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.

Background: In Uganda, injection drug use is a growing but less studied problem. Preventing the transition to injection drug use may help prevent blood-borne viral transmission, but little is known about when and how people transition to injection drug use. A greater understanding of this transition process may aid in the country's efforts to prevent the continued growth of injection drug use, HIV, and hepatitis C Virus (HCV) infection among people who inject drugs (PWID). Methods: Using a rapid situation assessment framework, we conducted semi-structured interviews among 125 PWID (102 males and 23 females)-recruited through outreach and snow-ball sampling. Participants were interviewed about their experiences on when and how they transitioned into injection drug use and these issues were also discussed in 12 focus groups held with the participants.Results: All the study participants started their drug use career with non-injecting forms including chewing, smoking, and sniffing before transitioning to injecting. Transitioning was generally described as a peer-driven and socially learnt behavior. The participants' social networks and accessibility to injectable drugs on the market and among close friends influenced the time lag between first regular drug use and first injecting-which took an average of 4.5 years. By the age of 24, at least 81.6% (95.7% for females and 78.4% for males) had transitioned into injecting. Over 84.8% shared injecting equipment during their first injection, 47.2% started injecting because a close friend was already injecting, 26.4% desired to achieve a greater "high" (26.4%) which could reflect drug-tolerance, and 12% out of curiosity.Conclusions: Over 81% non-injecting drug users in Kampala and Mbale districts transitioned into injecting by the age of 24; a process that reproduces a population of PWID but also puts them at increased risk of HIV and HCV infection. As Uganda makes efforts to introduce and/or strengthen harm reduction services, interventions targeting non-injecting drug users before they transition into injecting should be considered as a key component for HIV/HCV epidemic control efforts, and their evaluation considered in future researches.

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IntroductionBribery and offering gifts for health service delivery remains one of the main challenges in many healthcare systems around the world; and the distinction between both is often quite narrow (Slot et al., 2017; Moldovan & Van de Walle, 2013; Werner, 2002). Collectively referred to as informal payments or under-the-table payments, bribes and gifts form a significant part of the private health expenditure in most developing countries (Cherecheş et al. 2011; Lewis, 2007; Gaal et al., 2006). They are used to secure access to health services, to increase the quality of services received, or to speed up service, and are paid for a service that is normally free of charge. In some cases, they can mean the difference between life and death if they're used to exclude patients from accessing critical care (Transparency International 2019; Balabanova and McKee, 2003). They have therefore become the subject of various studies looking especially into the scale, nature, and determinants of these transactions (Moldovan and Van de Walle 2013).In Uganda, studies about informal payments during childbirth are limited. Anecdotal evidence however, suggests that women across the country pay bribes and gifts to health workers in order to access childbirth services (The Observer, 5 August 2012; Daily Monitor, July 14, 2014). This could affect the utilization of skilled birth attendance and childbirth in health facilities thus increasing the risk of maternal and newborn deaths (Kuruvilla et al., 2014). Despite this, there has been no research conducted to-date to explore the experiences and perceptions of mothers and health workers in regard to giving and receiving bribes and gifts during childbirth in Kasese District. Also, there is limited qualitative understanding of whether and how gifts and bribes for care during childbirth occur in both public and private not for profit (PNFP) hospitals; and their comparison in the two settings. This limits strategies designed to reduce informal payments for maternity services.