, but because it is able to provide tourists with a host of services that compare very well with those of other international destinations. In addition, it has much else to offer.

But this is not what makes a world-class city.

The safety of its residents, its streets and its capacity to deal with crime are also determining factors. Implicit in the definition of a world-class city is the notion of human security. The UN Commission on Human Security argues that:

"Human security means protecting vital freedoms. It means protecting people from critical and pervasive threats and situations, building on their strengths and aspirations. It also means creating systems that give people the building blocks of survival, dignity and livelihood. Human security connects different types of freedoms - freedom from want, freedom from fear and freedom to take action on one's behalf."

If we see Cape Town in this context then we have to ask a few serious questions when it comes to crime and crime strategies.

There is the notion of two Cape Towns that bedevils its world-class ambitions - one rich and one poor. Despite the fact that crime affects people of all races and religious persuasions, the notion of safety for the rich and poor are two diametrically opposed realities in our divided city.

Many people who are comfortable behind high walls, security fences and security cameras are also those who are obsessed with criminals. For many people on the Cape Flats - who do not have access to water, sanitation, safety or security guards - survival is uppermost in their minds. Having something to eat for supper seduces them.

So fear is a temporary thing when you have to live side by side with your local criminal - as long as he does not interfere with you or your family.

Those who can afford long-term planning to protect their family and possessions do so with insurance and security booms. To the people of Joe Slovo in Langa, who have had their houses burned for the umpteenth time, security is the last thing on their minds when they have to worry about how they will find a roof over their heads.

I make this point because the realities of crime are so different for so many people in this city of ours. And yet, when you read the newspapers, you will believe that the areas where the rich live are completely under siege!

Our realities are different.

Our crime statistics paint a very bleak and sobering picture of this reality, despite the fact that there are those who do not want to know how the crime patterns have changed over the years.

Historically, Cape Town has had different crime patterns for different parts of the city.

If we examine the statistics, we find that crimes against women and children in particular have been particularly acute in the northern suburbs and Mitchell's Plain, where particularly brutal attacks have occurred against children in the last two years.

We also see that violent crimes such as murder, rape and armed robbery have risen in areas such as Khayelitsha, Nyanga, Kuils River and Mitchell's Plain.

Drugs have been synonymous with areas such as Woodstock, Salt River and Cape Town. Areas such as Lavender Hill, Hanover Park, Nyanga and Manenberg have faced a high incidence of firearms and ammunition.

Pinelands, Melkbosstrand and Simon's Town have high incidences of residential burglary. The statistics are uneven and fit neatly into the stereotype of a divided city where violent crime is perpetrated against (and by) inhabitants of the poorer sections of the city.

It is this view of Cape Town crime that persists in the minds of its inhabitants when it comes to the fact that we are about to host the Fifa World Cup in 2010.

However, today that crime trend is changing fast. That is the central issue that we have to come to terms with. The patterns of crime will change for a variety of reasons before and after 2010.

If we are to make any inroads, then the opportunity to influence and shape a positive outcome is upon us.

The staging of the World Cup has historically stopped wars, if even for just over one hour, as the Iran-Iraq wars have shown.

We should now use this golden opportunity to mobilise our communities to fight crime irrespective of race, geography and economic means. We have to do this because our much-maligned crime statistics have been showing a disturbing trend.

Drugs are becoming common in all communities, rich and poor. The incidence of drug availability, particularly to children, has to force a change in attitude by all - especially police agencies. If anything other than race can tear a community (and most definitely a city) apart, then it is drugs. If one considers the growth in the incidence of drugs then we should all be very proactive to combat the scourge of tik and other drugs affecting our youth. The statistics of the UN Office for Drugs and Crime, the Medical Research Council and indeed the Human Sciences Research Council all agree that drugs have by far shown a greater increase than other types of crime.

If we are to look at Figure 1 we can see that there has been a definite decrease in the corresponding years for murder in Cape Town. Notice the complete disparity when comparing the figures of Simon's Town, Table View and Pinelands as opposed to Khayelitsha, Nyanga and Mitchell's Plain.

The graph is so instructive that I will not even attempt to disaggregate the percentage drop in murders over the last six years.

If, on the other hand, we look at the same suburbs with respect to drugs, we see a different pattern, as Figure 2 demonstrates. If we were to add a trend line to this figure, no doubt it would rise at close to a 45° angle. This is because in areas such as Mitchell's Plain, drug cases have increased by a massive 580%!

Interestingly this trend affects all suburbs and communities including the well-off communities. Areas such as Melkbosstrand, Pinelands, Table View and Simon's Town all show increases above 50%.

The actions of vigilantes regarding this issue have clearly not borne fruit. Killing drug dealers has not led to less availability of drugs. On the contrary, it has led to a proliferation of drugs … and now they are in the hands of our children.

Studies undertaken by Luke Dowdney, of the Children Involved in Organised Armed Violence, in 10 areas which included Kingston, Medellin, Rio de Janeiro, Cape Town, Lagos, Chicago, Belfast, El Salvador, Ecuador and the Philippines, point to social marginalisation and lack of leisure facilities as reasons why young people turn to crime, gangs and drugs.

The social conditions that are driving young people into gangs, drugs and crime are not diminishing; they are becoming more acute and the disparity between haves and have-nots is increasing, thereby increasing the risk factors that drive young people to a life of crime.

That is why the initiatives shown by the Mitchell's Plain community become so important. In any community the greatest deterrent against criminals succeeding is a good relationship between the local police and the community. The name and shame campaign of the Mitchell's Plain community, under the leadership of director Jeremy Veary, has some drawbacks and issues with sustainability and right to privacy, but on the whole it activates a whole street, a whole section and finally a whole community to act against drugs and take back the streets.

The other example of a community coming to terms with crime, in a very different manner, is the Proudly Manenberg initiative, which mobilises the community to confront its identity and fear by involving everyone in developing the building blocks of survival, dignity and respect. We should not underestimate the potency of these campaigns in that they are the start of a fire that has captured the imagination of other Cape Town communities.

However, one has to caution against opportunists and vigilantes who will try to usurp positive community action in order to change the agenda. Only by safeguarding all communities and developing policy with respect to criminal threats and opportunities can the police and other law enforcement agencies hope to provide protection and support to communities.

A tremendous amount of goodwill has been generated as a result of the initiatives in Manenberg and Mitchell's Plain. One can only hope that the SAPS will grab the opportunity and assist in mobilising other communities.

The window of opportunity may soon close as we approach another taxi war on the Cape Flats. The police have to act fast, efficiently and professionally when it comes to these threats against the residents of Cape Town. When it comes to taxi wars, gangs and drugs, time is fast running out if we want to secure the city and make it a home for all.

Only when we realise that the lives of all people in Cape Town are equal, can the safety of tourists and football fans be assured.

Only then can we begin to look forward to a World Cup that delivers new standards for operational efficiency when it comes to policing. In order to see real benefits for all, we have to plan for way after 2010 and look forward to a city that begins to include all in the delivery of safety.

We can change Cape Town by having a joint city and provincial initiative to fight drugs, gangs and crime by:

Bringing on board community members willing to volunteer to deal with our tik-addicted youth.

Creating safety zones in each of our communities where people can claim the space and begin to organise safety in other areas.

Establishing programmes that advise families on where to go and what to do when children are at risk of being drawn in by gangs or drugs.

Encouraging residents to do voluntary work at hospitals so that patients can get better treatment; and by making more treatment centres available.

Getting the SAPS and metro police to develop a strong public relations partnership; work with communities affected by crime, and improve service delivery.

Encouraging participation in sport and building sports clubs, especially football, among the youth and other sectors in the community.

Developing a sense of ownership of the World Cup that has all communities working together.

Dealing with gangs and drugs in a more sustainable, imaginative manner through co-operation between the province and the city, together with the community and business.

We cannot live with the illusion that Cape Town is safe for all its peoples. Safety is not only for those who can afford it.

The architects of the Freedom Charter long ago spoke of a South Africa where "there shall be peace and friendship". Many of our brothers, sisters, mothers, fathers and children have died fighting for this ideal. We dare not disappoint them.

Irvin Kinnes is an independent criminologist and reasearcher, and co-founder of the Proudly Manenberg campaign