David Grelotti (l) and Matthew Mimiaga

David Grelotti (l) and Matthew Mimiaga

Popular South African street drug may contain HIV medication

Antiretroviral resistance could increase if untreated HIV-infected individuals exposed to antiretroviral medication

August 28, 2013 — A new study led by researchers at Harvard School of Public Health (HSPH) calls attention to a new street drug being used in South Africa. Known as whoonga, the drug cocktail may combine HIV antiretroviral (ARV) medication with illicit drugs. Believed to be extremely addictive, whoonga appears to have a devastating impact on those who use it—including children—and has the potential to complicate efforts to combat the HIV epidemic.

The study was published online in AIDS and Behavior on August 17, 2013.

“Our research suggests that the use of whoonga is associated with a number of health and social problems, such as crime, and could undermine efforts to treat HIV in communities where approximately one in four adults are infected with HIV,” said lead author David Grelotti, a child and adolescent psychiatrist and research fellow in the Department of Epidemiology at HSPH.

For the study, Grelotti, Matthew Mimiaga, assistant professor in the Department of Epidemiology at HSPH, and colleagues analyzed data from one-on-one interviews with people in an urban township of Durban, South Africa. Interviewees were all knowledgeable about substance abuse in the community. Although researchers didn’t specifically ask about whoonga in their questions, 77% of those interviewed identified whoonga as a significant problem in their community. They reported that whoonga is a mixture of different ingredients, and may be made up of ARVs (specifically efavirenz), and other substances such as household cleaners or rat poison. They described how whoonga is a highly addictive white powder that is smoked for a “high” and used by adults and children as young as 14.

“If whoonga indeed contains ARVs, abuse of the drug could have vast public health implications,” Grelotti said. “Recreational use of ARVs may take medication away from those who need it most, be associated with criminal activity from whoonga users, and drive up the cost of delivering ARVs to patients. It could also lead to an increase in ARV resistance, complicating HIV treatment for HIV-infected whoonga users.”

“Even if whoonga does not contain HIV antiretroviral medication, it is having a devastating impact on both the people who use it and their communities,” said Grelotti. “We still need more comprehensive studies to document the phenomenon and its impact. Because both HIV and substance abuse can be life threatening and carry significant stigma, the more we understand what is going on, the better our chances of improving the health of both the people who use whoonga and their communities.”

Funding for the study came from a grant from the Mark and Lisa Schwartz Foundation to Mimiaga.

Whoonga: Potential recreational use of HIV antiretroviral medication in South Africa,” David J. Grelotti, Elizabeth F. Closson, Jennifer A. Smit, Zonke Mabude, Lynn T. Matthews, Steven A. Safren, David R. Bangsberg, Matthew J. Mimiaga, AIDS and Behavior, online August 17, 2013

Karen Feldscher

photo: Aubrey Calo