CAPE TOWN, SOUTH AFRICA, 19 NOVEMBER 2025: A new study published in the Southern African Journal of HIV Medicine, highlights an urgent gap in HIV care among people who inject drugs (PWID), showing that less than half remain in treatment six months after starting antiretroviral therapy (ART). In the study population, out of 333 people who inject drugs who began ART between July 2022 and March 2023 across three South African districts, only 40% were still in care after six months. This means that for every 10 people who started HIV treatment, only four stayed on it long enough to sustain health benefits, far below the UNAIDS target of 95% treatment retention needed to help end AIDS by 2030.
“Staying on HIV treatment is like keeping a light on, if the power keeps cutting, the health benefits disappear. Stable housing and access to opioid agonist therapy (OAT) keep that light burning steadily for people who inject drugs,” commented Professor Harry Hausler, CEO of TB HIV Care.
The study, Retention in Care of People on Antiretroviral Therapy Who Inject Drugs in South Africa, analysed data from 333 PWID receiving antiretroviral therapy (ART) across Tshwane, Ehlanzeni, and eThekwini. Authors also found that:
- Stable housing is crucial: PWID with stable housing were six times more likely to remain in care compared to those living in unstable or homeless conditions (12% vs. 75% retained).
- OAT makes a difference: Those enrolled in OAT programmes were four times more likely to stay in care, with a 75% lower risk of dropping out.
- Social support matters: Participants with treatment supporters, such as family or peers, had significantly higher retention (54% vs. 10%).
“This research provides clear evidence that housing stability and access to harm reduction services such as OAT are essential to improving HIV outcomes,” said Phumzile Mngomezulu, lead author of the study and District Manager: Key Populations at TB HIV Care.
The research underscores how social and structural barriers, especially homelessness, directly undermine public health goals. When HIV treatment is interrupted, the virus can rebound, raising the risk of transmission and drug resistance. Expanding harm reduction measures such as needle and syringe programmes, opioid agonist therapy (OAT), psychosocial support, and stable housing initiatives can prevent these setbacks. Globally, these interventions are proven to be life-saving, cost-effective, and essential for epidemic control. Ensuring a continuum of integrated care for marginalised and underserved populations will help close the gap toward achieving the global 95-95-95 targets and protect one of the country’s most vulnerable groups.
As South Africa advances implementation of the National Drug Master Plan (2024–2029) and the National Strategic Plan for HIV, TB and STIs (2023–2028), this evidence underscores the critical need for structural and social interventions to strengthen health outcomes for key populations. At the forefront, TB HIV Care, through its harm reduction and key populations programmes, already implements community-based models that combine HIV treatment, OAT, and peer-led support, helping to improve continuity of care and treatment adherence among PWID.
“We can’t treat HIV in isolation,” added Mngomezulu. “To reach our public health goals, we must tackle the social barriers like homelessness and stigma that prevent people who inject drugs from staying in care.”
References:
- Mngomezulu, P.C., Roomaney, R.A. and Van Wyk, B.E., 2025. Retention in care of people on antiretroviral therapy who inject drugs in South Africa. Southern African Journal of HIV Medicine. https://doi.org/10.4102/sajhivmed.v26i1.1710
- Department of Social Development. (2024). National Drug Master Plan (2024–2029). Pretoria: Government of South Africa. (Access here)
- South African National AIDS Council (SANAC). (2023). National Strategic Plan for HIV, TB and STIs (2023–2028). Pretoria: SANAC. (Access here)
Issued by:
- Aziel Gangerdine
- TB HIV Care, Spokesperson
- E-mail: aziel@tbhivcare.org
- Cell: +27 (0) 66 545 6053
ENDS.
TB HIV Care
TB HIV Care is a registered non-profit company (NPC) that puts integrated care at the heart of responding to TB, HIV, and other major diseases. We work to prevent, find and treat TB and HIV in South Africa as well as targeting our interventions to address the needs of populations most at risk, including communities in the Eastern Cape and Western Cape, adolescent girls and young women in KwaZulu-Natal, inmates in correctional centres, sex workers and people who
