By Baltazar et al.

People who inject drugs (PWID) are at high risk of acquiring and transmitting blood-borne viruses, including HIV, from unsafe injection practices and risky sexual behaviors. The United Nations Office on Drugs and Crime (UNODC) estimates that around 29.5 million people suffer from drug use disorders worldwide of the estimated 15.6 million PWID in the world, subSaharan Africa has 1.4 million. The Southern and Eastern coasts of Africa are important routes for global heroin trafficking originating from Asia, and the region is fast becoming a final destination for these drugs, with a growing number of African consumers.

HIV prevalence among PWID is 18% globally, nearly 28 times higher than HIV prevalence among the general adult population. A systematic review determined that HIV prevalence among PWID in subSaharan Africa was 56%, but estimates in the region vary widely.

Adverse health outcomes among PWID are further intensified by punitive legal environments, a variety of human rights abuses and poor access to services. Few harm reduction programs and PWID-specific HIV prevention, care and treatment services are available in sub-Saharan Africa. As of 2017, only seven countries had publicly funded syringe exchange and medication-assisted opioid treatment programs. In Mozambique, publicly funded harm reduction and HIV care and treatment programs for PWID did not exist prior to this study.

An estimated 13.2% of the adult population in Mozambique are living with HIV; the percentage of PWID living with HIV was unknown. Information on blood-borne disease burden and demographic and behavioral characteristics of PWID are necessary to assess the unique prevention, care and treatment needs of this population. For this purpose, we conducted the first biological and behavioral survey (BBS) among PWID in two urban areas of Mozambique. PWID are one of five priority populations surveyed as part of the national HIV behavioral surveillance system, which include men that have sex with men, female sex workers, long-distance truck drivers, and mine workers. This manuscript presents the main findings of the PWID BBS survey.