Hurdles of Accessing HIV Treatment Among Homeless People Who Use Nyaope in Mogale City, Gauteng Province: An Exploratory Qualitative Study

Background/Objectives: The growing intersection between nyaope use and HIV infection constitutes a critical public health problem that undermines efforts to achieve universal access to HIV treatment in South Africa. Nyaope use is strongly associated with the increased risk of HIV of transmission. A significant amount of new HIV infections was linked to substance use through sharing of injectable needles. Despite significant progress made to increase public awareness and increase accessibility to HIV services, little is known about how addiction, stigma, and discrimination influence access to HIV treatment among homeless individuals who nyaope. This study explored the hurdles of accessing HIV treatment among people who use nyaope and are homeless in Mogale City, Gauteng Province. Methods: An exploratory descriptive qualitative research approach was employed among people who are homeless, living with HIV and using nyaope (PHHIVN) in Mogale City, between May and August 2024. Data were collected utilizing in- depth interviews in English, isiZulu and Setswana languages. Purposive sampling technique was followed to select participants, and a sample size of 25 participants was reached with a mean age of 32.28 and SD = ±5.54 years, of whom 21 (84%) were male, 3 (12%) were female and 1 (4%) identified as other. Audio recordings were transcribed, translated, and analyzed following inductive thematic analysis. Results: Social exclusion and fractured support system, prioritization of drug use, nyaope dependency, withdrawal symptoms, negative peer influence, socioeconomic factors and misconception about the interaction between nyaope and HIV treatment were reported as some of the main hurdles of accessing HIV treatment among PHHIVN in Mogale City, Gauteng Province. Conclusions: It is therefore concluded that access to HIV treatment among PHHIVN in Mogale City, Gauteng Province, remains a serious public health concern influenced by various hurdles. The development of tailored interventions to improve access and adherence to HIV treatment among this population group has potential to enhance the uptake of HIV treatment.