Karan Varshney

Conference 2022 Hot-Doc Presentation


Video title

Risks & consequences of Nyaope/Whoonga usage –
the drug cocktail of HIV antiretrovirals, rat poison, heroin, and other substances


Authors and Affiliations

Karan Varshney1,2, Samuel D. Browning3, Sujit K. Debnath4, Pavan Shet1, Darshan Shet5

1. School of Medicine, Deakin University
2. College of Population Health, Thomas Jefferson University
3. Faculty of Medicine, The University of New South Wales
4. Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay
5. School of Pharmacy, Monash University




South Africa currently has the highest number of cases in HIV in the world. In order to address this crisis, HIV antiretrovirals (ARVs) are publicly available across the country. However, a consequence of widely available ARVs has been the diversion of these drugs for recreational usage in a drug cocktail referred to as “nyaope” or “whoonga.” This drug cocktail, often also containing substances such as rat poison, heroin, and detergent, may pose a major public health concern. To better understand whoonga/nyaope, we conducted a scoping review investigating the risks and consequences associated with its usage.


Following the PRISMA Extension for Scoping Reviews (PRISMA-ScR), searches were conducted in eight different databases and screened thereafter. Articles were eligible for inclusion if they included analysis of least one whoonga/nyaope user, and considered either demographics, risk factors, or consequences of usage.


Searches produced a total of 225 articles and, after screening, a total of 21 articles were eligible for inclusion. There was a pooled total of 3,787 whoonga/nyaope users, all in South Africa. Major risk factors for usage were being male, unemployed, not completing secondary education, pressure from peer groups, as well as prior usage of cannabis and, to a lesser extent, other substances such as alcohol and tobacco. While young adults tend to be at a high risk, evidence also indicates that adolescents are at-risk. Consequences of usage include high rates of infective endocarditis, cortical atrophy, depression, and addiction. Addiction was shown to lead to individuals stealing from friends and family to pay for the drugs. Individuals also rob HIV-positive patients for ARVs.


Whoonga/nyaope’s rise has been linked to a number of health and social issues. Considering that this may also disrupt HIV control efforts in South Africa, there is an urgent need to address the rise of whoonga/nyaope.