Report to Parliament 2007: Alcohol and Drug Abuse Research Unit
Selected Research Highlights 2006-7
CDC/MRC I-RARE: drug use and HIVproject
An international rapid assessment response and evaluation assessment (I-RARE) was undertaken. Qualitative research methods were used to assess HIV risk behaviour (drug use and sexual behaviour) among drug-using men who have sex with men, commercial sex workers, injecting drug users and non-injecting drug users. A high prevalence of drug use was found in high-risk areas in Cape Town, Pretoria and Durban with cannabis, cocaine and heroin being the most commonly used across groups in all three sites. A clear relationship existed between drug use and sexual risk behaviour including multiple partners, group sex, irregular use of condoms and prolonged sex sessions. Some intravenous drug users engaged in numerous practices that put them and others at risk, such as sharing, re-use, inadequate cleaning and careless disposal of needles and syringes. HIV was substantially present in some of the sub-populations, and the risk of infecting the general population members due to sexual mixing and mobility patterns also existed. Most of the drug users agreed to VCT. There was also some general knowledge about HIV and its transmission, as well as misperceptions. Various barriers existed with regards to the access and use of HIV/AIDS, substance abuse and risk reduction services. To address drug related HIV risk behaviour there is a need for:
- scaling-up outreach efforts to targeted groups in high risk areas;
- tailoring community-based outreach to drug users that addresses HIV/AIDS risks and strengthening links with appropriate care and treatment services;
- providing confidential, routine HIV counselling and testing (VCT) in substance abuse programmes;
- training non-traditional partners in counselling/testing;
- adapting VCT to be more localized, mobile, population-specific;
- including risk reduction counselling in VCT that focuses on HIV and drug risks; and
- coordinating drug abuse treatment and HIV services among drug using vulnerable populations.
Methamphetamine use & associated health risks among adolescents
To assess the prevalence and nature of methamphetamine use among school-going adolescents in a defined geographical area in Cape Town, and to assess sexual risk behaviour and mental health among methamphetamine users. Overall, 9% of the 1561 students surveyed in phase 1 of this study had used methamphetamine at least once in their life (LT). Of these students 20% had used the drug in the past 7 days. In addition a number of risk factors were investigated using the Problem Oriented Screening Instrument for Teenagers (POSIT). The POSIT consists of ten sub-scales for assessing students at risk of which the following were investigated to date: substance abuse, physical health, mental health, family relationships, aggressive/violent behaviour, and educational status. In addition students completed the Beck Depression Inventory (BDI), questions on substance use and the POSIT HIV/STD Risk Scale. T-tests showed that LT methamphetamine users had significantly higher scores (minimum p < 0.05) on the six POSIT risk scales, than those who had used other substances but not methamphetamine. Comparing these two groups also showed that LT methamphetamine users had higher BDI scores. The proportion of methamphetamine users who had sex at least once was significantly higher (45%) compared to users of other substances (23%). A t-test showed that LT methamphetamine users also had significantly higher total scores on the POSIT HIV/STD Risk Scale (p < 0.01) than users of other illicit drugs.
These initial findings point to an association between methamphetamine use and a number of health and social problems and risk behaviours, indicating a need to address these issues in both prevention and treatment programmes.
Foetal Alcohol Syndrome
This project aims to characterize women at increased risk for an alcohol-exposed pregnancy and develop sustainable preventive interventions at community level, in South Africa. The project is focused on urban (Tshwane, Gauteng Province) and rural (West Coast, Western Cape Province) communities. Preliminary findings of the baseline situation analyses involving a household survey, services audit, case studies of families with alcohol-exposed pregnancies and liquor outlet mapping are available. The household survey revealed stark differences between women of child-bearing age in the rural and urban site. The urban women were significantly more likely to be unemployed, while also being more highly educated than their rural counterparts. The risk of having an alcohol-exposed pregnancy was significantly higher among the rural women primarily to their greater involvement in the use and misuse of alcohol, and lesser involvement in the use of family planning methods. Multiple level factors are associated with the women’s risk of having an alcohol-exposed pregnancy. These include demographic factors (especially socio-economic status and education); levels of substance use (tobacco and alcohol use); fertility-related norms; spousal/partner characteristics; and community factors (e.g. access to alcoholic beverages and to recreational facilities). The services-based research and case studies of families with alcohol-exposed pregnancies revealed a need for improved screening, counselling and referral systems for women with harmful or hazardous alcohol use in public health facilities. In addition, it suggests the need for improvements in services related to the screening, diagnosis and support of children affected with FASD.
South African Adolescent Smoking
The overall study sought to examine the risk and protective factors for tobacco use and dependence (initiation, maintenance and cessation) among adolescents in Johannesburg. Data were collected via a household survey, using a structured questionnaire. The study has assessed the factors that distinguish between three stages of smoking behaviour to which adolescents could be – i.e. non-smokers, experimental smokers or regular smoking. The independent measures were drawn from four domains, namely personal attributes, parental, peer, and cultural influences. Factors in all four domains significantly predicted three different stages of smoking. Personal attributes distinguished among the three stages. Parental factors (e.g., affection) reduced the odds of being a regular smoker compared with an experimental smoker or non-smoker, but did not differentiate experimental smokers from non-smokers. Peer substance use predicted an increase in the risk of being a regular smoker compared with an experimental smoker or non-smoker. In the cultural domain, ethnic identification predicted a decrease in the risk of being a result smoker compared with an experimental smoker, whereas discrimination and victimization predicted an increase in the risk of being an experimental smoker compared with a non-smoker. We will follow up this sample by examining the predictors of change in tobacco use. Nicotine dependence was assessed by the Fagerström Test for Nicotine Dependence (FTND). Logistic regression analyses showed that higher levels of nicotine dependence significantly predicted elevated levels of violent behavior, deviant behavior, marijuana and other illegal drug use, binge drinking, and sexual intercourse, controlling for the adolescents’ demographic characteristics, and peer delinquency. Neither gender nor ethnicity moderated the relationship between nicotine dependence and any of the problem behavior outcomes.
Access to substance abuse treatment in the Cape Town metropole
A mixed method study that combines qualitative methods with a case-control study to examine factors associated with access to substance abuse treatment in the Cape Town metropole for substance abusers from historically disadvantaged communities. When controlling for the effects of gender and race, limited awareness of when, where and how to access services; logistic barriers to treatment such as traveling time; and affordability barriers including income and competing financial priorities were the strongest predictors of difficulties in accessing substance abuse treatment for individuals from historically disadvantaged communities in the Cape Town metropole. These findings were confirmed by results obtained from the qualitative phase of this project. This phase also identified the limited availability of treatment facilities and the limited capacity of facilities to provide services (due to scarce resources) as barriers to service provision and timely access to treatment.
The study also identified socio-demographic differences on these barriers to treatment utilization. For instance, individuals from Black/African communities were relatively less aware of treatment services than individuals from Coloured communities. In contrast, traditionally Coloured communities had relatively lower levels of social capital, particularly social trust and collective efficacy, than Black/African communities. These differences have implications for the design of interventions that target these barriers. Black/African communities are more in need of awareness-raising activities than Coloured communities. In contrast, for any substance-related interventions to be successfully received and accepted into traditionally Coloured communities, interventions that address the lack of social trust in “outside interventions” and develop collective efficacy against the dominant norms and a neighbourhood environment supportive of drug use first need to be implemented.