Injection and sexual risk among people who use or inject drugs in Kampala, Uganda: An exploratory qualitative study

Abstract

Background 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. Methods 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. Results 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.

Challenges of sexually transmitted infections and sexual health among people who inject drugs

“…The substantial body of evidence on the increased vulnerability of PWID through transactional sex continued to grow. Sex work was reported by 49% of WWID in Kenya [32], 66% in Mexico [52], and the majority of qualitative interview sample in Uganda [53]. Notably, a growing number of studies are reporting the exposure to sex work among men.…”

Mortality Among Patients Admitted in a Psychiatric Facility: A Single-Centre Review

“…HIV/ AIDS is one of the most prevalent conditions in Uganda, with 6.7% of adults living with HIV in Uganda. 9 However, its accurate diagnosis was rare in the late 1990s and the early 2000, and with minimal or no attention paid to psychiatric complications of HIV at the time, 10 thus, more deaths occurred in 2002.…”

The Role of Context in Integrating Buprenorphine into a Drop-In Center in Kampala, Uganda, Using the Consolidated Framework for Implementation Research

“…Drug markets have expanded west, and Uganda has experienced increasing numbers of people who use and inject drugs (PWUD and PWID, respectively) [ 14 , 15 , 16 , 17 ]. HIV prevalence among PWID in Uganda is estimated to be around 17% in multiple studies [ 14 , 17 ], with heroin being the most commonly injected drug among over 70% of PWID [ 18 ]. Further, most women who inject drugs also exchange sex for money or drugs, begin injecting earlier, and their HIV prevalence is likely even higher [ 18 ].…”

“…HIV prevalence among PWID in Uganda is estimated to be around 17% in multiple studies [ 14 , 17 ], with heroin being the most commonly injected drug among over 70% of PWID [ 18 ]. Further, most women who inject drugs also exchange sex for money or drugs, begin injecting earlier, and their HIV prevalence is likely even higher [ 18 ]. There are no current estimates of HCV infection as testing is not routinely done in Uganda, although HCV rates are high in other East African countries [ 13 ].…”