Reaching and linking substance abusing vulnerable women in South Africa to HIV testing and care after PEPFAR

Issues: PEPFAR has been the greatest resource in South Africa for HIV testing and treating with ARVs. However, because of the lack of targeted outreach endeavors, these large scale efforts have had limited success reaching vulnerable drug users. Drug using women are at extremely high risk and among those who test HIV+ less than 20% initiate treatment. In a recently completed NIH trial in Pretoria, 63% of drug using female sex workers tested HIV+ and 32% of other drug using women tested HIV+. Yet many were unaware of available HIV care options or how to access services. Further, they often felt stigmatized. Description: A newly awarded NIDA-funded study plans to reach similar women in a prospective, geographically clustered, randomized two-group design to compare the standard HIV testing and referral methods in a large PEPFAR-funded program with an enhanced woman-focused HIV prevention intervention along with referral, tracking and ART retention for HIV+ women. Lessons Learned: Since the award, PEPFAR in South Africa has changed its priorities and partners have moved into technical assistance, leaving reach, test, and referral to health care linkages in question. Therefore, health departments and local organizations are still working at filling in the gaps to create a network that assures linkages to care and treatment for vulnerable people. Study trials must adjust and test the realities of real on-the ground practice. Recommendation: Strategic planning for vulnerable women who have the greatest rate of HIV is essential.