title: HIV prevalence and risk among people who inject drugs in five South African cities.
abstract: BACKGROUND
  Policy and programming for people who inject drugs (PWID) in South Africa is limited by the scarcity of epidemiological data.
  
  
  METHODS
  We conducted a cross-sectional survey among 450 PWID (362 males and 88 females) from five South African cities in 2013, using outreach and peer referral to recruit participants. We carried out rapid HIV tests on participants' saliva and assessed drug-using and sexual practices by means of a questionnaire.
  
  
  RESULTS
  We found that 26% of females and 13% of males reported to always share injecting equipment, while 49% of all participants had used contaminated injecting equipment the last time they injected. Only 6% of participants usually used bleach to clean their injecting equipment. We found that half of participants reported using a condom the last time they had sex. A quarter of participants reported symptoms of a sexually transmitted infection (STI) in the previous 12 months and 22% had ever worked as a sex worker (51% of females). HIV prevalence among participants was 14% (18% among females and 13% among males). In multivariate analysis HIV was significantly associated with being 25 years and older (adjusted odds ratio (aOR) 2.1, 95% confidence interval (CI) 1.0-4.6, p=0.06), belonging to a racial group other than white (aOR 4.2, 95% CI 1.9-9.4, p<0.001), coming from Gauteng province (aOR 2.3, 95% CI 1.1-5.5, p=0.023), having ever worked as a sex worker (aOR 3.4, 95% CI 1.7-7.2, p=0.001) and the presence of STI symptoms in the last 12 months (aOR 2.4, 95% CI 1.1-4.4, p=0.019).
  
  
  CONCLUSIONS
  This study highlights the need for increased access to sterile injecting equipment, education around safer injecting practices and access to sexual and reproductive health services for PWID in South Africa. Programmes for PWID should also address the specific needs of female PWID, PWID who sell sex and PWID from previously disadvantaged communities.
authors: Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine and Department of Medicine, University of Cape Town, Cape Town, South Africa. Electronic address: andrew.scheibe@gmail.com.
authors: Andrew
authors: A
authors: Scheibe
authors: International Organisation for Migration, Pretoria, South Africa.
authors: David
authors: D
authors: Makapela
authors: Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine and Department of Medicine, University of Cape Town, Cape Town, South Africa.
authors: Ben
authors: B
authors: Brown
authors: Foundation for Professional Development, Pretoria, South Africa; Department of Psychology, University of South Africa, Pretoria, South Africa.
authors: Monika
authors: M
authors: dos Santos
authors: United Nations Office on Drugs and Crime, Vienna, Austria.
authors: Fabienne
authors: F
authors: Hariga
authors: United Nations Office on Drugs and Crime, Lagos, Nigeria.
authors: Harsheth
authors: H
authors: Virk
authors: Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine and Department of Medicine, University of Cape Town, Cape Town, South Africa.
authors: Linda-Gail
authors: LG
authors: Bekker
authors: UNAIDS, Geneva, Switzerland.
authors: Olga
authors: O
authors: Lyan
authors: UNAIDS, Pretoria, South Africa.
authors: Nancy
authors: N
authors: Fee
authors: UNAIDS, Cotonou, Benin.
authors: Margarete
authors: M
authors: Molnar
authors: United Nations Office on Drugs and Crime, Pretoria, South Africa.
authors: Alina
authors: A
authors: Bocai
authors: United Nations Office on Drugs and Crime, Pretoria, South Africa.
authors: Jason
authors: J
authors: Eligh
authors: United Nations Office on Drugs and Crime, Vienna, Austria.
authors: Riku
authors: R
authors: Lehtovuori
mesh_terms: D000328:Adult; D000367:Age Factors; D017280:Condoms / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D015995:Prevalence; D012309:Risk-Taking; D060386:Sex Workers / Q000706:statistics & numerical data; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology*; D013019:South Africa / Q000453:epidemiology; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: HIV; Injecting drug use; People who inject drugs; Risk practices; Sex work; South Africa