Whoonga (also known as sugars [1] or wonga) is a waste product of heroin processing white powder packaged in capsules, used by placing powder onto a tin foil heating with a gas lighter and inhaling vapour through a straw, that came into widespread use in South Africa [2] in 2009.
Whoonga dealers often sell the drug as a super-powerful marijuana blend. Dealers add powdered substances to the mix to bulk it up. Additives range from actual pharmaceutical drugs and cleaning chemicals to any powder-based substance that can be found. Whoonga/nyaope is very addictive because of its heroin content. [3]
Whoonga is sometimes said to contain antiretroviral drugs (ARVs), particularly efavirenz, which are prescribed to treat HIV, but analysis of samples shows no such content, and police have remarked that dealers are known to add "all sorts of stuff" to a drug to bulk it out. Adulteration with ARVs was the subject of Getting High on HIV Medication, a 2014 documentary video by Vice correspondent Hamilton Morris. [4] The first scientific publications of whoonga use containing ARVs were in 2013 [5] [6] and 2014. [1]
Whoonga is a recreational drug. It generates intense feelings of euphoria, deep contentment, and relaxation. It also reduces appetite. Effects of whoonga may last two to four hours. [7] The drug is usually smoked with cannabis in the form of a joint, [8] but it may be injected intravenously. [9]
The cost of whoonga is reported to be about 30 rand (Approximately US$2.50, as of April 2018) per straw. [10] A whoonga addict needs several doses a day; [11] however, users are typically too poor to afford the drug from legal income, and so turn to crime to raise the money for their supply. There are speculative reports that whoonga addicts are attempting to become HIV-positive, as anti-retroviral drugs are distributed to HIV patients free of charge by the South African Department of Health. [12]
In early 2017, a growing trend of sharing the drug-induced high through small blood transfusions was identified by local media in a practice known as "bluetoothing" (from the Bluetooth wireless technology). In reality, such a blood sample could not contain an active quantity of the drug, [13] and the practice is virtually unheard of on the street. [14]
The effects of whoonga typically wear off in 6 to 24 hours, followed by the onset of unpleasant side-effects. [8] These include stomach cramps, backaches, sweating, chills, anxiety, restlessness, depression, nausea, and diarrhea. [8] More serious side-effects include internal bleeding, stomach ulcers, and potentially death. [11]
Whoonga is famous for allegedly containing antiretroviral drugs prescribed for HIV, [15] [16] [17] but its exact ingredients are disputed, and it has been argued that the claim is an urban legend. [18] One version of the claim is that whoonga contains classic psychoactive drugs such as cannabis, [12] [19] methamphetamine [20] or heroin [20] [21] potentiated by interactions with ritonavir, an antiretroviral medication used to treat HIV/AIDS that is thought to enhance or prolong the effects of some street drugs, such as MDMA. [15] Another claim is that the drug contains efavirenz (alone or with the ingredients mentioned above), another antiretroviral which has psychoactive side effects. Dr. David Grelotti has noted that efavirenz has a "well-known tendency to cause especially vivid and colorful dreams and other central nervous system effects. Hypothetically, that could enhance the effects of cannabis, methamphetamine, heroin, and other illicit drugs." [15]
AIDS experts point out that the ingredients of anti-retroviral drugs are unlikely to cause the whoonga high, and users may thus be fooling themselves. [17] A laboratory analysis of samples of whoonga failed to detect any anti-retroviral drugs in its makeup, [22] and a medical scientist who has analysed the contents of the drug concluded that it does not contain AIDS anti-retroviral medication. [18] According to some experts of the South African Police Service and drug rehabilitation centres, whoonga is essentially just a rebranding of older heroin-based drugs. [20] A member of the South African police's Organised Crime Unit said that "drug dealers add all sorts of stuff to the heroin, the primary ingredient, just to increase the mass of the drug when it's sold and make the heroin go further. A lot of the stuff has no effect and users have no idea what's going in." [20]
The anti-retroviral drugs allegedly used to make whoonga are those distributed in the area to patients with HIV who are enrolled in government drug rehabilitation projects. The claimed major source of these anti-retrovirals appears to be robbery from HIV patients, with media reports claiming that patients are being mugged for their pills as they leave the clinics where they obtain them. Reports also claim that some patients sell their HIV medications, and that some corrupt health workers may be selling the anti-retrovirals illegally back into the whoonga market. [12] [23] [24]
A Harvard School of Public Health researcher has expressed concern that people with HIV who smoke whoonga may develop mutant strains of the virus which are resistant to the medication. [15] HIV drug resistance is growing due to recreational use of efavirenz and ritonavir, rendering them ineffective not only for whoonga users but non-users as well, [25] with one study showing that 3% to 5% of people with HIV in areas where whoonga was used were showing "pre-treatment resistance" to antiretroviral drugs used to treat HIV. [15]
As of February 2013, the South African Department of Justice and Constitutional Development was in the process of amending the Drugs and Drug Trafficking Act 140 of 1992 to ban the possession and trafficking of the drug. [26]
The management of HIV/AIDS normally includes the use of multiple antiretroviral drugs as a strategy to control HIV infection. There are several classes of antiretroviral agents that act on different stages of the HIV life-cycle. The use of multiple drugs that act on different viral targets is known as highly active antiretroviral therapy (HAART). HAART decreases the patient's total burden of HIV, maintains function of the immune system, and prevents opportunistic infections that often lead to death. HAART also prevents the transmission of HIV between serodiscordant same-sex and opposite-sex partners so long as the HIV-positive partner maintains an undetectable viral load.
The Treatment Action Campaign (TAC) is a South African HIV/AIDS activist organisation which was co-founded by the HIV-positive activist Zackie Achmat in 1998. TAC is rooted in the experiences, direct action tactics and anti-apartheid background of its founder. TAC has been credited with forcing the reluctant government of former South African President Thabo Mbeki to begin making antiretroviral drugs available to South Africans.
Stavudine (d4T), sold under the brand name Zerit among others, is an antiretroviral medication used to prevent and treat HIV/AIDS. It is generally recommended for use with other antiretrovirals. It may be used for prevention after a needlestick injury or other potential exposure. However, it is not a first-line treatment. It is given by mouth.
Lamivudine, commonly called 3TC, is an antiretroviral medication used to prevent and treat HIV/AIDS. It is also used to treat chronic hepatitis B when other options are not possible. It is effective against both HIV-1 and HIV-2. It is typically used in combination with other antiretrovirals such as zidovudine, dolutegravir, and abacavir. Lamivudine may be included as part of post-exposure prevention in those who have been potentially exposed to HIV. Lamivudine is taken by mouth as a liquid or tablet.
Tenofovir disoproxil, sold under the trade name Viread among others, is a medication used to treat chronic hepatitis B and to prevent and treat HIV/AIDS. It is generally recommended for use with other antiretrovirals. It may be used for prevention of HIV/AIDS among those at high risk before exposure, and after a needlestick injury or other potential exposure. It is sold both by itself and together in combinations such as emtricitabine/tenofovir, efavirenz/emtricitabine/tenofovir, and elvitegravir/cobicistat/emtricitabine/tenofovir. It does not cure HIV/AIDS or hepatitis B. It is available by mouth as a tablet or powder.
Nevirapine (NVP), sold under the brand name Viramune among others, is a medication used to treat and prevent HIV/AIDS, specifically HIV-1. It is generally recommended for use with other antiretroviral medications. It may be used to prevent mother to child spread during birth but is not recommended following other exposures. It is taken by mouth.
Efavirenz (EFV), sold under the brand names Sustiva among others, is an antiretroviral medication used to treat and prevent HIV/AIDS. It is generally recommended for use with other antiretrovirals. It may be used for prevention after a needlestick injury or other potential exposure. It is sold both by itself and in combination as efavirenz/emtricitabine/tenofovir. It is taken by mouth.
Delavirdine (DLV) is a non-nucleoside reverse transcriptase inhibitor (NNRTI) marketed by ViiV Healthcare. It is used as part of highly active antiretroviral therapy (HAART) for the treatment of human immunodeficiency virus (HIV) type 1. It is presented as the mesylate. The recommended dosage is 400 mg, three times a day.
The first AIDS case identified in Brazil was in 1982. Infection rates climbed exponentially throughout the 1980s, and in 1990 the World Bank famously predicted 1,200,000 cases by 2000, approximately double the actual number that was later reported by the Brazilian Ministry of Health and most international organizations. South and Southeast have 75% or more of this infection. The Northeast has 33% of the population but only 10% of AIDS.
Efavirenz/emtricitabine/tenofovir, sold under the brand name Atripla among others, is a fixed-dose combination antiretroviral medication used to treat HIV/AIDS. It contains efavirenz, emtricitabine, and tenofovir disoproxil. It can be used by itself or together with other antiretroviral medications. It is taken by mouth.
Raltegravir, sold under the brand name Isentress, is an antiretroviral medication used, together with other medication, to treat HIV/AIDS. It may also be used, as part of post exposure prophylaxis, to prevent HIV infection following potential exposure. It is taken by mouth.
Etravirine is a drug used for the treatment of HIV. Etravirine is a non-nucleoside reverse transcriptase inhibitor (NNRTI). Unlike the currently available agents in the class, resistance to other NNRTIs does not seem to confer resistance to etravirine. Etravirine is marketed by Janssen, a subsidiary of Johnson & Johnson. In January 2008, the Food and Drug Administration approved its use for patients with established resistance to other drugs, making it the 30th anti-HIV drug approved in the United States and the first to be approved in 2008. It was also approved for use in Canada on April 1, 2008.
Rilpivirine, sold under the brand names Edurant and Rekambys, is a medication, developed by Tibotec, used for the treatment of HIV/AIDS. It is a second-generation non-nucleoside reverse transcriptase inhibitor (NNRTI) with higher potency, longer half-life and reduced side-effect profile compared with older NNRTIs such as efavirenz.
In South Africa, private and public health systems exist in parallel. The public system serves the vast majority of the population. Authority and service delivery are divided between the national Department of Health, provincial health departments, and municipal health departments.
Dolutegravir (DTG), sold under the brand name Tivicay, is an antiretroviral medication used, together with other medication, to treat HIV/AIDS. It may also be used, as part of post exposure prophylaxis, to prevent HIV infection following potential exposure. It is taken by mouth.
Aspen Pharmacare Holdings Limited is a public multinational pharmaceutical company headquartered in uMhlanga, South Africa. Founded in 1997, it listed on the Johannesburg Stock Exchange (JSE) in 1998, and purchased South African Druggists in 1999 before expanding into international markets. Currently the largest pharmaceutical company in Africa through aggressive mergers and expansion, with major manufacturing sites in locations such as Gqeberha in South Africa, Bad Oldesloe in Germany, Notre-Dame-de-Bondeville in France, and Oss, Netherlands, Aspen is known for manufacturing and distributing branded pharmaceuticals as well as generic HIV/AIDS antiretrovirals (ARVs) and cancer medications. Among other products, Aspen has also been involved in manufacturing the Janssen COVID-19 vaccine through "fill and finish", and has the rights to sell the product under its own brand name Aspenovax. The company's revenue in 2022 was R38.6 billion. In 2016 Aspen was fined for high prices on cancer drugs, and after an investigation Aspen committed to reduce prices for 5 years in the European Union.
Ubhejane is a South African herbal medicine marketed as a treatment for HIV/AIDS, reportedly the most popular alternative medicine treatment for the disease in South Africa. It was invented by former truck driver Zeblon Gwala, who has claimed that he got the idea for it in a dream. Gwala advises his patients to take ubhejane instead of antiretroviral drugs (ARVs), saying that while both ubhejane and ARVs work, ubhejane, unlike ARVs, does not have side effects. The price at which ubhejane was sold has been reported variously at $25 and $50 US dollars.
Treatment as prevention (TasP) is a concept in public health that promotes treatment as a way to prevent and reduce the likelihood of HIV illness, death and transmission from an infected individual to others. Expanding access to earlier HIV diagnosis and treatment as a means to address the global epidemic by preventing illness, death and transmission was first proposed in 2000 by Garnett et al. The term is often used to talk about treating people that are currently living with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) to prevent illness, death and transmission. Although some experts narrow this to only include preventing infections, treatment prevents illnesses such as tuberculosis and has been shown to prevent death. In relation to HIV, antiretroviral therapy (ART) is a three or more drug combination therapy that is used to decrease the viral load, or the measured amount of virus, in an infected individual. Such medications are used as a preventative for infected individuals to not only spread the HIV virus to their negative partners but also improve their current health to increase their lifespans. When taken correctly, ART is able to diminish the presence of the HIV virus in the bodily fluids of an infected person to a level of undetectability. Consistent adherence to an ARV regimen, monitoring, and testing are essential for continued confirmed viral suppression. Treatment as prevention rose to great prominence in 2011, as part of the HPTN 052 study, which shed light on the benefits of early treatment for HIV positive individuals.
Efavirenz/lamivudine/tenofovir (EFV/3TC/TDF), sold under the brand name Symfi among others, is a fixed-dose combination antiretroviral medication for the treatment of HIV/AIDS. It combines efavirenz, lamivudine, and tenofovir disoproxil. As of 2019, it is listed by the World Health Organization as an alternative first line option to dolutegravir/lamivudine/tenofovir. It is taken by mouth.
Dolutegravir/lamivudine/tenofovir (DTG/3TC/TDF) is a fixed-dose combination antiretroviral medication used to treat HIV/AIDS. It is a combination of dolutegravir, lamivudine, and tenofovir disoproxil. As of 2019, it is listed by the World Health Organization (WHO) as the first line treatment for adults, with tenofovir/lamivudine/efavirenz as an alternative. It is taken by mouth.
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