HIV- and hepatitis C-related risk behaviors among people who inject drugs in Uganda: implications for policy and programming

Abstract

Background There is a dearth of evidence on injecting drug use and associated HIV and hepatitis C virus (HCV) infections in Uganda. As such, policy and programming for people who inject drugs (PWID) is limited due to scarcity of epidemiological data. We therefore conducted this study to assess the injecting drug and sexual practices among PWID in Kampala Capital City and Mbale Municipality. Methods Using a rapid situation assessment framework, we conducted semi-structured interviews among 125 PWID (102 males and 23 females)—recruited through outreach and snowball sampling. We assessed their injecting drug and sexual practices. We also conducted 12 focus group discussions among PWID and 30 in-depth interviews among key informants. Results A total of 125 PWID (81.6% males and 18.4% females) were recruited into the study. Approximately three quarters of PWID started injecting before the age of 25. More females (21.7%) compared to males (13.7%) started injecting by the age of 17. Fifty-seven percent of the PWID in Kampala and 50% in Mbale shared injecting equipment in the last 3 months prior to the study. There was an emerging practice of mixing drugs with blood and sharing it among different PWID as a sign of oneness. Heroin was being injected by 72% of the participants. Less than one half of the PWID had used a condom during the last casual sex, and 42.7% did not use a condom the last time they engaged in sex work. Seventy-six percent of the PWID had undertaken an HIV test in the last 12 months, and 9.2% self-reported to be HIV positive. Conclusions This study highlights the need for introducing harm reduction policies and services including increased access to sterile injecting equipment and education around safer injecting and sexual practices. Programs for PWID should also address the specific needs of female sex workers who inject drugs.

When and how do individuals transition from regular drug use to injection drug use in Uganda? Findings from a rapid assessment

“…The study was a rapid situation assessment (RSA) [32]. It was conducted from February to September 2017 as part of a broader study to establish the current situation of injecting drug use in Uganda and identify the country specific links between drug use and HIV and HCV risk, that are in part described elsewhere [16,22,33].…”

“…We also inquired on their experience on the first injection including their age at first injection, drugs they used at first injection, and whether or not the shared injecting equipment at first injection. The broader study, including the detailed methods, are described in full elsewhere [16,22,33].…”

“…Injecting drugs also carries high risk of human Immunodeficiency virus (HIV) and viral hepatitis transmission if sterile injecting equipment is not easily accessible and injecting equipment is shared among users. In 2016, more than half of the PWID worldwide were living with hepatitis C virus (HCV), one in eight were living with HIV, and 82.4% of the PWID living with HIV were co-infected with HCV [12][13][14][15][16]. The risk of acquiring HIV for PWID in 2017 was 22 times higher than that for people who did not inject drugs [17].…”

“…While only 15.2% of PWID start injecting before the age of 17, 81.6% reported injecting by the age of 25. The drugs commonly injected included brown heroin (44.8%), white heroin (30.4%), and cocaine (16%) [16,24,25]. Many non-injecting drug users may be at risk of transitioning to injecting drug use, increasing their risk of acquiring or transmitting blood-borne infections.…”

“…Additionally, in Uganda, there is a call to and indeed some efforts are being put in place for introduction of harm reduction services for PWID as part of the efforts to control the HIV epidemic [16,30,31]. However, there are limited strategies available to support the people who use but do not inject drugs.…”