Trends and factors associated with drug use in South Africa: findings from multiple national population-based household surveys

Background: Illicit drug use has the potential to impact on health and wellbeing, but there is little data on its trends and predictors in sub-Saharan Africa. We used data from South Africa to describe trends in recent drug use, assess factors associated with it, and evaluate whether recent drug use predict HIV outcomes. Methods: We analysed data among adults aged 15+ years from five national household surveys conducted in 2002(n=7,084), 2005(n=16,398), 2008(n=13,828), 2012(n=26,807) and 2017(n=24,996). Multivariable logistic regression was used to assess predictors of recent drug use (defined as, any past threemonths use of illicit drugs, excluding alcohol/tobacco), and to evaluate whether recent drug use predicted HIV outcomes while controlling for age, sex, race and province. Results: There were 89,113 respondents aged 15+ years from the five survey rounds. The prevalence of recent drug use increased from 1.5% in 2002 to 10.0% in 2017. Recent drug use was negatively associated with being female (adjusted odds-ratio [aOR] 0.29, 95% Confidence Interval [CI] 0.25- 0.32), aged 35-49 vs 15-24 years (aOR 0.61, 95%CI 0.52-0.71), rural vs urban (aOR 0.79, 95%CI 0.67- 0.93), grade 8-11 vs 0-7 (aOR 0.79, 95%CI 0.67-0.94) and grade 12+ vs 0-7 (aOR 0.57, 95%CI 0.47- 0.69). Conversely, recent drug use was positively associated with being of mixed-ancestry vs blackAfrican race (aOR 1.78, 95%CI 1.54-2.05), unemployed vs employed (aOR 1.42, 95% CI 1.25-1.60), frequent alcohol use vs none (aOR 3.55, 95%CI 2.96-4.24), and high-risk sex vs none (aOR 1.7, 95%CI (1.41-2.05). People who used drugs (PWUD) were more likely to be HIV-positive (aOR 1.24, 95%CI 1.05-1.47) compared to non-PWUD. Conclusion: Illicit drug use has increased substantially in South Africa in the last 15 years. 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. Disclosure of Interest Statement: The authors declare no conflict-of-interest. There were no pharmaceutical grants that were received in the development of this study.

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