Alcohol and Drug Abuse Research Unit

Report to Parliament 2006: Alcohol and Drug Abuse Research Unit

Selected Research Highlights 2005-6
The use of illegal stimulants such as crack cocaine, cocaine hydrochloride, methamphetamine (‘tik') and methcathinone (‘CAT') is on the increase in South Africa, but trends differ according to where one is in the country. Of 7655 patients seen in 63 alcohol/drug treatment centres in five provinces in the first six months of 2005 as part of the MRC's South African Community Epidemiology Network on Drug Use (SACENDU) project, almost one in three reported having one of the above stimulants as their primary or secondary drug of abuse. Of the patients in the study, 17% had cocaine as a primary or secondary drug of abuse compared to 12% for methamphetamine. Cape Town appears to be the methamphetamine capital of South Africa, with 98% of methamphetamine patients seen across the provinces coming from this city. In Cape Town methamphetamine is now the most common illicit drug that brings people into drug treatment, followed by cannabis, with one in three patients having methamphetamine as a primary or secondary drug of abuse. This drug has also emerged as the main substance of abuse among young patients in Cape Town with two-thirds of patients under 20 years having methamphetamine as a primary or secondary drug of abuse.

A cross-sectional rapid assessment ethnographic study (South African International-Rapid Assessment Response and Evaluation) funded by the President's Emergency Plan for AIDS Relief through the US Centers for Disease Control & Prevention (CDC) was undertaken using observation, mapping, key informant interviews and focus groups in known “hotspots” for drug use and sexual risk in Cape Town, Durban and Pretoria. Non-injection drug use (mainly cannabis, methaqualone, crack cocaine and crystal methamphetamine) and injection drug use (mainly heroin) is occurring in these cities.  Many drug users report selling sex for money to buy drugs, and sex workers often use drugs before, during and after sex. HIV seropositivity was highest among commercial sex workers (CSWs) and men who have sex with men (MSM). Intravenous drug users (IDUs) reported engaging in numerous behaviors including needle sharing and needle disposal practices that put them and others at risk for contracting HIV. Across the various groups there is a lack of awareness about where to access HIV treatment and preventive services and numerous barriers to accessing appropriate HIV and drug-intervention services were reported. Multiple risk behaviors of vulnerable populations and lack of access to HIV prevention services could accelerate the diffusion of HIV. The next phase of the project will involve identifying targeted interventions that could play an important role in limiting the spread of HIV in and through these under-reached and vulnerable populations.  

The aim of the Cape Town Women's Health Co-op, a collaborative project with Research Triangle Institute (RTI) International, was to adapt a brief, HIV risk reduction intervention for Black and Coloured substance abusing women.  A total of 113 women were recruited into the study via snowball sampling.  These women participated in an assessment interview, a two-session intervention and a follow-up interview one month later.   Results from the one-month follow-up revealed positive changes in the participants' sexual risk behaviours and substance use from baseline assessment, with use of male condoms increasing significantly from 43% at baseline to 66% at follow-up, use of female condoms increasing significantly from 2% at baseline to 20% at follow-up, and the use of alcohol and drugs before sex decreasing from 65% at baseline to 54% at follow-up.  The frequency of past month alcohol use decreased by nearly 50% from baseline to follow-up.  Significant reductions in past month substance use were also found for crack cocaine and methamphetamine.  For example, the average number of days in the past month in which methamphetamine was used decreased from 8.1 at baseline to 4.4 at follow-up.