A TB HIV Care’s Bio-behavioural Survey (BBS) underscores the prevalence of HIV and hepatitis C among people who inject drugs (PWIDs).
The survey was conducted between May and September 2023 across four cities in the country – Tshwane (Gauteng), eThekwini (KwaZulu-Natal), Mbombela and Mashishing in Mpumalanga.
It found that HIV had become prevalent among PWIDs. Tshwane recorded that 72.1% of PWIDs had HIV, eThekwini 49.3%, Mashishing 45.4% and Mbombela 30.3%.
Anti-hepatitis C prevalence was highest in Mbombela (90.5%), followed by Tshwane (89.0%), eThekwini (75.2%) and Mashishing (40.8%).
The BBS brought to light that drug users were prone to TB, with eThekwini recording 7.2%, Tshwane 2% and Mashishing and Mbombela less than 1%.
This was the first kind of data captured in South Africa and it called for an intensified need for TB diagnosis and treatment.
Andrew Scheibe, a technical adviser at TB HIV Care, said hepatitis C continued to escalate because it was asymptomatic.
He said access to quality health care and budget constraints in the health-care system were barriers to effective treatment.
“Hepatitis C is often called the silent killer because many people remain completely asymptomatic until the infection progresses, causing serious liver damage and life-threatening health issues. We need to continue to advocate for easier, cost-effective access to generic DAAs (direct-acting antivirals), especially for populations at risk,” Scheibe said.
TB HIV Care’s communications manager Aziel Gangerdine said the survey illuminated significant gaps in access to quality health care for drug users, despite having the world’s largest antiretroviral therapy programme (ART).
He said that called for an integration of viral hepatitis services in primary health-care institutions.
Gangerdine applauded Tshwane for having the largest percentage of people who adhered to their HIV treatment (92.2%), further suppressing the spread of the virus.
That the City of eThekwini ranked 63.3%, Mbombela 59.9% and Mashishing 42.3% meant that significant strides could be made towards the 95% viral suppression of the Joint UN Programme on HIV and Aids 95-95-95 targets aimed at closing the wide gap of HIV prevalence.
Centres for Disease Control and Prevention South Africa (CDC) director Dr John Blandford said there needed to be great efforts from PWIDs and the country’s health-care system to reduce the spread of diseases.
The survey also found that drug users practised safe injecting methods: 87.9% PWIDs in Mbombela used sterile needles when consuming drugs. In Tshwane it was 76.3%, eThekwini 71.3% and Mashishing 65.0%.
With regard to practising safe sex, 66.6% of drug users surveyed in eThekwini used condoms, while the remaining cities tallied above 50%.
Blandford expressed alarm that a third of drug users had not accessed health-care services last year due to fear of stigmatisation and discrimination.
In eThekwini, 52.7% of the study population avoided health-care facilities because of the stigma around drug use, compared to 34% in Mashishing, 36.8% in Mbombela and 47.5% in Tshwane.
Blandord said: “We know that the prevalence of physical or sexual violence across all the sites was more than 30%. This information allows CDC partners to include post-violence care in their programmes and sensitisation training for health-care workers. The high HIV and anti-hepatitis C virus prevalence means we need to focus on harm reduction efforts and continue to advocate for the rights of key populations.”
Additionally, PWIDs expressed their eagerness to take pre-exposure prophylaxis (PrEP) in efforts to scale down the vast spread of HIV and Hepatitis C.
In Mashishing, 66.8% of PWIDs said they would take PrEP. The figure stood at 57.4% in Tshwane, 51.6% in eThekwini and 48.9% in Mbombela.
The Star