Knowledge and experiences of overdose among formerly incarcerated people living with HIV and hazardous opioid use in South Africa: A qualitative study

BACKGROUND: Drug overdose is a leading cause of death among people released from correctional facilities, and the risk of overdose is higher among people living with HIV (PLWH). Overdose remains understudied in people in South Africa despite the high burden of HIV and hazardous opioid use. The researchers aimed to qualitatively explore how formerly incarcerated people living with HIV and OUD in South Africa understand, experience, and respond to overdose. METHODS: People with HIV and self-reported hazardous opioid use prior to correctional facility release or shortly after release were enrolled in a convenience sample. Twenty-three formerly incarcerated people living with HIV and opioid use in or around Tshwane, South Africa completed sequential in-depth interviews that explored medication-assisted treatment for hazardous opioid use and HIV care delivery. Transcripts were analyzed thematically using both deductive and inductive coding, with a focus on participants' knowledge and definition of overdose, personal experiences with overdose, and responses to overdose. RESULTS: All participants used the term "overdose", but there was no unified understanding of what constitutes an overdose or how to manage an overdose. The period immediately following release from incarceration was identified as a key moment in which overdose occurred. Pouring water onto the person overdosing was reported to be the most prevalent response strategy. Only two participants contacted or watched their peers contact the ambulance. Fear of law enforcement involvement was perceived as a barrier to calling for emergency services. CONCLUSION: The findings identify a gap in overdose knowledge among corrections-involved people living with HIV and hazardous opioid use in South Africa. There is a need to increase knowledge regarding overdose recognition and responses.