The world has come a long way since the early eighties when we first heard about HIV and Aids. Over the past 20 years, efforts to address the HIV/ Aids epidemic have seen significant strides, although more work remains.
South Africa has been among the United Nations member countries committed to improving the quality of life for all its citizens.
According to UNAIDS, 39 million people globally were living with HIV in 2022. That same year, 1.3 million people became newly infected with HIV and 630 000 people died from Aids-related illnesses.
Scientific advances in treatment and antiretroviral therapy have allowed people with HIV to live long and productive lives.
There was also a sense of scientific optimism that better treatment options could enhance prevention. Progress continued to be made toward finding a cure and developing a vaccine.
New findings from TB HIV Care's latest biobehavioural survey, conducted between May and September 2023, revealed a high prevalence of hepatitis C infections and high levels of HIV co-infections among people who inject drugs (PWID) in eThekwini, Ehlanzeni (Lydenburg and Mbombela) and Tshwane.
"Hepatitis B and hepatitis C infections are typically higher in key populations than in the general population, but data are limited," explained Joel Steingo, Strategic Information and Business Development Director at TB HIV Care.
"Biobehavioural surveys are critical because they allow us to estimate the population size of marginalized groups like PWID in sites across South Africa, estimate the prevalence of infections like HIV and viral hepatitis, assess health-seeking behaviour, gauge injecting practices and other risk factors, and examine the intersectionality between injecting drug use with behavioural, social, and structural factors – including the ability to access healthcare services," said Steingo.
According to the National Institute of Health Viral hepatitis is an infection that causes inflammation of the liver. It's often caused by hepatitis viruses like hepatitis B and C.
These infections can damage the liver over time and sometimes don't show symptoms until serious health issues arise.
Having viral hepatitis can increase the risk of HIV because both diseases share similar transmission methods, such as through unprotected sex or sharing needles.
When someone has an existing liver infection, their immune system is already compromised, making it easier for HIV to take hold if they are exposed to the virus.
A recent survey aimed at understanding the prevalence of HIV among people who inject drugs (PWID) in different cities revealed some eye-opening statistics.
In eThekwini, the estimated HIV prevalence among the PWID population was 49.3%, with a hepatitis B prevalence of 5.8%. The survey also found that 75.2% had been exposed to the hepatitis C virus (anti-HCV prevalence), and 43.2% were co-infected with both HIV and hepatitis C.
In Lydenburg, the numbers painted a different picture, with 45.4% estimated to be living with HIV and 0.9% with hepatitis B. The anti-HCV prevalence was 40.8%, and 26.7% were co-infected with HIV and hepatitis C.
Mbombela showed a 30.3% HIV prevalence among PWID, with 1.6% for hepatitis B. A staggering 90.5% had been exposed to hepatitis C, and 28.1% were co-infected with HIV and hepatitis C.
Tshwane presented the highest numbers, with an estimated HIV prevalence of 72.1% among PWID. The hepatitis B prevalence stood at 2.8%, while 89.1% had been exposed to hepatitis C, and a significant 69.2% were co-infected with both viruses.
Andrew Scheibe, Technical Advisor at TB HIV Care, highlighted the urgent need for increased prevention, testing, and treatment efforts. "The high HIV and anti-HCV prevalence highlight the need for increased HCV prevention, testing, treatment with direct-acting antivirals (DAAs), and the scale-up of evidence-based services among people who inject drugs".
He further explained the challenges, saying, “Hepatitis C is often called the silent killer because many people remain completely asymptomatic until the infection progresses, causing serious liver damage and life-threatening health issues.
“Today’s DAAs are highly effective, but cost and access are issues in South Africa. We need to continue to advocate for easier, cost-effective access to generic DAAs, especially for populations at risk.”
These findings speak to the need for continued advocacy and support for vulnerable populations, ensuring they receive the care and resources necessary to improve their health outcomes, like uninterrupted needle and syringe services and opioid substitution therapy, as crucial components of HCV and HIV prevention for people who inject drugs.
Dr John Blandford, CDC Country Director, highlighted the significant stigma and discrimination faced by key populations, making it difficult for them to access healthcare services.
This biobehavioural survey has given us a deeper understanding of the challenges faced by people who inject drugs,” Blandford stated.
He revealed that over 30% of people who inject drugs (PWID) experience physical and sexual violence. Additionally, one-third of PWID have avoided healthcare in the past year due to fear of stigma or discrimination.