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Last updated: 10 March 2025

1.1 People who use drugs, HIV and viral hepatitis 

• The estimated national HIV prevalence rate in South Africa is approximately 13.9% which is approximately 8.45 million people living with HIV in South Africa.
• There are an estimated 75,701 people who inject drugs in the country.
• There are estimated to be 400,000 people who use heroin, 350,000 who use cocaine, and 290,000 use methamphetamines.
• HIV prevalence among people who inject drugs is 55% as of 2023.
• The HIV prevalence amongst people in prisons is estimated to be 17.5% (as of 2020). 
• The prevalence of hepatitis C (HCV) among people who inject drugs is estimated to be 83%, compared with 0.47% among the general population. 

1.2 HIV prevention and treatment and harm reduction  

• Data required to assess progress towards the 90-90-90 targets for people who inject drugs is not available.  
• Condom use among people who inject drugs is reported to be 52%.
• Coverage of the core package of HIV, TB and STI services for people who inject drugs is 25% (2021/2022), which is lower than coverage among other key populations, with the exception of transgender people.
• Coverage of harm reduction services is extremely low. 5% of people who inject opioids were receiving opioid substitution therapy (OST)1 at the end of 2023. 
• Some of the medication used for OST in South Africa are Methadone, Buprenorphine (Subutex) and Buprenorphine-Naloxone combinations (e.g. Suboxone).
• 36 needles and syringes are distributed per person per year, far below the UN recommended amount of 200 for HIV prevention and 300 for HCV prevention. 

• In 2024, needle and syringe programmes operated in 11 health districts and OST was provided in 8 health districts.  
• Coverage of HIV testing amongst people who inject drugs is estimated to be 69.2% 

The PEPFAR/CDC funded service centres in Tshwane and Ehlanzeni districts stopped providing services for a period of 15 days, from 29th January 2025 – 14 February 2025. One thousand people who use and inject drugs from Mpumalanga (Ehlanzeni district) and 4,000 people from Gauteng (Tshwane district) faced disruption in accessing OST and NSP. Clients were encouraged to utilise the public health care facilities near them, however, none of them offered OST or NSP, except for in the city of Tshwane where University of Pretoria provide services through COSUP (Community Oriented Substance Use Program).  

TB/HIV Care, the implementing organisation for PEPFAR, received instruction to resume limited waived HIV interventions, including harm reduction, from CDC on the 13th of February 2025. These services are to run for up until the 90 days as per the waiver.