People Who Inject Drugs Profile

In a snapshot: struggling to stay afloat while bearing the heavy weight of drug addiction.

The category of people who inject drugs (PWID) includes any person who injects drugs for nontherapeutic purposes, irrespective of the type of drug injected. PWID are discriminated against, criminalized, and often socially isolated. While unsafe injection practices put PWID at high risk for HIV, their health is just one among many interconnected challenges they face—and dealing with their addiction almost always takes top priority. Engaging PWID in preventive health services is thus a difficult task.

The PWID population may be small but they are having an increasing impact on HIV rates. 

While many drug users are socially isolated, a 2015 AIDS and Behavior study did find that more than half of sexually active PWID in Nairobi had non-injecting sex partners, creating a significant bridge for transmission to the general population. 1

PWID have ambitious long-term dreams but are swamped with present-day worries.

Market research conducted in Kenya in 2017 (OPTIONS research) found that PWID generally care about their health and value having a job. Many hope to run a business or start a family in the long term. However, their addictions get in the way of these aspirations—almost a third of respondents said getting arrested, not earning enough money, or abusing drugs prevented them from pursuing their goals. 2

PWID deal with homelessness, hunger, and violence, on top of the health and financial struggles associated with addiction.

As drug use is criminalized and highly stigmatized, PWID face severe discrimination; in the OPTIONS research, 70 percent of surveyed PWID reported experiencing stigmatization or victimization from people in their own social circle. 2

Despite the competing pressures on their resources, PWID are concerned about their own health; they may be especially concerned with disease transmission. 2 However, the demands of addiction may act as barriers to PWID seeking healthcare. As one person described:

“If I need to go to hospital today and I have not dealt with withdrawal, I will not go to hospital, you see?… This stuff has taken control of my life.” 3

–PWID in Kenya  

Importantly, healthcare workes’ stigma and discrimination present a significant deterrent to PWID seeking care. 

A study in Uganda suggested that discrimination against PWID leaves this group with inadequate health services. 4 A 2016 report from Kenya interpreted that users may be motivated to hide their drug use from providers. 3 Still, it is important to keep in mind that PWID are very receptive when healthcare is accessible, as reported by some advocates and service providers. 5

When it comes to HIV, PWID may be more likely to engage in risky behaviors, and may underestimate their own risk. 

Multiple studies across sub-Saharan Africa have found that PWID engage in high-risk injection practices, such as sharing syringes. Many of the PWID engaging in these practices may be HIV positive; in a 2015 study in Nairobi, nearly one in four respondents who reported sharing needles was HIV positive. Additionally, sexually active PWID are likely to engage in high-risk sexual practices. 1 A 2015 study in South Africa found that fewer than half of PWID surveyed had used a condom during their last sexual encounter. 6

Several studies have suggested that a majority of PWID know their HIV status. However, stigma of HIV and silencing of HIV-positive people isolates PWID and prevents their seeking care. 3

Further, many HIV-negative PWID underestimate their own risk. In the OPTIONS research, 76 percent of respondents said their peers were at high risk of contracting HIV, but only 32 percent perceived themselves as facing the same risk. 2

These insights can help guide effective ways to encourage PWID to adopt PrEP.

In the OPTIONS research, respondents had a low awareness of PrEP. However, once they received information, they showed high understanding of PrEP’s efficacy and saw the benefit of “protection.” PrEP may be fairly socially acceptable for PWID; unlike other populations surveyed, 44 percent of PWID reported that their peers would support their using PrEP. The research suggested that, once awareness is created, PWID’s interest in PrEP may be strong (although local investigation is always needed). 2

A more detailed, comprehensive version of this audience profile, including the relationship between PWID and high-risk activities and sexual and reproductive health, can be downloaded here.

For a sample demand creation strategy, including the best media and tactics to reach PWID, check out the Communications Fast Tracker.