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Presented at: ICASA 2021 in Durban, South Africa |6-11 December 2021

Abstract Track: Track C – Epidemiology and prevention science

Abstract sub-category: Social Epidemiology of HIV

Trends and factors associated with illicit drug use in South Africa:

Findings from multiple national population-based household surveys

K. Kipkoech 1,3,  J. Stone 1,  H. Fraser 1,  A. Scheibe 2,  L. Johnson 3,  P. Vickerman 1

1University of Bristol, Bristol, United Kingdom, 2TB HIV Care, Cape Town, South Africa , 3University of Cape Town, Cape Town, South Africa

  • We acknowledge and thank the South African general population who generously participated in the HIV surveys in which this research was made possible. The authors declare no conflict-of-interest.

There were 90,324 respondents aged 15+ years from the 5 pooled surveys.

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  • Recent drug use increased from 1.5% in 2002 to 10.0% in 2017.

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    • Recent use of drugs of higher risk increased from 0.1%-2.5% from 2002-2017.
    • About 1.7% and 1.4% reported using opiates and stimulants respectively in 2017.

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  • The increasing trend in recent drug use and recent use of drugs of higher risk was significant across various socio-demographic characteristics such as age, sex, race, etc.

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  • Our analyses suggest that illicit drug use has increased substantially in South Africa in the last 15 years, and is associated with poorer demographic characteristics, numerous risk behaviors and poorer health outcomes.

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  • Evidence-based interventions focused on reducing unemployment, problematic alcohol-use, and high-risk sex, targeted by age, sex, race and geography are required to mitigate the impact of illicit drug use in South Africa.

References

[1] Degenhardt et al., Lancet Psychiatry 2018; [2] Peltzer et al., South African Journal of Psychiatry 2010; [3] Peltzer et al., South African Journal of Psychiatry 2018; [4] SABSSM, HSRC, Pretoria South Africa, 2002; [5] SABSSM, HSRC, Pretoria South Africa, 2005; [6] SABSSM, HSRC, Pretoria South Africa, 2008; [7] SABSSM, HSRC, Pretoria South Africa, 2012; [8] SABSSM, HSRC, Pretoria South Africa, 2017; [9] Kessler et al., Archives of general psychiatry 2003; [10] Shisana et al., Cape Town: HSRC Press 2012; [11] UNAIDS, Global AIDS response progress reporting, 2013

  • Illicit drug use has substantial ongoing impact on health and wellbeing globally and in sub-Saharan Africa (SSA).

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  • Drug use disorders are considerably high in SSA, for instance, opioid use disorder and cannabis use was estimated at 377 and 204 per 100,000 population respectively in 2016.1

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  • Further, illicit drug use accounted for about 1.1% of all disability adjusted life years (DALYs) in southern SSA in 2016.1

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  • In South Africa, available data, shows that the prevalence of recent (past 3-months) illicit drug use increased from 3.7% in 20082 to about 4.4% in 20123.

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  • However, there is little data on trends and predictors of illicit drug use in SSA in general and in South Africa in particular.

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  • We set out to:
    1. Describe population-level trends in illicit drug use and their predictors.
    2. Evaluate whether illicit drug use is associated with behavioral and health outcomes in South Africa.

Contact: Abstract

Kennedy Kipkoech #PEC003

pp19281@bristol.ac.uk

Preamble

Background

Methods

Results – trends in drug use

Conclusions

Results – factors associated with drug use

  • Recent drug use was:

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    • Negatively associated with being female, older age, living in rural area, and higher education attainment.

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    • Positively associated with being of mixed-ancestry race, unemployment, and increased across the survey rounds

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  • Prevalence of recent drug use was high in some groups
    • 16-33% (depending on race) among young male in urban areas.
  • Similar characteristics were associated with recent use of drugs of higher risk except for some levels of education (Grade 8-11).
  • Compared to non-PWUD, people who used drugs (PWUD) were:

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    • More likely to have multiple sexual partners (past 12 months), earlier sexual debut, to be frequent alcohol users, experienced psychosocial distress, experienced intimate partner violence, and perceived high-risk of contracting HIV.

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    • Less likely to have ever been tested for HIV.

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  • Recent drug use was not associated with HIV positivity, being on ART, being virally suppressed, ART defaulting, having comprehensive knowledge about HIV, age-disparate sexual partners, or condom use.

Results – HIV outcomes among people who use drugs (PWUD) compared to non-PWUD

  • Recent use of drugs of higher risk was associated with multiple sexual partners (past 12 months), earlier sexual debut, to be frequent alcohol users, and experienced psychosocial distress.