Abstract

BackgroundThere 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.MethodsUsing 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.ResultsA 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.ConclusionsThis 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.

Highlights

  • An estimated 275 million people used drugs at least once in 2016, 10.9 million of whom injected their drugs [1]

  • Injecting drugs carries a high risk of human immunodeficiency virus (HIV) and viral hepatitis transmission if sterile injecting equipment is not accessible and injecting equipment is shared among users

  • Whereas hepatitis B virus (HBV) and HIV are transmitted via blood or body fluids [7], sharing injecting equipment poses the greatest risk of hepatitis C virus (HCV) transmission among people who inject drugs (PWID) [8]

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Summary

Introduction

An estimated 275 million people used drugs at least once in 2016, 10.9 million of whom injected their drugs [1]. In 2016, more than half of the people who inject drugs (PWID) worldwide were living with hepatitis C. Whereas hepatitis B virus (HBV) and HIV are transmitted via blood or body fluids [7], sharing injecting equipment poses the greatest risk of HCV transmission among PWID [8]. Risk factors for HCV among PWID include sharing needles and other injecting equipment [13, 14], longer duration of injecting career [15], increased frequency of injection [15, 16], requiring help injecting [17, 18], being female [15, 19], and history of imprisonment [15, 16].

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