Abstract
Countries in Sub-Saharan Africa (SSA) have seen rapid increases in injection drug use since 2008. In Uganda, the Global Sate of Harm report and studies conducted by Makerere University Crane Surveys have estimated HIV prevalence among people who inject drugs (PWID) at approximately 17%. The objective of the research was to document injection and other drug-related risks among people who use drugs in Uganda to develop comprehensive HIV/HCV prevention interventions. Between August and September 2018, we conducted qualitative interviews among male and female people who use drugs. Interview topics included the availability and accessibility of clean syringes, injection risks, overdose, sexual-risk behaviors, and the availability and accessibility of harm reduction and drug treatment services. Participants reported several injection-related risks including sharing and reusing syringes, pooling and mixing drugs in the same container, measuring drugs using syringes, getting prefilled injections from dealers, being injected by other people who inject drugs, and using contaminated water or blood to dilute drugs. Participants reported a scarcity of harm reduction services, although a few appear to have participated in the syringe exchange pilot conducted by the Uganda Harm Reduction Network (UHRN). Even fewer reported knowing organizations that helped people who use drugs abstain from or reduce their use. Medication assisted therapy (MAT) and naloxone to reverse overdoses are not currently available. Comprehensive prevention and treatment services are needed in Uganda and should include expanded syringe exchange programs, social network HIV testing, HCV testing, provision of naloxone and MAT, and linkage to and retention in HIV care.
Highlights
HIV prevalence in Uganda is among the highest in the world, with national prevalence estimated at 6.2% [1] and prevalence among high risk populations such as fisherfolk and female sex workers at 30% [2] and 33% [3] respectively
Participants reported a scarcity of harm reduction services, a few appear to have participated in the syringe exchange pilot conducted by the Uganda Harm Reduction Network (UHRN)
Comprehensive prevention and treatment services are needed in Uganda and should include expanded syringe exchange programs, social network HIV testing, HCV testing, provision of naloxone and medication assisted therapy (MAT), and linkage to and retention in HIV care
Summary
HIV prevalence in Uganda is among the highest in the world, with national prevalence estimated at 6.2% [1] and prevalence among high risk populations such as fisherfolk and female sex workers at 30% [2] and 33% [3] respectively. Countries in SSA have seen rapid increases in injection drug use since 2008 including heroin and cocaine [7,8,9,10], and these drugs are present and increasingly used in Uganda [11,12,13]. A recent review of studies found a substantial proportion of heroin users who inject in Kenya and Tanzania [14] and that these groups may have high HIV prevalence rates. In Uganda, the Global Sate of Harm report and studies conducted by Makerere University Crane Surveys have estimated HIV prevalence among people who inject drugs (PWID) at approximately 17%. The objective of the research was to document injection and other drug-related risks among people who use drugs in Uganda to develop comprehensive HIV/HCV prevention interventions
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