High risk injection drug use and uptake of HIV prevention and treatment services among people who inject drugs in KwaZulu-Natal, South Africa

Abstract

We conducted a mixed-methods study to understand current drug use practices and access to healthcare services for people who use injection drugs in KwaZulu-Natal, South Africa. We used respondent-driven sampling to recruit 45 people who used injection drugs within the past 6 months from KwaZulu-Natal, South Africa. We found high rates of practices that increase HIV/viral hepatitis risk including the use of shared needles (43%) and direct blood injections (bluetoothing) (18%). Despite 35% living with HIV, only 40% accessed antiretroviral therapy within the past year, and one accessed PrEP. None of the participants ever tested for Hepatitis C.

Access to and acceptability of sexual and reproductive health, harm reduction and other essential health services among people who inject drugs in Durban, South Africa

“…Although these targeted services provided PWIDs with access to general healthcare services (including primary healthcare and HIV and TB testing and treatment), key stakeholder and PWID participants reported limited access to contraceptive services, pap smears, STI testing and screening and termination of pregnancy in targeted services in Durban. However, as has been reported elsewhere, in parts of South Africa, and in Durban more specifically, COVID-19 resulted in improved provision of care to PWID, especially through targeted and harm reduction services [ 17 ]. Participants described that harm reduction services were available in the district – in the form of methadone and needle exchange programmes [ 17 , 20 ].…”

“…Participants in this study had high risk injection use practices, highlighting a need for access to SRH and HIV related services [ 17 ]. However, they reported various barriers to accessing healthcare services, especially from government supported public healthcare facilities.…”

“…The survey data describing drug use behaviour and access to healthcare services were quantitatively analysed, and have been reported elsewhere [ 17 ].…”

“…In South Africa, most people who inject drugs use a cheaper, low-grade heroin, which may be mixed with various substances [ 12 ], known locally as “whoonga” in KwaZulu-Natal (KZN) Province and “nyaope” in Gauteng Province [ 13 ]. PWID are at increased risk of acquiring HIV through unsafe drug use practises like sharing needles and “cooking” equipment (to mix and heat drugs) [ 14 ], as well as “bluetoothing” – the act of voluntarily injecting blood from someone who has just injected drugs into a person who has not used so that person may obtain a less-potent, secondary high [ 15 – 17 ]. PWID are also vulnerable to HIV infection through unsafe sexual practises [ 14 , 18 ], such as unprotected transactional and non-transactional sex [ 19 ], as well as sexual violence and rape [ 13 ].…”

“…Stigma and discrimination associated with being “ amaphara” (derogatory term to refer to a criminal/drug user) [ 22 ], are cited as reasons for under-utilisation of public healthcare services by PWID, and they may rely on civil society organisations for healthcare needs over public sector services [ 13 ]. In South Africa, HIV prevention and treatment programmes which target PWID are limited in number, location, consistency and funding [ 17 ].…”