SUBSTANCE ABUSE & DRUG

INJECTION TRENDS IN SOUTH AFRICA

Ms SIPHOKAZI DADA
EMCDDA 13th ANNUAL TDI MEETING
LISBON, SEPTEMBER, 2013
BACKGROUND¹
• South Africa (SA) is home to
51.8 million people and over 26
million people (51%) of the
population are female.
•Black Africans are in the
majority, constituting just over
79% of the total SA population.
•Majority of people are between
the ages of 15-64 years, and the
mean age for the country is 25
years.
 BACKGROUND¹
•A third of the population has some secondary
schooling, with only 12% of the population having
higher education (i.e. post-graduate certificate, diploma
or degree).

•25.5% of the population are in some form of

employment and the average annual income per
household is R103,204.00 (about €7,374 or €615 per
month).

•The unemployed rate is 29.8%.

SUBSTANCE ABUSE IN SOUTH AFRICA
• Substance abuse data has been limited in SA.
• Information mostly come from ad hoc cross-sectional
national surveys, that aimed to look at health issues in SA
and generally substance abuse was squeezed in
somewhere.
• More recently:
– national and provincial school surveys are conducted on
a more regular basis.
– Increased research (intervention research) into
substance abuse among vulnerable populations
(adolescents, pregnant women, MSM) and more select
populations (workplaces).
 OVERALL SUBSTANCE ABUSE IN SA
• Alcohol is the most common substance of abuse among
adult population in SA.

• Although a relatively low proportion of South Africans

report drinking alcohol (27,9%)³, those who do often
drink at harmful or hazardous levels, particularly on
weekend⁴.

• Cannabis use is mostly common among youth.

 OVERALL SUBSTANCE ABUSE…cont
• Among secondary school learners, the prevalence of
cannabis is 12.7%⁵.

• Methamphetamine was largely confined to the Western

Cape Province, but is beginning to creep into provinces
in SA.
OVERALL SUBSTANCE ABUSE
TRENDS IN SA: TX DATA
 INJECTING DRUG USE IN SA
• Despite gradual increases in heroin use over the last 10
years, research related to injection drug use remains
limited.
• Most data on heroin use comes from the SACENDU
project, which is currently the best indication of heroin
use patterns in the country.
• Although SACENDU monitors drug abuse trends using
data collected from over 60 treatment centres in SA it is
limited as it reflects only those seeking treatment.
INJECTING DRUG USE IN SA ….cont
• The most commonly injected drug in SA is heroin.
• Most heroin is smoked, either alone or in combination with
other drugs e.g.:
– In Gauteng region it is mixed with cannabis and known
as ‘nyaope’.
– In the Durban region there have been reports of
‘Whoonga’ (mixture of illicit drugs and antiretrovirals
(especially, efavirenz).

• More recently patients from treatment centres also

reported injecting other drugs, such as cocaine,
methcathinone (CAT), methamphetamine (MA) and over-
the-counter/prescription (OTC/PRE) medicines.
 INJECTING DRUG USE IN SA…cont
• According to a study by Wolfe et al (2010), it is estimated
that there are 67,000 PWID in SA, and this is
approximately 0.2% of the adult population¹º.

• Study conducted by Pluddemann et al on heroin users in

Cape Town (SA), found that the majority of heroin users
injected heroin and 69% of them injected daily⁷.

• Data from treatment centres show similar findings⁶.

 PROFILE OF PEOPLE WHO INJECT
DRUGS IN SA TREATMENT CENTRES
 PROPORTIONS OF DRUGS INJECTED
Year 2010 (Total 2011 (Total 2012 (Total
sample = sample = sample =
17501) 16864) 19230)
Drug N % N % N %
Heroin 2721 15.5 3032 17.9 3268 16.9
MA (‘Tik’) 3155 18.0 3356 19.9 4247 22.1
CAT 360 2.1 840 4.9 1073 5.6
Cocaine 1860 10.6 1970 11.7 1860 9.7
OTC/PRE 378 2.2 848 5.0 626 3.3
DEMOGRAPHICS (%)
DEMOGRAPHICS(%)….cont
AGE DISTRIBUTION (%)
DRUG INJECTION TRENDS (%)
FREQUENCY OF INJECTING (%)
HIV TESTED IN LAST PAST YEAR (%)
HEALTH CONSEQUENCES ASSOCIATED
WITH IDU
• Injecting drug use is associated with health and social
harms such as hepatitis and other infectious diseases,
more specifically HIV².
• People who inject drugs (PWID) tend to engage in
sexual and other risk behaviours, including having more
than one sexual partner⁷.
• The HIV prevalence among PWID in SA is estimated to
be 19.4%⁹.
 HEALTH CONSEQUENCES….cont
• Pluddemann et al. (2008) in his study found 89% of
injectors shared needles in the past 30 days, 6% had
been paid for sex and 1% never used condoms⁸.
• Other cross-sectional surveys conducted among
injecting drug users in the country found an HIV
prevalence between 5% - 35%².
ART & HARM-REDUCTION SERVICES FOR
IDU IN SA
• There are few substance abuse interventions and
integrated HIV services that focus specifically on IDU
including those in prison.
• ART services are available in general health care
facilities in SA , however the proportion of HIV+ PWID
receiving ART is unknown⁹.
• IDU is surrounded by stigma and most of the time when
PWID go to these public health centres they are labelled
and discriminated against².
ART & HARM-REDUCTION SERVICES…cont
• Such stigma and discrimination are the main barriers to
accessing medical as well as HIV services in SA⁸.
• In terms of the availability of HIV prevention services,
there is only one NSP site that has been established in
SA.
• However this service is providing services to men who
have sex with men (MSM), which indicates limited
reach to PWID who are not MSM⁹.
 ART & HARM-REDUCTION SERVICES
….cont
• Opioid-substitution therapy (OST) sites providing
methadone maintenance therapy (MMT) and
buprenorphine maintenance therapy are also available in
SA⁹.
• However these are mostly accessible via private sector at
high costs².
• Even with the available OST programmes, access to safe
injecting equipment has been limited; participants in
Pluddemann study also reported that it was very difficult
to obtain clean needles⁷.
 RECOMMANDATIONS
• A national prevalence study of drug practices among
PWID is needed.
• Harm-reduction programmes, including OST and needle
syringe exchange programmes need to be scaled-up.
• There is a need for integrated HIV, IDU and mental
health services.
• Training of health workers to reduce stigma and
discrimination against PWID and build trust between
health workers and PWID.
 REFERENCES
1. C.,Molongoana (2012). Census 2011 Statistical release – P0301.4. Statistics South Africa
2. Scheibe , A., Brown, B., et al. (2011). Key Populations, Key Responses: A Gap Analysis for Key
Populations and HIV in South Africa, and Recommendations for the National Strategic Plan for
HIV/AIDS, STIs and TB (2012–2016). Desmond Tutu HIV Foundation Report, Cape Town.
3. Shisana, O., Rehle, T. et al. (2005). South African National HIV prevalence, incidence, behaviour
and communication survey. Cape Town. HSRC press.
4. Parry, CHD. (2000). Alcohol Problems in Developing Countries: Challenges for the New
Millennium. Presented at the Symposium: "Medicine Meets Millennium“.
5. Reddy SP., James S., et al. (2010). Umthente Uhlaba Usamila – The South African Youth Risk
Behaviour Survey 2008. Cape Town: South African Medical Research Council.
6. Dada, S., Plüddemann, A., Parry, C.D.H., et al. (2012). Monitoring alcohol and drug abuse
treatment admissions in South Africa: July 1996 – December 2012. SACENDU Research Brief,
15(1), 1-12.
7. Plüddeman, A., Parry, CDH., et al. (2008). Heroin users in Cape Town, South Africa: Injecting
practices. HIV- related risk behaviors and other health consequences. Journal of Psychoactive
drugs, Vol 30 (3): 273-76.
8. Dos Santos,M., Rataemane, ST. et al (2010). An approach to heroin use disorder intervention
within the South African context: a content analysis study. Journal of Substance abuse treatment,
prevention, and policy. Vol 5: 13.
9. Petersen, Z., Myers, B. et al. (2013). Availability of HIV prevention and treatment services for
people who inject drugs: findings from 21 countries. Harm Reduction Journal, 10:13, pages 2-7.
10. Wolfe, D., Patrizia, M. et al. (2010). Treatment and care for injecting drug users with HIV infection:
review of barriers and ways forward. Lancet, 376: 355-66.
THANK YOU VERY MUCH FOR YOUR
ATTENTION!!!!
Ms Siphokazi Dada, MPH
South African Medical Research Council
Alcohol & Drugs Research Unit
Frans Van Zijl drive
Tygerberg, Cape Town
T: +2721 9380604
F: +2721 9380342
Email: siphokazi.dada@mrc.ac.za